Florida Medicaid Beneficiaries Sue Health Care Agency Over Misleading Materials Promoting Pilot Program

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Medical Malpractice / Litigation
Article Date: 16 Jan 2008 - 9:00 PDT

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Three Broward County, Fla., residents on Friday filed a class-action lawsuit in federal court against the Florida Agency for Health Care Administration alleging that a Medicaid pilot program improperly keeps beneficiaries in unsuitable health coverage, the AP/St. Petersburg Times reports (AP/St. Petersburg Times, 1/13). Former Gov. Jeb Bush (R) in December 2005 created a pilot program to shift some of the state's Medicaid beneficiaries to managed care plans and cap spending growth on the program at 8% for the next five years. Under the new system, the state pays HMOs higher rates for treating sicker beneficiaries than for treating healthy beneficiaries. The plan began on July 1, 2007, in Duval and Broward counties (Kaiser Daily Health Policy Report, 1/31/06). About 200,000 beneficiaries in Broward County are enrolled in the HMO-style plans.

According to the lawsuit, federal law allows beneficiaries to change plans if they have "good cause," but promotional information sent to beneficiaries in the pilot program did not fully explain that right. In addition, counselors hired by the state provided inaccurate information to potential beneficiaries, who were told that they had to remain under their plan for a year, the lawsuit said. Lawyers for the plaintiffs maintain that beneficiaries needlessly retained health coverage that did not cover their physicians or medications.

C. Shawn Boehringer, an attorney at Legal Aid Service of Broward County, said, "The Medicaid reform program has been imposed on poor and disabled people, and they are not getting the medical care and rights the law promises them" (AP/St. Petersburg Times, 1/13).

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