Attorneys for people with disabilities have filed a federal lawsuit alleging the Florida Agency for Health Care Administration has not provided adequate oversight of Medicaid managed care plans that care for people in their homes.
The 79-page lawsuit, filed Monday in Tallahassee, centers on part of Florida’s Medicaid system that contracts with managed care plans to provide what are known as home- and community-based services for people who need long-term care. The services are aimed at helping people avoid going into nursing homes or other institutions.
Filed on behalf of five adults with disabilities such as quadriplegia, Alzheimer’s disease and debilitating genetic disorders, the lawsuit contends that managed care plans have not provided adequate information about decisions to reduce or deny services. Also, it contends an Agency for Health Care Administration hearing process for appeals does not hold the plans accountable.
“Plaintiffs have been harmed by AHCA’s failure to require that plans provide them with adequate and timely written notice of denial, reduction, or termination of services and other information needed to meaningfully challenge plan decisions,” the lawsuit said. “This harm will continue until AHCA institutes corrective action.”
The lawsuit alleges violations of constitutional due-process rights, the Americans with Disabilities Act and other federal laws. To operate the home- and community-based services program, Florida needed to obtain what is known as a “waiver” from certain requirements in federal Medicaid laws.
While services can include nursing care, they also can involve help with personal care such as bathing, dressing, eating and going to the bathroom and assistance with such things as laundry and housekeeping. The lawsuit said the state contracts with seven managed care plans to provide the long-term care services.
The lawsuit names as a defendant AHCA Secretary Jason Weida, but not the managed care plans. In part, it seeks an injunction to require the agency to ensure that managed care plans provide “timely and adequate notice before denial, reduction or termination” of services and to prevent plans from “placing arbitrary limits on services.”
Also, it seeks an injunction to ensure the agency’s “hearing process provides a meaningful review of managed care plan decision-making, including but not limited to all issues pertaining to requested services, adequacy of notices, continuation of services that are reduced or terminated, information needed to meaningfully challenge adverse decisions, and the appropriate array of services or amounts of services that would meet the enrollee’s stated needs.”
The lawsuit, which was filed by Gainesville attorney Nancy Wright and lawyers from Southern Legal Counsel and Legal Services of Greater Miami, has been assigned to U.S. District Judge Robert Hinkle, according to a court docket.
