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Class Action Suit Over Medicaid Coverage Heads to Trial

Children’s doctors and dentists have won a critical round in their four-year-old fight with state officials over Florida’s Medicaid program, which they maintain fails to properly serve at least 1.7 million children.

South Florida U.S. District Judge Adalberto Jordan has certified class-action status and set a Dec. 7 trial for the lawsuit filed in 2005 by the Florida Pediatric Society and Florida Academy of Pediatric Dentistry, which claim the state has failed to meet federal requirements that low-income children receive periodic health screening and routine dental checkups.

The medical groups maintain that 200,000 children eligible for the state-federal Medicaid program receive no benefits because Florida officials have failed to employ outreach programs. Another 1.5 million children enrolled don’t receive the kind of coverage mandated by the federal government, the lawsuit contends.

“This has been worth waiting for,” attorney Stuart Singer said Friday.

Singer, managing partner of the Boies, Schiller and Flexner law firm’s Fort Lauderdale office, represents the medical groups that first filed suit against then-Gov. Jeb Bush’s administration and the Agency for Health Care Administration.

“Florida has failed miserably in meeting regulations requiring preventative care for Medicaid children,” he added. “But without this ruling, we wouldn’t be headed to trial.”

The ruling comes as Florida’s $20 billion Medicaid program struggles with a $480 million deficit this year, with a $1.2 billion shortfall projected for the 2010-11 budget, according to state analysts.

The lawsuit, if successful, is certain to increase the program’s red ink even more. Some 2.7 million low-income Floridians are already in the program, with enrollment spiking 13 percent this year as the punishing recession tightened its grip on the state.

AHCA had sought to have the case dismissed and argued that class-action status should not be granted. Agency spokeswoman Tiffany Vause told the News Service of Florida that AHCA was still “determining how it will proceed,” following Wednesday’s court ruling.

The lawsuit alleges that for more than a decade, close to half of the children enrolled in Medicaid “failed to receive even one of the health checkups that they were entitled to under federal law” and more than 75 percent receive no dental care.

The state also does not inform families of available health care services they are entitled to under Medicaid, sends families to HMOs that are too full to serve additional patients, and does not pay doctors and dentists rates that cover their expenses.

The lawsuit seeks higher reimbursement rates for doctors and dentists, arguing that will increase the number of providers accepting Medicaid beneficiaries.

The organizations are not asking the state to pay monetary damages – but, instead improve Medicaid services so they meet federal obligations.

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