Child at hospital. Photo: Dmytro Zinkevych/Shutterstock.com

A new proposed class action lawsuit in Florida has accused state agencies of wrongfully terminating Florida residents’ Medicare coverage on a systemic basis.

The complaint alleged the Florida Agency for Health Care Administration and the Florida Department of Children and Families have repeatedly abridged the due-process clause of the Fourteenth Amendment of the U.S. Constitution, as well as federal Medicare law, in their treatment of beneficiaries.

According to the suit, the defendants have engaged in a “pattern and practice of terminating Medicaid benefits for individuals whose coverage would continue” under separate qualifications and additional review.

The named plaintiffs, Clayton Harrell and Austin Trueblood, were purportedly not notified that their Medicaid benefits had ended, although they both remained eligible for the program under different categories outside the ones in which they had originally enrolled.

“Since 2014, the legal services organizations of undersigned counsel have represented at least 30 individuals who lost their Medicaid coverage due to termination of an adoption subsidy or [Supplemental Security Income] benefits and for whom defendants failed to conduct an ex-parte review of their continued eligibility under another Medicaid category,” the complaint said.

The suit claimed both Harrell and Trueblood were entitled to conduct hearings challenging the termination of their Medicaid enrollment, as well as receive ongoing coverage pending the outcome of their appeal.

The putative class would comprise individuals who were stripped of their Medicaid because their eligibility through Florida’s Adoption Assistance program or federal disability benefits concluded, “but who may remain eligible for another category of Medicaid,” according to the lawsuit.

Read the class action complaint:

“The legal services organizations … rely on individuals contacting them and it is unknown how many individuals are not aware of their services but may nonetheless be impacted by defendants’ failures,” the suit said. “Without assistance from undersigned counsels’ organizations to enforce their right to continued Medicaid eligibility and educate them about their right to adequate, pre-termination notice and hearing, these individuals would likely still be without Medicaid.”

Katy DeBriere, legal director of Florida Health Justice Project, told the Daily Business Review the proposed class might number in the thousands. She said the litigation’s origins lie with identical cases litigated by her and peers at Jacksonville Area Legal Aid and Disability Rights Florida. DeBriere said she and other advocates “were really tired of fixing these issues on an individual basis.”

“I can’t even imagine the amount of people who don’t realize it’s a legal issue, and they can call for legal help,” she said. “We would like to see this issue fixed on a systemic basis because we’ve seen too many clients to whom this has happened.”

The complaint noted “by its own admission, DCF does not employ a sufficient amount of staff” to correctly process Florida residents’ Medicare eligibility.

“All the written policies with DCF say the right things, they’re just not happening,” DeBriere said, adding additional staffing and more thorough information processing could alleviate the problems experienced by her clients. “Ideally we’d be working with these state agencies to come up with fixes to make sure people are not falling through the cracks. So we need to have a conversation, whether that be through litigation or sitting in mediation, and ask why aren’t these policies being implemented?”

DCF’s media office did not return requests for comment by press time. Patrick Manderfield, deputy communications director with the Florida Agency for Health Care Administration, said the agency does not comment on pending litigation.

Florida’s Children First founder and Talenfeld Law managing partner Howard Talenfeld said he’s observed the circumstances outlined in the complaint in his own practice. Talenfeld, a longtime advocate for children’s rights and on child-disability issues, is not involved in the class-action litigation. But he said Florida has an extensive history of being sued over inadequate welfare and disability programs.

“We’ve seen Medicaid extraordinarily limit services to its clients on many fronts,” Talenfeld said, noting problems such as those detailed in the suit stem in part from significant budget cuts to public assistance programs. The attorney added Florida courts have been “extremely supportive” of certified classes with similar allegations.

“This case is extremely concerning, because we know that when they fall off of Medicaid or the adoption subsidies end, these children are without resources to fully transition into adulthood,” he said. “I’m extremely hopeful that the agency leaders … will respond to these serious allegations with corrective action.”

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