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Morning Briefing

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Wednesday, Apr 6 2016

Full Issue

Florida Settles Lawsuit And Agrees To Improve Medicaid Services For Children

Under terms of the agreement, the state will raise its reimbursements to doctors in an effort to get more providers to see Medicaid patients and will set benchmarks for preventive and dental treatment. The settlement ends an 11-year class action lawsuit.

Florida health officials, in a settlement announced Tuesday, agreed to improve access to health care for poor children, ending a long-running class-action lawsuit that had accused the state of shortchanging doctors and leaving low-income families to trek long distances to visit specialists. The state reimbursed doctors so little for Medicaid services that many doctors refused to treat the patients, lawyers argued in a suit filed in 2005 by pediatric doctors on behalf of nine plaintiffs. Hundreds of thousands of children who were on Medicaid never received checkups, and for years, 80 percent of the children never saw a dentist, the worst rate in the nation. (Robles, 4/5)

Florida officials will boost access to health and dental care for poor children in settlement of an 11-year-old class-action lawsuit, the groups behind the legal action said on Tuesday. The settlement calls for Florida to increase payments to physicians who treat poor children and sets benchmarks for preventative and dental treatment to be met over five years, according to the Philadelphia-based Public Interest Law Center, which represented the plaintiffs. (Dobuzinskis, 4/6)

One of the biggest victories for the plaintiffs requires insurance plans to provide a "reasonable opportunity" for pediatricians to earn rates that are on par with Medicare, which typically pays more than Medicaid. In later years, those reimbursement opportunities will extend to specialists, addressing a huge gap in the system by improving doctor participation in the Medicaid program and preventing children from having to travel long distances to receive treatment. (Kennedy, 4/5)

[H]ealthcare for needy children had become a public relations nightmare for the state. Administrators at the Department of Health last year purged 13,000 children from one of the premier Medicaid plans for youngsters, Children鈥檚 Medical Services, and had shuttered CMS offices, including clinics for children with disfigured faces and other disabilities. Public outrage over the cutbacks, and other agency moves, may have cost the health department鈥檚 secretary, John Armstrong, Senate confirmation. (Marbin Miller, 4/5)

In Medicaid news from other states 鈥

North Carolina's Medicaid program is again mistakenly overpaying some doctors and hospitals, an annual compliance audit released Monday found. This time, state auditors disclosed a likely program-wide cost: $835 million. (Robertson, 4/5)

According to a release from DHHS, the department will 鈥渃ontinue its efforts to educate providers about documentation standards and will target education and training to specific provider types if they are consistently having issues.鈥 (Hoban, 4/5)

What was a woman accused of 11 counts of dependent adult abuse and ongoing criminal conduct doing working for AmeriHealth Caritas Iowa, one of the three private, out-of-state Medicaid management companies hired by the state to serve low-income and disabled Iowans? That was the question burning in the mind last week of Jennifer Duncan, a whistle-blower and mother whose son was one of the adults Tonya Nicole Fustos of Glenwood is accused of ripping off. ... James Martin Davis, Fustos' attorney, said his client is pleading not guilty to the charges. ... Davis said he hasn't seen all the state's evidence, but an Iowa Department of Human Services investigation concluded last summer that Fustos was not responsible for exploiting clients. (Rood, 4/5)

The last two mental health providers under investigation for possible Medicaid fraud have been cleared by New Mexico's top prosecutor. Attorney General Hector Balderas sent a letter Tuesday to state lawmakers informing them of the outcome in the cases of the nonprofits Pathways and TeamBuilders. (Bryan, 4/6)

This is part of the Morning Briefing, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
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