Settlement Reached In Long Running Fight Over Children's Medicaid

Apr 5, 2016

A decade long lawsuit against Florida’s Medicaid program has come to a close. Florida and organizations representing the state’s dentists and pediatricians, have reached a settlement deal  that could lead to kids having more access to healthcare in the program.

The lawsuit began in 2005 when the Florida Chapter of the American Academy of Pediatrics, the Florida Academy of Pediatric Dentistry, and parents with kids in Medicaid sued the state. They argued Florida’s low reimbursement rates to providers hindered their willingness to accept Medicaid patients, limiting access. In 2011 Florida transitioned to a Medicaid Managed care system—effectively privatizing the program. That privatization required providers to sign up with health insurance companies. And part of the deal was that those insurers could pay providers more by coordinating care.

In 2015, a federal judge ruled in favor of the groups, based upon the shortcomings of the old Medicaid system.

The settlement reached with the state calls for the state to start increasing reimbursement rates to pediatric providers to that of what Medicare pays—which is closer to a market rate.

The state Agency for Healthcare Administration, which oversees Medicaid, would have to find ways to increase the number of kids getting preventive care, and expand access if requires. The agency would also have to increase participation in preventative pediatric dental care. A new law calls for a study of pediatric dental care in Florida’s Medicaid Managed care program, and would create a separately-insured program just for dental in 2019.  It’s a response to concerns managed care companies aren’t paying dentists properly, and children aren’t receiving services.

The state is required to pay $12 million in legal fees to the plaintiffs attorneys.