Enforcing Health Care Rights
HEALTH LAW AND LITIGATION
When needed, the Florida Health Justice Project (FHJP) uses litigation to enforce the health care rights of vulnerable Floridians. In the short video below, FHJP Legal Director, Katy DeBriere, explains why enforcement actions, including litigation, are critical tools for health justice.
|
|
Katy Debriere, Legal Director
FHJP legal director, Katy DeBriere, identifies the major systemic issues that impact health equity for vulnerable and marginalized Floridians. She then works with other social justice lawyers, including the National Health Law Program’s Health Law Partnership, in securing our clients’ health care rights through effective enforcement strategies. |
CASES and ISSUES
As a statewide health law program, we use litigation as one advocacy tool to enforce the health rights and raise the voices of vulnerable Floridians. Our legal enforcement actions seek to correct system wide violations of Medicaid law in Florida’s administrative, state, and federal courts.
PROTECTING DUE PROCESS RIGHTS OF VULNERABLE MEDICAID RECIPIENTS
Harrell et al. vs. Poppell et al.: Class Action Complaint for Injunctive and Declaratory Relief
This class action successfully challenged Florida’s system-wide failure to protect the due process rights of extremely vulnerable beneficiaries, including children with disabilities aging out of the state’s adoption assistance program. The case resulted in significant corrective actions, including restoration of Medicaid for over 32,000.
This class action successfully challenged Florida’s system-wide failure to protect the due process rights of extremely vulnerable beneficiaries, including children with disabilities aging out of the state’s adoption assistance program. The case resulted in significant corrective actions, including restoration of Medicaid for over 32,000.
Ensuring Access to Medically Necessary Care for vulnerable Children & PERSONS WITH DISABILITIES
W.B. et al. vs. Marstiller: Class Action Complaint for Declaratory and Injunctive Relief
Although numerous Florida courts of appeal have found that Florida’s standard to determine coverage of children’s Medicaid services is more restrictive than that set forth in the federal Medicaid Act, the state Medicaid agency refuses to correct it. This federal class action lawsuit seeks to stop Florida from denying care to children based on its overly restrictive standard.
Although numerous Florida courts of appeal have found that Florida’s standard to determine coverage of children’s Medicaid services is more restrictive than that set forth in the federal Medicaid Act, the state Medicaid agency refuses to correct it. This federal class action lawsuit seeks to stop Florida from denying care to children based on its overly restrictive standard.
Dekker et al. v. Marstiller et al.: Complaint for Declaratory, Injunctive and other Relief
In response to a state rule denying Medicaid coverage of all medically necessary gender-affirming care for transgender Florida residents, FHJP, along with Lambda Legal, Southern Legal Counsel, the National Health Law Program, and Pillsbury Winthrop Shaw Pittman LLP, filed a federal lawsuit. The rule left thousands of transgender people in Florida without access to critical medical care for the treatment of gender dysphoria. The Florida Medicaid Agency finalized the rule after ignoring expert testimony and thousands of public comments during the rule-making process. In May 2022, FHJP and co-counsel participated in a three week trial in the Northern District of Florida. Shortly before the close of trial, the Governor signed Fla. Stat. 286.31 into law which, among other things, prohibited the use of Medicaid funding to pay for gender affirming medical care. Counsel amended their Complaint to challenge this newly enacted ban along with AHCA's rule. On June 21, 2023, the Honorable Judge Robert L. Hinkle entered a 54 page long Order declaring that both the rule and the statute violate the Equal Protection Clause of the U.S. Constitution, the Affordable Care Act, and the federal Medicaid Act and, as such, could not be enforced against Florida Medicaid beneficiaries.
In response to a state rule denying Medicaid coverage of all medically necessary gender-affirming care for transgender Florida residents, FHJP, along with Lambda Legal, Southern Legal Counsel, the National Health Law Program, and Pillsbury Winthrop Shaw Pittman LLP, filed a federal lawsuit. The rule left thousands of transgender people in Florida without access to critical medical care for the treatment of gender dysphoria. The Florida Medicaid Agency finalized the rule after ignoring expert testimony and thousands of public comments during the rule-making process. In May 2022, FHJP and co-counsel participated in a three week trial in the Northern District of Florida. Shortly before the close of trial, the Governor signed Fla. Stat. 286.31 into law which, among other things, prohibited the use of Medicaid funding to pay for gender affirming medical care. Counsel amended their Complaint to challenge this newly enacted ban along with AHCA's rule. On June 21, 2023, the Honorable Judge Robert L. Hinkle entered a 54 page long Order declaring that both the rule and the statute violate the Equal Protection Clause of the U.S. Constitution, the Affordable Care Act, and the federal Medicaid Act and, as such, could not be enforced against Florida Medicaid beneficiaries.
