A federal judge Tuesday ruled that Florida has violated the constitutional rights of people who were dropped from the Medicaid program because it sent notices to them that “border on the incomprehensible.”
U.S. District Judge Marcia Morales Howard, in a 273-page ruling in a class-action lawsuit, also barred the state from terminating benefits of people for financial-eligibility reasons unless it provides adequate notices.
Howard wrote that people who receive what is described as family-related Medicaid coverage “are among the state’s most vulnerable citizens.”
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“They are primarily pregnant and postpartum women, infants and children,” she wrote. “And as is evident from the applicable income standards, these individuals are the poorest of the poor. Prior to terminating the Medicaid benefits on which these individuals depend, the Constitution requires the state of Florida to provide them with adequate notice. The state of Florida is violating this constitutional requirement.”
In finding that the state violated due-process rights, Howard wrote that the notices are “vague, confusing and often incorrect and misleading.” She said people cannot understand the notices and whether the state made mistakes in denying them benefits.
“This increases the likelihood that when the state makes an error, which is inevitable in a program of this size and complexity, impoverished parents, children, pregnant women and infants will lose vital medical benefits for which they are eligible,” the ruling said. “This causes tremendous harm not only to these individuals, but to society at large. Indeed, it is in the public interest to require the state to comply with its constitutional obligations and ensure that individuals eligible for Medicaid receive those benefits without interruption.”
Attorneys for people who had lost benefits filed the lawsuit in 2023 in Jacksonville, and Howard certified it as a class action in 2024. It applies to people who lost benefits after March 2023 or could lose benefits because of determinations by the state that they do not meet income-eligibility requirements for coverage.
The lawsuit is rooted, at least in part, in the 2023 end of a federal COVID-19 public health emergency. During the emergency, the federal government provided extra money to the state for the Medicaid program — with the caveat that the state would not drop people from the program.
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But after the emergency ended, the state began what is known as a “redetermination” process to review the continued eligibility of beneficiaries. Over a yearlong period, the Department of Children and Families redetermined the eligibility of more than 4 million people, Tuesday’s ruling said.
Citing DCF records, Howard wrote that 497,918 people were terminated from Medicaid based on income-eligibility reasons between March 2023 and March 2024 and had not been reinstated as of March 2024.
The lawsuit centered on the notices, but Howard’s voluminous ruling also detailed problems related to issues such as a decades-old state computer system and a call center. The ruling said people who sought help about terminated benefits from the call center could have their calls blocked because of heavy volumes, face long wait times or receive erroneous information.
It was not clear from Tuesday’s ruling how quickly the state could make changes to provide adequate notice before terminating benefits. But Howard wrote that a “constitutionally adequate notice must unambiguously identify the state’s decision to terminate full Medicaid benefits based on a finding of financial ineligibility, the person or persons to whom that decision applies, and the reasons for that decision. The reasons must be set forth in sufficient detail to allow the recipient to assess the accuracy of the decision and decide whether to challenge the determination.”
“Although the state presented evidence that it intends to modify its notices in the future as part of its modernization project (of the computer system), it has no immediate plans to correct the serious flaws in the NOCAs (Notice of Case Actions) and offered no evidence as to what information would be included in the modernized NOCAs,” the judge wrote. “As such, absent injunctive relief, the state will continue to violate the constitutional rights of the class members.”
Howard, however, rejected a request by the plaintiffs’ attorneys to reinstate to the Medicaid program people who have lost benefits and not been reinstated. The state, however, will have to provide adequate notices to such people about why their benefits were terminated, which could lead to hearings about reinstatement.
The lawsuit names as defendants DCF Secretary Taylor Hatch and Agency for Health Care Administration Secretary Shevaun Harris. While AHCA runs much of the Medicaid program, DCF makes eligibility determinations.
