Florida doctors, patients sue over Medicaid rates

Pediatric groups are seeking higher payment levels and monitoring of managed care plans.

By Amy Lynn Sorrel, AMNews staff. Dec. 19, 2005.

Florida's state health agencies have violated federal law by not ensuring that children on Medicaid have adequate access to primary and preventive health care.

That's what physicians and dentists allege in a federal class-action lawsuit taking on the state's Agency for Health Care Administration, the Dept. of Children and Family Services and the Dept. of Health.

The lawsuit was filed Nov. 21 in Miami by the Florida Pediatric Society/Florida Chapter of the American Academy of Pediatrics, the Florida Academy of Pediatric Dentistry and families of Medicaid-enrolled children.

The complaint accuses the system of "the endangerment of young lives" and failing to serve Florida's 1.6 million children on Medicaid by inadequately reimbursing physicians, failing to inform recipients of available medical services and abruptly referring them to HMOs with no room to accept them. "We were not happy to have to go the legal route but to no avail tried all legislative remedies available to us," said Louis St. Petery, MD, executive vice president of the Florida Pediatric Society.

Hundreds of fruitless meetings with the Legislature and Gov. Jeb Bush finally drove them to the courts, he said. Successful precedents in Oklahoma and Pennsylvania encouraged them to seek relief from the courts.

The plaintiffs are not seeking damages but reforms, such as adequate payment levels to attract enough physicians and dentists to the program, monitoring of managed care, and equal and regular access for Medicaid recipients to the same services as those available to children with commercial insurance.