Meza et al. v. Marstiller: Class Action Complaint for Declaratory and Injunctive Relief
Although the Florida Medicaid program covers the cost of incontinence supplies for medically incontinent children, the state stops paying for this essential medical service when the child turns 21. Along with co-counsel Disability Rights Florida (serving as both co-counsel and an organizational plaintiff) and Lewis Golinker, FHJP filed a class action complaint asking that the federal court order the state to provide much needed medical supplies for plaintiffs like Blanca M., a 22 year old Floridian who suffers from multiple disabilities, including spastic quadriplegic cerebral palsy, and who relies on a gastronomy tube for nutrition.
Although the Florida Medicaid program covers the cost of incontinence supplies for medically incontinent children, the state stops paying for this essential medical service when the child turns 21. Along with co-counsel Disability Rights Florida (serving as both co-counsel and an organizational plaintiff) and Lewis Golinker, FHJP filed a class action complaint asking that the federal court order the state to provide much needed medical supplies for plaintiffs like Blanca M., a 22 year old Floridian who suffers from multiple disabilities, including spastic quadriplegic cerebral palsy, and who relies on a gastronomy tube for nutrition.
Dobson vs. Secretary of Health and Human Services
The Eleventh Circuit Court of Appeals ruled that Medicare must provide coverage for a beneficiary’s off-label use of a critically needed medication.
The Eleventh Circuit Court of Appeals ruled that Medicare must provide coverage for a beneficiary’s off-label use of a critically needed medication.
Jones et al. vs. Agency of Health Care Administration (AHCA): Unpromulgated Rule Challenge in the Division of Administrative Hearings
The Florida Medicaid Agency was refusing priority enrollment into the Long Term Care (LTC) waiver for 18-20 year old medically fragile youth who need 24-hour health care, an essential protection designed to ensure that critical health services are not reduced when the child turns 21. Shortly after FHJP and Disability Rights Florida filed an administrative petition challenging the agency’s erroneous interpretation of state law, the agency undertook extensive and robust corrective actions.
The Florida Medicaid Agency was refusing priority enrollment into the Long Term Care (LTC) waiver for 18-20 year old medically fragile youth who need 24-hour health care, an essential protection designed to ensure that critical health services are not reduced when the child turns 21. Shortly after FHJP and Disability Rights Florida filed an administrative petition challenging the agency’s erroneous interpretation of state law, the agency undertook extensive and robust corrective actions.
Ensuring transparency in Medicaid fair hearings
Wright vs. Agency for Health Care Administration (AHCA): Complaint for Declaratory and Injunctive Relief
The Florida Medicaid Agency’s refusal to publicly post fair hearing decisions makes it impossible for advocates and pro se litigants to fully understand adverse actions by managed care organizations and the agency decisions when those actions are challenged. This case seeks to ensure that AHCA will post orders on a publicly accessible website.
The Florida Medicaid Agency’s refusal to publicly post fair hearing decisions makes it impossible for advocates and pro se litigants to fully understand adverse actions by managed care organizations and the agency decisions when those actions are challenged. This case seeks to ensure that AHCA will post orders on a publicly accessible website.
Ensuring that former foster children retain Medicaid
Although the Affordable Care Act (ACA) required coverage for youth aging out of foster care until age 26 (“Former Foster Care” Medicaid), Florida’s application process resulted in former foster care children losing their Medicaid, and as of July 2020, only 67 children were in the program. In response to the detailed legal demand letter sent by FHJP and our partners, the state implemented corrective actions.
Visit the "Medicaid | The Lived Experience: Former Foster Care Children" page.
Visit the "Medicaid | The Lived Experience: Former Foster Care Children" page.
Protecting the Rights of Caregivers and Frail Seniors
Home health care benefits are critical for low-income Floridians who are so frail and disabled that they require home and community based services (HCBS) as an alternative to institutionalization. FHJP successfully combines storytelling with litigation, a strategy which both helps individual storytellers/plaintiffs secure their health care rights and helps educate the public and decision makers about the importance of HCBS.
Diwantie & Mankuar vs. Medicaid Managed Care Plan
When her 87-year-old mother, Mankuar, fractured her back, it fell upon her daughter Diwantie to pick up the pieces, becoming her mother’s voice and caretaker through the travails of hospital and rehabilitation center visits.
When her 87-year-old mother, Mankuar, fractured her back, it fell upon her daughter Diwantie to pick up the pieces, becoming her mother’s voice and caretaker through the travails of hospital and rehabilitation center visits.
Thelma & Hortense vs. Medicaid Managed Care Plan
Thelma quit a good job to care for her elderly mother (who needs care 24/7), when her mother’s Medicaid managed care plan promised to pay Thelma for 41 hours/week at $10.76/hour and provide home delivered meals. Instead, the plan kept cutting Thelma’s hours and pay and stopped providing meals.
