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Settlement Agreement Reached in Florida Medicaid Case to Improve Medical and Dental Care for Florida Children

April 5, 2016

The Florida Chapter of the American Academy of Pediatrics (“FCAAP”), the Florida Academy of Pediatric Dentistry (“FAPD”), Boies Schiller & Flexner LLP and the Public Interest Law Center announce that a settlement has been reached in a 10-year-old class action suit brought on behalf of the more than two million Florida children who depend on the state’s Medicaid program for their health care.

The settlement agreement provides for the Agency for Health Care Administration (“AHCA”) and other state agencies to make substantial improvements in the access of children on Medicaid to medical and dental care throughout the state, and is designed to raise Florida to at least national norms over several years. 

Key aspects of the settlement include:

  • Beginning with contracts effective October 1, 2016, managed care plans will be required to offer board-certified pediatricians a reasonable opportunity to earn Medicare-equivalent reimbursement rates, which are significantly higher than Medicaid reimbursement rates, for pediatricians that meet objective measures of access and treatment for children. 
  • The incentive plans are designed to expand in successive years to provide opportunities to earn Medicare-equivalent rates for other providers of medical care for Medicaid children.
  • AHCA commits to meet national norms by 2019 for the percentage of children on Medicaid receiving preventive care, and meeting other metrics, and AHCA commits to take additional steps to expand access to care if required. 
  • AHCA also agrees to a series of steps that will bring Florida’s Medicaid program up to national norms in preventive dental care and dental treatment by not later than 2021. 
  • The settlement provides for enhanced outreach for children eligible for but not enrolled in Medicaid and to promote use of preventive care.
  • AHCA and the Department of Children and Families are required to continue to reduce administrative obstacles to receiving care.  
  • FCAAP and FAPD will work collaboratively and on an ongoing basis with state agencies under the settlement. 

“This settlement is a significant step forward in improving access to medical care for the two million Florida children on Medicaid,” said Dr. Tommy Schechtman, president of FCAAP. “We look forward to this new collaborative relationship with Florida’s state agencies to ensure all Florida children obtain the quality health care they need and deserve.”

Dr. Louis St. Petery, past executive vice president and long-term member of FCAAP, said: “I am hopeful that today’s announcement will represent real change and will improve the health care and dental access issues that Medicaid children have been struggling with for many years.”

The FAPD’s president, Dr. Eric Berry, said: “The Academy is pleased that the mediated settlement of the lawsuit will create an opportunity for improved access for the children at highest risk for dental disease and that the hope for these improvements will not be delayed any further.”

The class action lawsuit was brought in 2005 by FCAAP, FAPD, and the parents of children on Medicaid to secure rights to medical and dental treatment under federal law. Following a 90-day trial, federal Judge Adalberto Jordan found extensive violations of federal law, including that Florida’s children on Medicaid did not receive care with reasonable promptness.

Even before Judge Jordan’s ruling on December 31, 2014, Florida had begun addressing a number of the issues identified in the lawsuit and had moved to a managed care system for Medicaid statewide.  The proposed settlement is based upon utilizing efficiencies in the managed care system to generate financial savings which will be directed into further improvements in children’s medical care. 

“After 10 years of litigation, we are pleased that we have been able to reach a comprehensive settlement that will substantially improve health care access and outcomes for the millions of Florida children who depend on Medicaid,” said Stuart Singer, the head of Boies, Schiller & Flexner’s Fort Lauderdale office and the lead counsel for the plaintiffs.

Ben Geffen of the Public Interest Law Center added, “Children who get high-quality health care will be healthier as adults. So today’s settlement is great news for Florida’s children and great news for keeping lifelong health care costs under control.”

A motion for court approval of the settlement will be filed shortly.