Categories: Health Care, Health Law, Patient Care,

Pediatricians who treat poor or low-income children in Florida have been fighting back against low Medicaid payments in the state’s courts for the past several years. Now, a pending class action lawsuit could change the tide of the fight, and give pediatricians and other primary care doctors the ability to determine what is fair and adequate compensation from Medicaid and other plans, health care attorneys in Fort Lauderdale report. 

The original lawsuit against the Agency for Health Care Administration, the Department of Children and Families, and the Department of Health was filed in 2005 by a group of pediatricians, dentists, and nine children. Their lawsuit claims that these organizations have provided inadequate Medicaid services for children, and that the low pay rates from Medicaid have further hampered doctors’ abilities to provide quality care. Since it was filed, the lawsuit has been through several hearings and delays, but a federal judge is expected to provide a final ruling in October 2014.

With the passage of the Affordable Care Act (ACA), Medicaid payments for pediatricians and other primary care doctors were increased for two years, but that time frame is set to expire on Dec. 31, 2014. At that time, the ACA funding will run out, and compensation rates may return to their original – and lower levels. According to court documents in the class action suit, before the passage of the ACA, “Florida’s Medicaid reimbursement rate was among the lowest in the nation.” 

Many Florida doctors and pediatricians have been forced to significantly lower their Medicaid patient caseloads in order to stay afloat, Fort Lauderdale health care lawyers report. And the lack of care provided to children in Florida who qualify for Medicaid under the income and poverty rates seems to be growing, at least according to evidence presented at trial. Plaintiffs argued that Florida did not comply with federal requirements that regulate children’s health and dental services, to the detriment of nearly 2 million poor children in Florida. The lawsuit asks that Florida put in place regulated payment levels that will encourage more doctors and dentists to continue treating Medicaid patients.

The Florida Legislature has passed a $3.4 million increase in Medicaid payments for pediatricians in the upcoming year, but this amount will not even begin to bring payments up to the current standard levels for comparable services across the country. If the lawsuit is decided in favor of the doctors and dentists, many of these practitioners will be able to begin treating Medicaid payments again, as the state will be forced to come up with $227 million per year to permanently increase the payment rates received by those who provide these services. But the risk of an appeal is another delay, and has left many doctors in limbo, waiting to see if they can afford to continue practice. 

Lubell Rosen is a Florida, Georgia, New York and New Jersey law firm specializing in representation for health care professionals, especially those who have been affected by recent changes in the ACA or to Medicare and Medicaid. For more information regarding your concerns, contact a health care attorney at Lubell Rosen for a consultation today.