Medical/Legal

THE FLORIDA MEDICAID LAWSUIT - AN EFFORT TO ASSURE THAT CHILDREN ON FLORIDA MEDICAID HAVE THE SAME ACCESS TO HEALTH AND DENTAL CARE AS DO CHILDREN ON PRIVATE INSURANCE

By Louis St. Petery, M.D.

In 2002, the late Dr. Rick Bucciarelli, then FCAAP President, learned that the Oklahoma Chapter of the AAP had successfully sued the State of Oklahoma to assure that children on OK Medicaid would have equal access to health and dental care as did OK children on commercial insurance. The EPSDT (Early Periodic Screening Diagnosis and Treatment) requirement under the federal Medicaid law states that, among other things, State Medicaid programs must pay a sufficient amount to assure equal access for Medicaid children. Dr. Bucciarelli announced that the FCAAP Executive Committee had voted to follow Oklahoma’s lead and sue Florida Medicaid for failure to assure that children on Florida Medicaid have appropriate access to EPSDT services. Those Florida problems included not only low payments, but also issues like “switching” in which children were often moved from one Medicaid provider to another without the parents’ knowledge or permission.

I was the Executive Vice President (EVP) of FCAAP at that time and was assigned to lead this effort. Oklahoma had worked with OK attorneys Louis and Pat Bullock of the law firm of Bullock, Bullock & Blakemore and with attorney Jim Eiseman of the Public Interest Law Center of Philadelphia. I was able to get in touch with these law firms through Buck Wright, M.D., the Oklahoma Pediatric Chapter President. With the help of the Bullocks and Jim Eiseman, and after being turned down by several law firms, the Ft. Lauderdale office of the law firm Boies, Schiller & Flexner (BSF) agreed to take our case on a pro-bono basis. The Florida Medicaid Lawsuit was filed in Federal District Court in Miami in 2005 and the 2-1/2 year trial began in 2010, ending in 2012. My wife Judy and I attended in person almost every session of the trial in the Federal District Court House in Miami, 50+ days in all. We worked primarily with BSF attorneys Stuart Singer and Carl Goldfarb. The judge in the case was Adalberto Jordan, who was subsequently appointed to the 11th Circuit Court in Atlanta, but fortunately has held onto this case since its inception.

After the trial ended in 2012, it was 2 years (2014) before Judge Jordan finally agreed that the case should move forward, and another 2 years before a final settlement was reached and Florida was required to fix the problems with Florida Medicaid, namely increase payments and resolve issues like “switching” so that children on Florida Medicaid indeed have access to health and dental care to the same extent as do children on private insurance.

That final settlement in this case was good until the end of 2022, meaning that Florida Medicaid would no longer be required to assure that children on Florida Medicaid have equal access to the same care as do children on private insurance beyond 2022. However, in the spring of this year the BSF lawyers approached me and the FCAAP leadership about seeking to extend the settlement to 2030. Such an extension was prepared and Florida’s Medicaid Agency, the Agency for Health Care Administration (AHCA) agreed to the extension, and very recently Judge Jordan has also signed off on that extension. Thus, as far as I am aware, Florida is the only State in the US with Medicaid paying at Medicare levels until 2030.

BSF attorney Stuart Singer recently summarized the case stating:

“Yesterday’s entry by Judge Jordan of his order approving the amended settlement agreement marks the end of an undertaking begun 17 years ago. Back in 2005, Dr. Louis St. Petery, and Jim Eiseman of the Public Interest Law Center asked if our firm would undertake this case. At that time, David Boies, our firm chairman, said that this is precisely the type of case our firm should be doing, and that has remained our view throughout.

I am proud that Carl and I and our team, working together with Jim and then Ben Geffen at the Public Interest Law Center, have seen it through years of motion, decision, a joyous New Year’s Eve in 2014, when Judge Jordan’s decision arrived, and an even happier 2016 as we finally reached a definitive settlement. Throughout this process, the Florida Chapter and its leadership have been our client and our partner, and we have enjoyed greatly the opportunity to work together on this cause.

As you are aware, that definitive settlement has led to programmatic changes to deal with wrongful terminations, switching, and resulted in hundreds of millions of additional dollars being spent on reimbursement to increase access to care. Now that will continue until at least 2030 and benefit millions of Florida children who depend on Medicaid.

On behalf of our firm, let me say we feel privileged as well as proud of our involvement in the Florida Medicaid case over these many years.

With best wishes,