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State can face Medicaid class-action suit over supplies for adults with disabilities

A judge grants a request to handle the case as a class action. The claimants say the state stops providing incontinence supplies to Medicaid beneficiaries older than 21.

A judge has cleared the way for a class-action lawsuit alleging that Florida’s Medicaid program has violated federal laws by denying coverage for incontinence supplies for adults with disabilities.

U.S. District Judge Marcia Morales Howard issued a 37-page decision granting a request by attorneys for two women and the organization Disability Rights Florida to handle the case as a class action. While it is not clear how many people the case could affect, the 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.

“Here, AHCA’s (the state Agency for Health Care Administration’s) policy categorically excluding incontinence supplies for persons over the age of 21 from Medicaid coverage applies generally to the proposed class,” Morales Howard wrote. “Moreover, plaintiffs seek a declaration that this policy violates federal law and a permanent injunction prohibiting AHCA from continuing to implement this policy. If plaintiffs were to succeed in their challenges, such injunctive and declaratory relief would be appropriate with respect to all members of the class.”

The lawsuit, filed in July in federal court in Jacksonville on behalf of Duval County resident Blanca Meza and St. Johns County resident Destiny Belanger, contends that the state is violating federal Medicaid law and laws including the Americans with Disabilities Act.

It said the state provides incontinence supplies, such as briefs, diapers and underpads, for Medicaid beneficiaries under age 21 and for certain adults, including people in nursing homes.

But the lawsuit 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.”

The state has fought the lawsuit and the request to make it a class action. In a document filed in September, attorneys for the state argued, in part, that the Medicaid program operates under regulations approved by the federal Centers for Medicare & Medicaid Services.

“Defendant (the state) has a comprehensive, effectively working plan for providing qualified individuals with necessary services to prevent unnecessary institutionalization,” the document said. “Alternatively, any relief the court deems necessary should be limited to narrowly address the harm before it and not unnecessarily affect defendant’s otherwise comprehensive, effectively working plan for the delivery of Medicaid services that has been reviewed and approved by CMS (the Centers for Medicare & Medicaid Services).”

Morales Howard, in her March 27 decision, said the plaintiffs had met a series of legal requirements to pursue the case as a class action. Those requirements include showing that the legal issues are common to potential class members and that the claims involving Meza and Belanger are typical of the class.

“Both Meza and Belanger are adult Medicaid beneficiaries with prescriptions for incontinence supplies that were categorically denied based on their age,” Morales Howard wrote. “Meza and Belanger both live at home and their treating physician believes it is in their best interest to remain there. While the precise medical and financial circumstances of each plaintiff may be unique, as will be true of all class members, Meza and Belanger’s claims are entirely typical of the claims of class members generally.”

While the case will move forward as a class action, it remains far from being resolved, Morales Howard, who was appointed to the bench by former President George W. Bush, issued an order in February that said a trial is scheduled in January 2024.

Copyright 2023 Health News Florida

Jim Saunders is the Executive Editor of The News Service Of Florida.