Judge rules against state on Medicaid notices

A federal judge on Tuesday ruled that Florida violated the constitutional rights of people dropped from the Medicaid program because the state sent notices that “border on the incomprehensible.”

U.S. District Judge Marcia Morales Howard, in a 273-page ruling in a class-action lawsuit, also barred the state from terminating benefits for financial-eligibility reasons unless it provides adequate notice.

Howard wrote that people who receive what is described as family-related Medicaid coverage “are among the state’s most vulnerable citizens.”

“They are primarily pregnant and postpartum women, infants and children,” she wrote. “And as is evident from the applicable income standards, these individuals are the poorest of the poor. Prior to terminating the Medicaid benefits on which these individuals depend, the Constitution requires the state of Florida to provide them with adequate notice. The state of Florida is violating this constitutional requirement.”

In finding that the state violated due process rights, Howard wrote that the notices are “vague, confusing and often incorrect and misleading.” She said recipients cannot understand the notices or determine whether the state made mistakes in denying benefits.

“This increases the likelihood that when the state makes an error, which is inevitable in a program of this size and complexity, impoverished parents, children, pregnant women and infants will lose vital medical benefits for which they are eligible,” the ruling said. “This causes tremendous harm not only to these individuals, but to society at large. Indeed, it is in the public interest to require the state to comply with its constitutional obligations and ensure that individuals eligible for Medicaid receive those benefits without interruption.”

Attorneys for people who lost benefits filed the lawsuit in 2023 in Jacksonville, and Howard certified it as a class action in 2024. It applies to people who lost benefits after March 2023 or who could lose benefits because of state determinations that they do not meet income-eligibility requirements.

The lawsuit is rooted, in part, in the 2023 end of the federal COVID-19 public health emergency. During the emergency, the federal government provided additional funding to states for Medicaid, with the condition that beneficiaries would not be removed from the program.

After the emergency ended, Florida began a “redetermination” process to review continued eligibility. Over a yearlong period, the Department of Children and Families redetermined eligibility for more than 4 million people, the ruling said.

Citing department records, Howard wrote that 497,918 people were terminated from Medicaid for income-eligibility reasons between March 2023 and March 2024 and had not been reinstated as of March 2024.

While the lawsuit focused on the notices, Howard’s ruling also detailed broader problems, including issues with a decades-old state computer system and the Medicaid call center. People seeking assistance could have calls blocked because of high volume, face long wait times or receive incorrect information, the ruling said.

It was not clear from Tuesday’s ruling how quickly the state must make changes. But Howard wrote that a “constitutionally adequate notice must unambiguously identify the state’s decision to terminate full Medicaid benefits based on a finding of financial ineligibility, the person or persons to whom that decision applies, and the reasons for that decision.”

“The reasons must be set forth in sufficient detail to allow the recipient to assess the accuracy of the decision and decide whether to challenge the determination,” she wrote.

Although the state presented evidence that it plans to modify its notices as part of a broader modernization project, Howard said Florida has no immediate plans to correct serious flaws in the current Notices of Case Action and offered no evidence about what information would be included in revised notices.

“As such, absent injunctive relief, the state will continue to violate the constitutional rights of the class members,” Howard wrote.

Howard rejected a request from plaintiffs’ attorneys to automatically reinstate people who lost Medicaid coverage. However, the state must provide adequate notices explaining why benefits were terminated, which could lead to hearings on reinstatement.

The lawsuit names Department of Children and Families Secretary Taylor Hatch and Agency for Health Care Administration Secretary Shevaun Harris as defendants. While the Agency for Health Care Administration oversees much of the Medicaid program, the Department of Children and Families determines eligibility.