A federal judge this week dismissed a lawsuit alleging the state failed to provide adequate oversight of Medicaid managed-care plans that care for people in their homes, but he gave plaintiffs three weeks to file an amended complaint.
The lawsuit, filed in September on behalf of five adults with disabilities such as quadriplegia, Alzheimer’s disease and debilitating genetic disorders, contends managed-care plans have not provided adequate information about decisions to reduce or deny services. Also, it contends a Florida Agency for Health Care Administration hearing process for appeals does not hold the plans accountable.
But, siding with the state agency, U.S. District Judge Robert Hinkle’s ruling said the plaintiffs lacked legal standing because none of them alleged they are not receiving services they need or are facing a reduction or denial of services.
Hinkle gave the plaintiffs until April 24 to file an amended lawsuit and instructed them to “address head-on the lack of a concrete, imminent injury to the plaintiffs themselves that is traceable to” the state health-care agency.
The lawsuit alleged that notices sent to plaintiffs about benefits did not include enough information, failed to include policies or were received late. “But none of the plaintiffs are currently facing a reduction in benefits.
It is speculative that any plaintiff will face a reduction or denial of benefits in the future. It is even more speculative that the various issues they experienced in the past related to the notices will recur.
Moreover, even in the past instances where the notices were allegedly insufficient, the plaintiffs for the most part ultimately succeeded in challenging the reduction or denial either before the plan or before AHCA,” Hinkle wrote in the 18-page ruling Wednesday.
In addition, the judge said “the issues with the notices are not traceable” to the state agency, which has contracts with the managed-care providers requiring that their plans comply with federal law.
The plaintiffs also alleged that benefits were reduced while the review process was ongoing, which the secretary of the agency acknowledged “is not supposed to happen,” Hinkle wrote. “There apparently is no nonspeculative basis to believe it will happen again,” the judge wrote, adding “there is also no reason to believe” the issue was traceable to the agency.
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