Florida health agency reaches Medicaid class action lawsuit settlement
TALLAHASSEE. The state health management agency has reached a class action settlement that is expected to result in Medicaid providing incontinence funds for adults with disabilities, according to court documents.
State attorneys, two women with disabilities and a Florida disability advocacy group asked a federal judge last week to approve the settlement and stay the lawsuit while the Health Management Agency advances the rulemaking process. The claim will be dismissed if incontinence remedies are provided as a result of the rulemaking process.
“The bottom line of the agreement is that the AHCA (Health Management Agency) agrees to participate in the development of rules to amend its policies and any other administrative rules necessary to ensure that coverage is extended to medically necessary incontinence drugs for Medicaid recipients aged 21 and older,” the petition filed Thursday in Jacksonville said.
The lawsuit, filed in July 2022, alleged that Medicaid violated federal laws by denying incontinence coverage for adults with disabilities. The lawsuit was filed on behalf of Duval County resident Blanca Mesa and St. Johns County resident Destiny Belanger, who are incontinent and unable to care for themselves. Disability Rights Florida is also a plaintiff.
U.S. District Judge Marcia Morales Howard on March 27 recognized the case as a class action. Morales Howard’s ruling cites one estimate that at least 480 Medicaid beneficiaries a year turn 21 and lose coverage of urinary incontinence drugs they received as children. The State provides supplies such as underpants, diapers, and pads for Medicaid recipients under the age of 21 and some adults, including people in nursing homes.
Speaking before a Senate committee in April, AHCA Secretary Jason Veida said the agency does not believe the provision of incontinence funds is required by the federal centers for Medicare and Medicaid services, which oversee Medicaid rules. But he also indicated that the AHCA had discussed the possibility of changing the policy.
“I can tell you that from lawsuits in the past where we’ve been sued and we’re in the middle of litigation, sometimes we decide to change a policy that would essentially give plaintiffs some or all of what they wanted, and sometimes those lawsuits tend to get moot or just disappear,” Wade’s lawyer told the Senate Committee. “I can’t tell you exactly how we’re going to get rid of this right now. But what I can tell you is that we are looking at this not only in terms of judicial strategy of how we are going to defend ourselves, but also in terms of whether it is the right thing to do? And if we finally decide it’s the right thing to do, we’ll do it.”
The petition, filed on Thursday, said the agreement was reached after informal negotiations and negotiation of a settlement through an intermediary.
The lawsuit alleged that the state’s incontinence supplies policy violated federal law and Medicaid laws, including the Americans with Disabilities Act. It states that the state stopped supplying supplies to Meza and Belanger after they turned 21, although they are incontinent and unable to take care of themselves.
As an example of their disability, the lawsuit states that Mesa “has been diagnosed with spastic cerebral palsy, muscle spasticity, neuromuscular scoliosis, and partial epilepsy.”
“Plaintiffs are adults in debilitated health, all of whom suffer from bladder and bowel incontinence,” the lawsuit says. “As low-income Florida residents with a severe disability, they receive health care through Medicaid in Florida. Plaintiffs’ physicians have prescribed certain incontinence products, including briefs and pads, as medically necessary to treat plaintiffs’ incontinence, keep their skin dry and clear, prevent skin lesions and infections, and maintain their ability to live in the community.”
