No quick end to Medicaid lawsuit quagmire

A month ago, after presiding over a decade of litigation, U.S. Circuit Judge Adalberto Jordan concluded that Florida’s public insurance program for needy and disabled children was so underfunded that impoverished children were sometimes forced to do without necessary care.

At a hearing at Miami’s federal courthouse Friday, lawyers for the state said the problem has been fixed — but it’s going to take them more time to prove it.

The state Attorney General’s Office, which represents three health and social service agencies in the class-action lawsuit, contends that Florida’s Medicaid insurance program for the needy now barely resembles the insurer Jordan found was in violation of federal law. Within the past four months or so, the Medicaid program has transitioned into a managed care model that, the state says, will offer significantly better healthcare options for needy children.

Senior Assistant Attorney General Albert J. Bowden III told Jordan at Friday’s hearing that the state likely would need until next fall for the results of the managed care implementation to be available for review. The state hopes to prove that Jordan’s findings are “moot” because recent changes to the insurance program will lead to major improvements in care. The state will need the extra time, though, “to show you we can meet our burden,” Bowden said.

The state’s challenge, Bowden said, was “getting the required number of doctors for an adequate network of doctors so that kids will get care — which is what this case is about.” Administrators with the state Agency for Health Care Administration, which oversees the Medicaid program, believe the new managed care system will ensure that occurs, Bowden said.

Jordan, who sits on the federal appeals court bench but was a U.S. District Court judge when he first was assigned the case, expressed reluctance to wait another six or eight months for the state to show it has fixed the Medicaid program.

“It’s one thing to change something on paper,” Jordan said. “It’s another to see if that change on paper works.” With regard to waiting months to determine whether Medicaid has dramatically improved — while taking no other action to fix it — Jordan said: “We can’t do that, because this will never end. Facts change from day to day.”

“The heart of this case,” Jordan said, was AHCA, which long has administered an insurance program that critics contend is forced to ration care because lawmakers haven’t increased funding.

“It’s a money problem,” Jordan said. “It’s an allocation problem.”

Last month, Jordan declared Florida’s Medicaid program to be in violation of several federal laws. In his 153-page ruling, Jordan said lawmakers had for years set the state’s Medicaid budget at an artificially low level, causing pediatricians and other specialists for children to opt out of the insurance program. In some areas of the state, the judge wrote, parents had to travel long distances to see specialists, such as neurologists or orthopedists.

Jordan’s long-awaited ruling handed a victory to doctors and children’s advocates who had fought for almost a decade to force the state to pay pediatricians enough money to ensure impoverished children can receive adequate care.

At Friday’s hearing — the first since Jordan’s opinion was released — a lawyer for the plaintiffs said that his clients don’t believe that the state has reformed the Medicaid program. Furthermore, attorney Stuart Singer said, Bowden’s request for another half-year to develop the state’s case would, in effect, “build in delay” so that children are forced to wait ever longer for health and dental care. Singer, who represents, among others, the Florida Pediatric Society, asked Jordan to sign a declaratory judgment requiring the state to improve pediatric healthcare for children now.

Such a judgment, Singer said, might force the Legislature, which will begin its annual lawmaking session March 3, to consider setting aside enough new dollars to entice more pediatricians and specialists to sign up with Medicaid, and, hence, make medical care more readily available for needy children.

This story was originally published January 30, 2015 at 7:34 PM with the headline "No quick end to Medicaid lawsuit quagmire."