Miriam Harmatz

Miriam Harmatz, Director of Advocacy and Founder

Miriam, one of Florida’s leading Medicaid advocates, is a former senior health law attorney at Florida Legal Services and adjunct professor in the Health Law Clinic at Florida International University College of Law. As a young child with a health issue, Miriam learned that everyone must have insurance and that healthcare is a human right. She wrote her senior college thesis on why Congress failed to pass a national health insurance bill in 1974, and as a legal services attorney for 30 years she focused on ensuring access to healthcare for her clients.

Miriam has been lead counsel on multiple federal court cases resulting in statewide relief for Medicaid beneficiaries. These successful outcomes, including federal court cases of first impression and with national import, are the result of highly collaborative work with national experts, Florida legal aid lawyers and pro bono attorneys. On a local level, Miriam led collaborative efforts that improved access and transparency at Miami-Dade County’s publicly funded hospital. This work includes administrative complaints successfully challenging outpatient and inpatient admission deposit policies, discrimination against foreign born county residents, and violations of consumer protections provided under the ACA, the first complaint of its kind in the nation.

Because Florida has not yet expanded Medicaid under the ACA, Miriam has focused on outreach and education detailing the tremendous human and economic benefits of extending coverage and the adverse impact of failing to do so. And since the 2016 election, she has been part of the massive advocacy effort devoted to defending the ACA and Medicaid.

Watch Miriam receive the Georgetown Center for Children and Families 2015 Annual Award for Healthcare Advocacy

Education

University of Wisconsin Law School, Madison, WI, Juris Doctor, 1979

Stanford University, Palo Alto, CA, Bachelor of Arts, 1975, Phi Beta Kappa; Honors in Social Thought and Institutions

Significant Cases

Lead Counsel:

K.G. ex rel. Garrido v. Dudek, 981 F. Supp. 2d 1275 (S.D. Fla. 2013), aff’d in part and modified in part, 731 F. 3d 1152 (11th Cir. 2013)

Challenged Florida’s rule excluding coverage of any behavioral treatments of autism, including Applied Behavior Analysis (ABA), the only evidence based treatment for autism. The trial court found that the rule violated the Medicaid Act’s EPSDT and comparability requirements; and, that the state’s determination that ABA was experimental was arbitrary and capricious. On appeal, the Eleventh Circuit struck language specifically referring to nonparties, while holding that the "district court did not abuse its discretion in issuing a permanent injunction that ...requires Medicaid coverage of [ABA] treatment." Received attorneys’ fees in the amount of $750,000.

Smith v. Benson, 703 F. Supp.2d 1262 (S.D. Fla.)

Challenged state Medicaid rule that excluded coverage of diapers without exception. Under federal Medicaid law, states are required to cover medically necessary services, including medical supplies such as diapers, for recipients under the age of 21. The Court granted summary judgment and enjoined the state Medicaid agency from denying coverage of medically necessary diapers. Although the case was not a class action, the ruling benefits over 12,500 medically incontinent Florida Medicaid recipients. Received attorneys’ fees in excess of $178,000.

Reid, et al. v. Agwunobi, Case No. 08-60040 Civ-Zlock (S.D. Fla. 2008.)

Class of Medicaid recipients in counties where recipients are required to enroll in managed care plans. The case challenged the Medicaid agency’s failure to provide the requisite notice regarding good cause disenrollment rights form Medicaid managed care organizations. Prior to a ruling on summary judgment, the agency agreed to amend their notices and choice counselor script to comply with federal law the case, and the parties settled.

Edmonds, et al. v. Levine, 417 F. Supp. 2d 1323 (S.D. Fla. 2006)

Class challenged state policy of denying off-label uses of a widely prescribed drug. Under federal Medicaid law, states are required to cover prescription drugs for “medically accepted indications,” which the statute defines as uses approved by the FDA (on label) or “off-label” uses that are supported by citation in one of three Congressionally specified compendia. Plaintiffs’ motion for summary judgment was granted, and the Court ordered permanent injunctive relief. Court awarded over $280,000 in attorneys’ fees.

Hernandez, et al. v. Medows, No. 02-20964, U. S. Dist. Ct., S.D. Fla.

Class of present and future Medicaid recipients whose prescription drug claims were denied without notice or hearing rights challenged state’s violation of due process. under federal Medicaid law and the Fourteenth Amendment. Court certified the class (see Hernandez v. Medows, 209 F.R.D. 665). The parties executed a comprehensive and enforceable settlement agreement which is incorporated in a final order and in the state’s rule governing prescription drug coverage. Relief includes the right to written notice of the reason for coverage rejection, the opportunity for appeal, and the circumstances for continued coverage pending the outcome of the appeal. Since 2003, the parties have engaged in two medications which have led to continued improvement of notices and process. Awarded $750,000 in attorneys’ fees for work leading up to mediation.

