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Settlement of Florida Medicaid lawsuit a victory for children, pediatricians :

May 12, 2016

Low-income children in Florida will have better access to medical and dental care and pediatricians could see increases in Medicaid payment rates, under a recent lawsuit settlement.

The settlement resolves a 2005 lawsuit filed by the Florida Chapter of the American Academy of Pediatrics (FCAAP), the Florida Academy of Pediatric Dentistry and several families against the Florida Agency for Health Care Administration (AHCA). The groups contended that low-income children enrolled in Medicaid were not receiving adequate preventive health care services outlined by federal law.

“Pediatricians in Florida have pursued access for low-income children in their state for more than a decade,” said AAP President Benard P. Dreyer, M.D., FAAP. “The Academy commends those pediatricians and pediatric dentists who began the lawsuit as well as the Florida Chapter leaders who negotiated this important settlement. Pediatricians got a fair deal and families will get improved access to essential medical and dental services.”

Roughly 44% of children enrolled in Medicaid in Florida did not receive a well-child visit from 1999 to 2004, according to reports at the time. Roughly 75% of children in the program did not receive dental care.

These children and their pediatricians faced multiple hurdles, including children being switched to different providers without warning and families being unaware of services available to them, according to Louis B. St. Petery Jr., M.D., FAAP, past executive vice president of the FCAAP. In addition, the state’s payment rate for providers is less than appropriate under federal law.

“The reality is that people can’t open their doors freely to Medicaid kids like they would like to because of the fiscal situation,” Dr. St. Petery said.

In December 2014 following more than 90 days of trial, a federal judge agreed the state had violated federal law regarding Medicaid. Several months later in a separate case, the U.S. Supreme Court ruled doctors cannot sue states over low Medicaid payment rates. Ultimately, the judge in the Florida case ordered mediation that resulted in the recent settlement.

Under the deal, the AHCA will increase Medicaid payment rates through incentives for pediatricians and other providers who meet targets for patient access and outcomes. The state will have 30 months to improve participation.

The AHCA also has agreed to reduce administrative obstacles to care for the 2 million children on Medicaid. It will improve outreach to low-income families to inform them of Medicaid benefits that are available and to promote preventive care for those already enrolled. In addition, the settlement lays out steps to improve access to dental services.

FCAAP President Tommy Schechtman, M.D., M.S.P.H., FAAP, called the case a “long laborious effort by many” and commended all of those who gathered data, gave depositions and attended court hearings.

“Certainly, this was an effort that was put forward by many many pediatricians in the state,” Dr. Schechtman said. “Many pediatric leaders of the chapter were very much engaged in this over the years.”

The ongoing shadow of the lawsuit made it difficult to collaborate with state agencies on children’s health issues, but Dr. Schechtman said the settlement allows all groups to move forward.

“This is a brand new day for children on Medicaid here in Florida,” Dr. Schechtman said. “We look forward to working with the state and trying to improve and build a system of delivery of health care to children that will not only ensure their ability to access that care but also will achieve quality health care outcomes.”

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