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Florida Case Challenges Medicaid Rates for Children

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Florida Case Challenges Medicaid Rates for Children

January 12, 2015
Last month, a Federal district court in Florida ruled that the state's program had failed to pay rates sufficient to ensure that children enrolled in the program had adequate access to care. The case centers around structural, financial and administrative barriers that the plaintiffs allege result in children not receiving the access to care to which they are entitled to under federal law. The argument is in six pieces. The plaintiffs argue that: 
  • Florida's Medicaid reimbursement structure is fundamentally inconsistent with the Federal Medicaid Act, as it requires "budget neutrality" without consideration as to whether rates are sufficient;
  • Florida wrongfully terminated thousands of young children from eligibility, and switched children to a different primary provider, resulting in disruptions in services;
  • Children are not receiving the primary care they are entitled to under EPSDT requirements, as evidenced by data contained in reports submitted by the state to the federal government;
  • Children enrolled in Medicaid face long delays and unreasonable obstacles in receiving access to specialist care in many areas of the state;
  • Florida does not provide children with adequate access to dental care, with only 21% of children on Medicaid receiving dental care, and with the state ranking last in the nation, due to low reimbursement rated for Florida dentists, which results in a shortage of dentists willing to accept Medicaid children; and
  • The state uses an application form that is unnecessarily complex and it does not provide adequate outreach to inform Medicaid-eligible children of their rights to services. Plaintiffs argue that a quarter million Florida children are eligible for, but are not enrolled in, the Medicaid program. 
The Florida case is one of several that have been filed by private parties against the state seeking to compel the Federal government to step in and force states to increase their Medicaid rates. ANCOR recently filed an amicus brief in another rate-setting case out of Idaho, Armstrong v. Exceptional Child, in which plaintiffs argue that the state has not maintained rates adequate to sustain services.