As both sides of a decade-long lawsuit over Florida’s Medicaid program heralded the case’s official close last week, state taxpayers also had something to celebrate: the end of a 10-year stream of legal bills they will cover.
In a federal court in Miami, U.S. Court of Appeals Judge Adalberto Jordan certified a settlement in the case, which requires the state of Florida to pay $12 million in legal fees to attorneys defending parents and pediatric providers. The state must also work with both groups to correct the problems identified in the lawsuit — namely that the more than 2 million poor children enrolled in Medicaid must have access to health care and administrative hurdles to care need to be addressed.
The $12 million in settlement payments is in addition to the state’s own legal fees.
Since the suit was filed in late 2005, Florida’s Medicaid health agencies — the Department of Health, the Agency of Health Care Administration and the Department of Children and Families — have racked up $7.8 million in legal costs, a Herald-Tribune analysis of invoices found.
The three agencies, as well as the state Attorney General’s Office, provided invoices reflecting charges incurred between Feb. 8, 2006 and May 10, 2015, in response to a Herald-Tribune public records request.
The records show that legal expenses were divided roughly in half between attorneys from the state attorney general’s office and three private law firms — Miami-based Kenny Nachwalter, Tallahassee-based Ausley McMullen and Washington, D.C.-based Hogan Lovells.
Taxpayers will cover the state’s expenses as well as $12 million in legal fees that the pediatricians and parents won in the settlement.
Settlement details
The agreement is good news for Medicaid-enrolled children, who for the length of the case have not seen significantly improved access to health care, according to state and federal data. In 2014, just 53 percent of kids who should have seen a doctor actually saw one. That’s actually lower than the rate in 2004, before the case was filed.
The access rates were even lower for dentists — just 32 percent of Florida children got any kind of oral health care at all in 2014. Those findings were the basis of a Herald-Tribune investigation, “2 Million Kids. $24 Billion Battle,” detailing the challenges parents and pediatricians face while trying to care for children enrolled in the Medicaid system.
The low rates of health care access were also cited as a leading concern by pediatricians in a statewide survey of the members of the Florida chapter of the American Academy of Pediatrics, conducted by the Georgetown University Center for Children and Families in partnership with the Community Foundation of Sarasota County and the Herald-Tribune.
The lawsuit settlement requires that the Medicaid agencies regularly meet with pediatricians and pediatric dentists, and make sure that Medicaid insurance companies, which are responsible for connecting Medicaid members with health providers to treat them, steadily increase the percentage of children receiving health care to meet the national averages for Medicaid-enrolled children across the country.
For instance, in 2014, about 61 percent of children nationally received a medical visit and 47 percent received a dental visit.
The settlement comes just over 18 months after Jordan, of the Eleventh Circuit, found that the state was violating federal Medicaid law and denying children adequate medical and dental care. The state objected, and the two sides litigated for more than a year before coming to a preliminary agreement in April. The deal resolved most issues raised in the case, wrote Stuart Singer, lead attorney for the parents and pediatricians, in a motion for settlement.
“The settlement will provide much of the relief that plaintiffs sought in litigation, while providing for ongoing cooperation between plaintiff medical and dental associations and the defendants in improving Florida’s Medicaid program,” Singer wrote.
If at any time between now and Sept. 30, 2022, the state or the pediatricians and parents do not uphold the deal, the court can step in and force compliance.
The Agency for Health Care Administration “is making improvements that will have a positive impact on the overall health of children enrolled in the Florida Medicaid program and is committed to improved quality outcomes and higher standards of care,” the agency wrote in a press release following the preliminary settlement.