State reaches settlement in Medicaid class

Jul 26, 2023

TALLAHASSEE — The state Agency for Health Care Administration has reached a settlement in a class-action lawsuit that is expected to lead to the Medicaid program providing incontinence supplies to adults with disabilities, according to court documents.

Lawyers for the state, two women with disabilities and the advocacy group Disability Rights Florida last week asked a federal judge to approve the settlement and put the lawsuit on hold while the Agency for Health Care Administration moves forward with a rule-making process.

The lawsuit would be dismissed if the rule-making process results in incontinence supplies being provided.

“The central thrust of the agreement is that AHCA (the Agency for Health Care Administration) agrees to engage in rule-making with the intention of amending its policies and any other administrative rules necessary such that coverage will be extended to medically-necessary incontinence supplies for Medicaid State Plan recipients age 21 years and older,” said the motion filed Thursday in Jacksonville.

The lawsuit, filed in July 2022, alleged the Medicaid program violated federal laws by denying coverage of incontinence supplies to adults with disabilities. The lawsuit was filed on behalf of Duval County resident Blanca Meza and St. Johns County resident Destiny Belanger, who are incontinent and unable to care for themselves. Disability Rights Florida also is a plaintiff.

U.S. District Judge Marcia Morales Howard on March 27 certified the case as a class action. Morales Howard’s decision cited one estimate that at least 480 Medicaid beneficiaries a year turn 21 and lose coverage for incontinence supplies that they received as children. The state provides the supplies, such as briefs, diapers and underpads, for Medicaid beneficiaries under age 21 and for certain adults, including people in nursing homes.

During an appearance before a Senate committee in April, AHCA Secretary Jason Weida said the agency did not believe providing incontinence supplies was required by the federal Centers for Medicare & Medicaid Services, which oversees Medicaid regulations. But he also indicated AHCA had discussed the possibility of changing the policy.

“I can tell you that from lawsuits in the past when we have been sued and we’re in the middle of litigation, sometimes we decide to change a policy which would essentially give the plaintiffs some or all of what they wanted, and sometimes those lawsuits tend to become moot or just go away,” Weida, an attorney, told the Senate committee. “I can’t tell you exactly how we’re going to shake out on that right now. But what I can tell you is that we’re looking at it not just from a litigation strategy of how we’re going to defend ourselves, but also from a perspective of, is it the right thing to do? And if we ultimately decide that it is the right thing to do, we’ll do it.”

The motion filed Thursday said the agreement came after informal talks and settlement discussions through a mediator.

The lawsuit alleged that the state’s policy on incontinence supplies violated federal Medicaid law and laws including the Americans with Disabilities Act. It said the state stopped providing the supplies to Meza and Belanger after they turned 21, though they are incontinent and unable to care for themselves.

As an example of their disabilities, the lawsuit said Meza “is diagnosed with spastic quadriplegic cerebral palsy, muscle spasticity, neuromuscular scoliosis and partial epilepsy.”

“Plaintiffs are medically fragile adults each with bladder and bowel incontinence,” the lawsuit said. “As low-income Florida residents with significant disabilities, they receive their health services through Florida’s Medicaid program. Plaintiffs’ physicians have prescribed certain incontinence supplies, including briefs and underpads, as medically necessary to treat plaintiffs’ incontinence, keep their skin dry and clean, prevent skin breakdowns and infections and maintain their ability to live in the community.”