Cross Creek Health Care v. DeCosta, 818 So. 2d 502, (Fla.1st DCA 2002)

Successfully represented client in appeal of nursing home discharge.

Harris, et al. v. Cook, No. 96-2994 Civ (S.D. Fla. 1996)

Class action which challenged the Agency for Healthcare Administration (AHCA) approval of a plan that eliminated Medicaid coverage of nonpublic transportation services for all mental health day treatment patients in Miami-Dade County. The court entered a consent order granting the due process relief prayed for in the complaint and attorneys’ fees.

Kurnik v. Agency for Health Care Administration, 661. So. 2d 914 (Fla. 1st DCA 1995)

Represented client seeking reimbursement for out-of-pocket losses due to Medicaid agency errors. Court found that Florida's policy of providing reimbursement only to providers violated client's rights under federal Medicaid law and ordered client reimbursement.

Dalger et al. v. Jackson Memorial Hospital (JMH), (HHS/OCR No. 04-92-3007)

Represented class of clients denied inpatient admissions to the public county hospital because they could not pay inpatient admission deposits. In settlement of this Hill-Burton class complaint, JMH agreed to corrective actions.

Little et al. v. Secretary of Dept of HRS, No. 80-2854 Civ. (S.D. Fla. 1991)

Represented class of District XI food stamp recipients whose applications were illegally delayed by the state. Brought three separate contempt proceedings: 1987, 1989, 1991. In each proceeding, the court entered Consent Decrees in which the defendant admitted violating federal food stamp regulations and agreed to implement extensive corrective actions.

Domenech v. Secretary of DHHS, 913 F.2d 882 (11th Cir. 1990)

Represented client whose disability benefits had been terminated. Court reversed termination decision pursuant to claim that beneficiary was deprived of his due process rights by not being allowed to cross-examine a physician who examined the claimant post-hearing.

G.E.Y. v. Cabinet for Human Resources, 701 S.W. 2d 713 (Ky. App. 1985)

Represented client whose parental rights had been terminated. Court reversed the termination decision based on argument that trial court improperly allowed, over hearsay objections, the client's case record.

Co-Lead Counsel or Co-counsel:

C.F. v. Dept. of Children and Families, 934 So. 2d 1 (Fla. 3rd DCA 2006)

Successfully challenged the state’s reduction of personal care services (PCA) for severely disabled child. The Court found that the state was using an overly restrictive definition of PCA and medical necessity in violation of federal Medicaid law.

Albo v. DOEA, DCF, AHCA, DOAH Case No. 02-1481 RX 02-1482RX, 02-1483RX
Successfully challenged state rules which required that applicant for Medicaid waiver services already be receiving the waiver services and case management before eligibility determination could be performed.

Grissom v. Sec. Agency for Health Care Administration, Case No. 6:01 VC-785-ORL-19-DAB (M.D. Fla. 2001)

Successfully challenged state’s refusal to guarantee coverage of liver transplant for client. After filing complaint and motion for temporary restraining order, state agreed to ensure coverage and pay attorneys’ fees.

Bell v. Agency for Health Care Administration, 768 So. 2d 1203 (Fla. 1st DCA 2000)

Represented Medicaid recipient in successful appeal of DOAH hearing that upheld the validity of state rule dealing with durable medical equipment. The DCA held that the rule violated federal law by failing to provide procedure for adult Medicaid beneficiaries to request supplies not on the approved list.

Grant et al. v. Kearney, et al., Case No. 99-2147 Civ Hoeveler, (S.D. Fla. 1999)

Challenged state’s termination of parents and children from Medicaid when they lost cash assistance. During the course of the litigation, the state remedied its unlawful termination policies and notice deficiencies. Case settled, which included payment of attorneys’ fees.

Padron et al. v. Feaver, Case No. 97-2883-Civ-Highsmith (S.D. Fla. 1997)

Successfully challenged state policy of failing to process Medicaid applications referred to it by the SSA after concurrent applications for SSI were denied. Prior to successful settlement, class was certified and motion to dismiss denied. See Padron v. Feaver, 1800 F.R.D. 448 (S.D. Fla.1998).

Reynolds v. Agency for Health Care Administration, Case No. 96-1682 RX, D.O.A.H.

Successfully challenged state rule limiting Medicare reimbursement of deductible and coinsurance to the state’s Medicaid reimbursement limit. Since Medicaid payment level is substantially lower than Medicare’s, this policy resulted in many private physicians not serving dual eligibility or improperly seeking out-of-pocket costs from them.

