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AHCA seeks to nix lawsuit challenging oversight of Medicaid managed-care plans

WMFE
/
WMFE

The lawsuit 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 state has urged a federal judge to toss out a 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.

Attorneys for the agency filed a 47-page motion to dismiss the lawsuit, which 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.

The lawsuit, filed in September on behalf of five adults with disabilities such as quadriplegia, Alzheimer’s disease and debilitating genetic disorders, contends managed-care plans have not provided adequate information about decisions to reduce or deny services.

Also, it contends an AHCA hearing process for appeals does not hold the plans accountable.

The motion to dismiss the case raised a series of arguments, including saying that the plaintiffs do not claim to “receive inadequate services today — or to live in an institutional setting. Any adverse benefit determinations or service interruptions were resolved months ago, well before plaintiffs sued.”

It also said the plaintiffs “allege past grievances but fail to plausibly allege sufficient ‘odds’ that those experiences will imminently reoccur and cause them concrete and cognizable injuries, such as unlawful institutionalization. This court should accordingly dismiss plaintiffs’ complaint.”

The case is assigned to U.S. District Judge Robert Hinkle, who has scheduled a trial in December 2025.