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Settlement Reached On Medicaid Reviews

The Florida Channel
CREDIT: iStock

A settlement has been reached in a federal lawsuit alleging Florida did not properly determine whether Medicaid beneficiaries could continue qualifying for coverage when they lose their initial eligibility, according to court documents.

The lawsuit was filed in August in federal court in Jacksonville on behalf of Clayton Harrell, a former foster child who received Medicaid benefits through an adoption-assistance program, and Austin Trueblood, who has Down syndrome and received Medicaid benefits because he qualified for Supplemental Security Income, or SSI, through the U.S. Social Security Administration.

The lawsuit said circumstances led to the men losing Medicaid eligibility through the adoption-assistance program and the link to SSI. But it alleged the state failed to follow requirements to determine whether the men could continue to receive Medicaid benefits based on other factors, a process known as conducting “ex parte” reviews.

Court documents filed this month said the plaintiffs had reached a settlement with the Florida Department of Children and Families and the Agency for Health Care Administration, which largely administer the state Medicaid program. The documents indicate the state agreed to make a series of changes to ensure that reviews are conducted in such situations.

“The settlement agreement provides for system enhancements and modifications in defendants’ processes to ensure ex parte reviewees receive pre-termination eligibility reviews and notice of those reviews,” one of the documents said.

“The settlement agreement also provides for reporting of progress regarding the system enhancements and modifications to plaintiffs’ counsel.”