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UPDATE: Medicaid Managed Care Program Lawsuit

Monday, December 28, 2015

A United States District Judge denied a motion by the Agency for Health Care Administration (AHCA) to dismiss a federal claim filed against the agency alleging that AHCA’s flawed implementation and oversight of its Long-Term Care Managed Care Waiver (LTC) Program places enrollees at risk of unnecessary institutionalization, in violation of the Americans with Disabilities Act.

The lawsuit, filed by Disability Rights Florida, Southern Legal Counsel and Gainesville attorney Nancy E. Wright in August, alleges that each of the five Plaintiffs named in the suit are elderly, have a disability, or both, with health care needs that would otherwise require care in a nursing home. Each has enrolled in the LTC Waiver Program in an effort to receive similar levels of care at home since, as the ruling mentions, the Plaintiffs “cannot remain safely in the community without adequate and reliable [home and community-based] services.”

However, upon enrollment the Plaintiffs found few standards or guidance outlining the types and amounts of services they can receive under the waiver. Without adequate care-planning, or information specifying the available services, important service decisions have instead been made by Plaintiffs’ managed care organizations (MCOs) that ignore critical issues such as individual need, caregiver availability, or the Plaintiffs’ ability to access the community.

In ruling that the allegations stated in the complaint are sufficient to invoke the Court’s jurisdiction and to state a claim under the ADA upon which relief can be granted, the order issued by US District Judge Robert Hinkle noted, “by a fair reading of the complaint, the plaintiffs allege that […] they will have to enter a nursing home in order to receive the Medicaid benefits to which they are entitled.”

Unrelated to the lawsuit, which is set to advance towards trial, AHCA is currently accepting and coordinating public comments regarding its submission of an LTC waiver amendment to the Centers of Medicare and Medicaid Services (CMS). A copy of the waiver amendment request is available on AHCA’s website for review and comment, and such comments will be accepted by the agency until January 14, 2016.

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agency for health care administration, litigation, managed care, medicaid,

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