Select Presentations and Publications

Florida Medicaid Overview, Co-presented webinar for Health Law Section of Florida Bar, Sept. 2017

The Amended Senate Healthcare Bill: Implications for Florida Still Problematic, July 2017, FLAdvocate.org

The Senate Healthcare Bill: Florida Coverage and Spending Implications, July 2017, FLAdvocate.org

Medicaid Per Capita Caps: Risks for Florida, May 2017, FLAdvocate.org

Work Requirements, Premiums and Lockouts: Considerations for the Florida Medicaid Program, March 2017, FLAdvocate.org

The American Health Care Act: Implications for Florida’s Medicaid Program, March 2017, FLAdvocate.org

What Does Capped Medicaid Funding Mean for Florida: Considerations to Address Before Moving Forward, February 2017, FLAdvocate.org

What Would Repeal of the Affordable Care Act Mean for Florida?, January 2017, FLAdvocate.org

Healthcare Advocacy, Plenary panelist presentation at Catalyst Miami’s Anti-Poverty Summit, June 2017

Health Care Access for Low Income Floridians, Potential Impact of Repealing ACA and Changing Medicaid Financing, Presentation to Miami nursing schools (faculty and students) and Hispanic Nurses Association, March 2017

Capped Medicaid Financing: Implications for Florida, Co-presented webinar to legal services and legal aid attorneys in Florida, March 2017

“Don’t Repeal ACA without an Instant Replacement,” Op- Ed, The Miami Herald, Dec. 25, 2016

Impact of ACA Repeal, Co-presented webinar to legal services and legal aid attorneys in Florida, March, 2017

Medicaid Rx Issues, Co-presented at National Health Law Annual Conference, Dec 2016

Implications of Affordable Care Act Repeal on Florida and Miami-Dade County, Presentation to the Miami-Dade County Board of County Commissioners, Dec. 2016.

New Florida Legal Services Report Examines Financial Challenges to Health Care System, Georgetown Health Policy Institute Center for Children and Families Blog, Aug. 24, 2016

Harmatz, Miriam, et al., Advocates’ Guide to Florida’s Medicaid Managed Care Program (Aug. 17, 2016), FLAdvocate.org

Harmatz & Cassel, Medicaid Safety-Net Funding Issues: Implications for Hillsborough County (July 2016), FLAdvocate.org

How Cuts to Safety Net Hospitals Impact the Uninsured in a State that Rejected Medicaid Expansion Funding, Georgetown University Health Policy Institute Center for Children and Families. (March 29, 2016)

Harmatz & Cassel, Medicaid Safety-Net Funding Issues: Implications for Counties and Low-Income Uninsured Floridians (Jan. 2016), FLAdvocate.org

Harmatz, Miriam, et al., The Fight for Medicaid Coverage of Evidence-Based Behavioral Treatments for Autism, Clearinghouse Rev. (Sept. 2015)

Federal Funded Coverage, Low Income Pool, and Intergovernmental Transfers: Impact on Miami-Dade County, Presentation to Health Foundation of South Florida Community Forum (May 2015).

Lessons From the Coverage Expansion Debate: Looking Back/ Looking Forward, Presentation to South Florida Hospital and Healthcare Association Annual Conference (June 2014).

Give Florida’s Uninsured Medicaid Coverage, The Miami Herald op-ed (Feb. 5, 2014)

Florida Due Process Rx Litigation: Lessons Learned and Unanswered Questions, Presentation at National Health Law Program Annual Conference (Dec. 2010).

Florida Medicaid 101, Presentation at the Florida Legal Services Statewide Continuing Legal Education (CLE) training in Tampa, Florida (Oct. 2009).

EPSDT: What Does it Mean for Your Clients and How Can You Use it?, Presentation for Florida Guardian ad Litem Training (Nov. 2008).

Proudly They Waive: The Use of Destructive Waivers to Undermine Medicaid, Presentation at Families USA Health Annual Conference in Washington, D.C. (Jan. 2006).

State Medicaid Prescription Drug Cuts: What Can State Advocates Do, Presentation at National Health Law Program Annual Conference in Washington D.C. (Dec. 2005).

Medicare Prescription D: What Can State Advocates Do, Presentation at National Legal Aid and Defender Association Annual Conference (July 2005).

Florida Medicaid 101, Presentation for CLE in Orlando, Florida (March 2005).

When Good Waivers Go Bad: What Can State Advocates Do, Presentation at Families USA Health Annual Conference in Washington, D.C. (Jan. 2005).

Dealing with Mental Health: Access to Care for Children on Medicaid, Presentation for Public Interest Law Section of The Florida Bar (June 2004).

Medicaid Prior Authorization Issues: Dangers to Consumers and How Advocates Can Minimize Problems, Continuing Legal Education presentation at the Health Access Partnership Annual Conference (Jan. 2004).

Due Process Issues in Medicaid and Medicare, Presentation at National Health Law Program Annual Conference in Washington D.C. (Dec. 2003).