Thelma quit a good job to care for her elderly mother (who needs care 24/7), when her mother’s Medicaid managed care plan promised to pay Thelma for 41 hours/week at $10.76/hour and provide home delivered meals. Instead, the plan kept cutting Thelma’s hours and pay and stopped providing meals.
Barbara & Haydee vs. Medicaid Managed Care Plan
Barbara is officially retired from law enforcement but she still works as a part-time reading coach and runs a tutoring business, all while caring for her 89-year-old mother, Haydee, and challenging unfair cuts to her mother’s home health care services.
Barbara is officially retired from law enforcement but she still works as a part-time reading coach and runs a tutoring business, all while caring for her 89-year-old mother, Haydee, and challenging unfair cuts to her mother’s home health care services.
Therese vs. Medicaid Managed Care Plan
Therese has twice been erroneously terminated from her Medicaid Long-Term Care benefits, and was helped by FHJP and a legal services partner. Then, in the midst of the COVID-19 crisis, Therese’s bureaucratic nightmare with her Medicaid Long-Term Care managed care plan entered a new chapter.
Therese has twice been erroneously terminated from her Medicaid Long-Term Care benefits, and was helped by FHJP and a legal services partner. Then, in the midst of the COVID-19 crisis, Therese’s bureaucratic nightmare with her Medicaid Long-Term Care managed care plan entered a new chapter.
RESOURCES AND PUBLICATIONS
- The Advocate’s Guide to the Florida Long-Term Care Medicaid Waiver (1st Edition Published 2018; 5th Edition Published July 2022) | Provides a roadmap to the complex Medicaid program providing home and community-based services for frail elderly and disabled Floridians who want to stay out of a nursing home after they can no longer handle the activities of daily living. The Guide provides advocates with an overview of the authority governing Florida's Medicaid managed care long-term care waiver and addresses basic questions including: who is eligible; how to apply; what to do if an application is denied or delayed; how the waitlist works; what to do if services are denied, delayed, terminated or reduced.
- The Advocate’s Guide to the Florida Medicaid Program (1st Edition Published 2018; 2nd Edition Published July 2022) | Provides a useful roadmap to a complex and critical safety net program serving over 5 million Floridians. The Guide looks at who is eligible for Medicaid; how to apply; what to do if an application is denied or delayed; what to do if eligibility is terminated; what services are covered; how Medicaid Florida’s managed care program works; and what to do if a beneficiary’s services are denied, delayed, terminated or reduced.
- MIE Article "Statewide Poverty Health Law Programs: Necessary to a Legal Aid Delivery System" | Although the top ranked civil legal problem is health, in a number of states, including Florida, few legal resources are available for residents facing systemic barriers to needed care. This article discusses why the "disconnect" exists and how a statewide health law program, like FHJP, can mitigate the delivery system's challenges and help enforce the healthcare rights of low-income clients.
HEALTH LAW AWARDS
Every 2 years the Florida Bar Foundation designates Goldstein-Van Nortwick Awards for Excellence. These prestigious awards are in recognition of significant impact projects affecting a substantial number of poor people and addressing important poverty law issues. The Florida Health Justice Project has received these competitive biennial awards two times since our work began in 2018.
Like the Goldstein-Van Nortwick Award, the Florida Bar Foundation (the Foundation) issues the Paul Doyle Children’s Advocacy Award (“Doyle Award”) to recognize and encourage systemic legal advocacy on behalf of low-income children accomplished by the Foundation’s Grantees. In 2023, upon its first application for the Doyle Award, Florida Health Justice Project was awarded First Runner-up for its work to ensure medically fragile children continued to receive critical medical services, like consumable medical supplies and private duty nursing services, when they turned age 21.
- 2022 Goldstein – Van Nortwick Award Recipient | Honored for enforcing Medicaid rights of former foster youth. First Runner-up.
- 2020 Goldstein – Van Nortwick Award Recipient | Honored for obtaining relief for thousands by reforming Florida’s flawed Medicaid “ex parte review” process. First Runner-up.
Like the Goldstein-Van Nortwick Award, the Florida Bar Foundation (the Foundation) issues the Paul Doyle Children’s Advocacy Award (“Doyle Award”) to recognize and encourage systemic legal advocacy on behalf of low-income children accomplished by the Foundation’s Grantees. In 2023, upon its first application for the Doyle Award, Florida Health Justice Project was awarded First Runner-up for its work to ensure medically fragile children continued to receive critical medical services, like consumable medical supplies and private duty nursing services, when they turned age 21.
- 2023 Paul Doyle Children’s Advocacy Award | Honored for its Ensuring Continuity of Care for Medically Fragile Children Aging Out of EPSDT
(the Medicaid Aging Out Project”). First Runner-up.
We are grateful to the National Health Law Program (NHeLP) for creating the Health Law Partnership,
a project that supports this vital work in Florida and other states.
a project that supports this vital work in Florida and other states.
