Florida loses appeal over Medicaid termination notices

A federal appeals court ruled on Thursday that the DeSantis administration failed to send adequate notice to people before removing them from Florida Medicaid. The decision upholds a permanent injunction issued earlier this year by U.S. District Judge Marcia Morales Howard in Jacksonville. The 23-page opinion was authored by Judge Barbara Lagoa of the U.S. Court of Appeals for the 11th Circuit.

The court found that the termination letters did not clearly explain why the state determined recipients were no longer financially eligible. Judge Lagoa agreed with the district court that the notices failed to unambiguously communicate the state's decision, the reasons behind it, or whom it applied to. The ruling comes after a six-day bench trial that examined the quality of the paperwork sent to beneficiaries.

Florida began its Medicaid unwinding process on April 1, 2023, the day after the federal public health emergency ended. The Department of Children and Families redetermined the eligibility of more than 4 million people in the following year. The state's Agency for Healthcare Administration and the Department of Children and Families did not immediately respond to requests for comment on the new ruling.

The lawsuit was filed by the National Health Law Program and the Florida Health Justice Project on behalf of plaintiffs who were erroneously removed from the program. Attorney Lynne Hearne of Florida Health Justice said in a written statement that the ruling confirms the standard for all Medicaid termination notices. Hearne noted that it took three years to confirm that enrollees must be informed of the grounds for ending their coverage.

Katherine DeBriere, a senior attorney at the National Health Law Program, stated that the ruling adds urgency to states preparing for eligibility changes under the One Big Beautiful Bill Act. She pointed out that Florida has already begun issuing notices to immigrant enrollees regarding coverage terminations. DeBriere argued that states must build protections into their systems to ensure people understand why the state proposes to end their coverage.

The original case focused on termination notices sent to children, parents, pregnant women, and former foster children under age 26. Judge Howard described these groups as some of the state's most vulnerable citizens. The district court found that the state did not provide enough case-specific information for recipients to understand how the state reached its decisions. This made it difficult for recipients to understand the intended action or the reasons for it.

One named plaintiff, Chianne D, received an 11-page notice in April 2023 stating that she and her newborn son were being disenrolled for financial reasons. The letter contained conflicting information, stating in one section that her son was ineligible due to high household income, while a later section advised that he was eligible. The notice did not include the family size, the qualifying income limit, or the specific eligibility category assigned to the recipient.

Court records show that a Department of Children and Families agent told Chianne D that her son's Medicaid remained open while also telling her he was being terminated. The state later determined that Chianne D's own coverage had been incorrectly terminated. Judge Lagoa wrote that when a trained state employee could read the notice and get the wrong answer, the district court was right to find the notice defective.

Another plaintiff, A.V, received an eight-page termination notice that did not specify the family size used for the calculation. The state had assigned a family size of six instead of A.V's actual family of eight. This smaller figure lowered the allowable monthly income for the Medically Needy program. The state also incorrectly inflated A.V's reported monthly income.

Attorney Andy Bardos represented the DeSantis administration on appeal. He argued that Florida only needed to meet minimum due-process requirements, such as stating the intended action and the reason. Judge Adalberto Jordan of the appeals panel questioned if that was all the state needed. Bardos replied that it was the minimum requirement of due process. Judge Jordan responded to the attorney by saying the situation was pretty bad.