Medicaid Prescription Drug Program: What Can Social Workers do if Coverage is Denied, Presentation CEU for the Florida Society of Oncology Social Workers (Oct. 2003).

Medicaid Waivers: Home and Community Based Services, Presentation for the South Florida Guardianship Association (May 2003).

Prior Authorization and Supplemental Rebates in Medicaid, Presentation at Families USA 2003 Health Action Conference (Jan. 2003).

Medicaid Prescription Drug Issues, Presentation at National Health Law Program Annual Conference in Washington D.C. (Dec. 2002).

Confronting Barriers to Quality Health Care for Immigrants, Presentation at National Legal Aid and Defender Association Conference (Dec. 2001).

Health Advocacy for Children and Families, Presentation for CLE in Orlando, Florida (Sept. 2001).

Data Collection Regarding Transitional Medicaid and Section 1931 Medicaid Coverage, Presentation at Center on Budget and Policy Priorities Conference (Dec.1999).

Issues and Concerns in Florida’s New Children’s Health Insurance Program, Presentation at the Children’s Defense Fund Conference on State Child Health Insurance Programs (1998).

National health insurance: Why Did the Kennedy-Griffiths Health Security Act Not Succeed in the 93rd Congress, Senior Honors Thesis, Stanford University, (1975)

Select Media Interviews and Quotations

Quoted in Miami Herald, “Partial repeal would leave more uninsured than before Obamacare, study says” (Dec. 6, 2016)

Interviewed on Facing South Florida: Obamacare Repeal, CBS Miami, (Jan. 15, 2017)

Quoted in Miami Herald, “Medicaid spending caps in GOP health plan could be costly for Florida, experts say” (March 7, 2017)

Quoted in Tampa Bay Times, “CBO score of Republican healthcare plan spells trouble for Florida, health experts say” (March 15, 2017).

Quoted in Bradenton Herald, “For Florida, caps on Medicaid would increase burden on local government” (March 15, 2017)

Quoted on Public Radio WLRN regarding release of Report related to hospital supplemental payments and Medicaid expansion funding (Jan. 16, 2016).

Quoted in Miami Herald “If you are low income and uninsured, you never had an easy time accessing the safety net, even at the height of [federal and state] funding, and now it’s going to be much, much harder [re reductions in hospital funding and Florida’s decision not to expand Medicaid],.” (January 20, 2016).

Quoted in Miami Herald regarding case in which young mother died awaiting admission to public hospital for transplant evaluation: “This is the kind of tragedy that's going to be happening more and more [without Medicaid expansion] as the safety net gets more stressed” (Jan. 15, 2016).

Quoted in Florida Politics, Florida Counties "In Crisis" Without Medicaid Expansion (Jan. 20, 2016).

Quoted in Miami Herald article regarding fact that local indigent care funding cannot substitute for Medicaid expansion funding, “Jackson’s program is not a replacement for Medicaid…It’s not real coverage" (April, 2015)

Interviewed for Public Radio series “What It's Like To Be In The Health Coverage Gap In Florida" | WLRN “ . . you've got this shocking anomaly where the poorest people get nothing.” South Floridians In The Gap (Apr 20, 2015).

Interview with the Sargent Shriver National Center on Poverty Law (April 2014).

Quoted in The Bureau of National Affairs regarding complaint filed with National Health Law Program under ACA (first of its kind in the nation) against Miami-Dade Public hospital (Sept. 3, 2014).

Interviewed on NBC Miami after federal court judge ruled from the bench following a week long trial ordering the state Medicaid Agency to immediately rescind rule excluding any behavioral treatments for children with autism and to begin coverage (March 28, 2012).

Quoted in St. Pete Times regarding fact that no paper records exist on Gov. Jeb Bush's plans to reform Medicaid, the federal-state health care program for the poor (March 31, 2004).

Honors and Awards

2015     Georgetown Center for Children and Families Annual Award for Healthcare Advocacy

2014     Daily Business Review Award for Most Effective Public Interest Lawyer

2013     Autism Speaks Annual Lawyer of the Year Award

2013     Florida Bar Foundation Paul Doyle Award for Children’s Advocacy Award

2010     Daily Business Review Award for Most Effective Public Interest Lawyer

2007     Daily Business Review (South Florida) Award for Most Effective Class Action Lawyer

2006     Florida Bar Foundation Steven M. Goldstein Award for Excellence

1992     Legal Services of Greater Miami, Inc. Alfred Feinberg Memorial Award

Board Membership and Bar Admissions

Board Membership: National Health Law Program Board of Directors

Bar Member: Florida

Court Admissions: S.D. Fla., M.D. Fla., N.D. Fla., 11th Cir. Ct. App., W.D. Wis., W.D. Ky.