A toddler suffering from chronic ear infections couldn't get necessary medical treatments. A teenager who broke his wrist had difficulty getting adequate care. A boy who had a tumor removed from his leg had trouble getting follow-up care.
Those are among the allegations in a 10-year-old class-action lawsuit in Floridathat appears to be finally reaching a conclusion. Florida health officials and a state medical and dental group reached a settlement agreement (PDF) in the case this week that they hope will help prevent access problems for Medicaid-eligible children in the future.
The settlement agreement, announced Tuesday, requires the Florida Agency for Health Care Administration to improve access to medical and dental care for children enrolled in Medicaid. The agency must also pay those who brought the lawsuit $12 million to cover attorneys' fees and other costs of the litigation.
The settlement will boost access for 2 million Florida children on Medicaid, said Dr. Tommy Schechtman, president of the Florida Chapter of the American Academy of Pediatrics, in a statement (PDF). The chapter brought the lawsuit along with the Florida Academy of Pediatric Dentistry and parents of children on Medicaid in 2005.
The groups had alleged that in fiscal 2004, more than 500,000 Medicaid enrolled Florida children received no preventive healthcare services, including more than 30,000 infants. They also alleged that between 1999 and 2004, more than 75% of Florida's Medicaid enrolled children received no dental care.
In the lawsuit, the groups blamed the access problems largely on “inadequate” reimbursement rates paid by Florida to Medicaid providers, which they said made it difficult to entice providers to see Medicaid patients. They also alleged that Florida's administrative systems for managing the Medicaid program created barriers to access, and that the state didn't adequately monitor managed care organizations providing services to Medicaid patients.
“I am hopeful that today's announcement will represent real change and will improve the health care and dental access issues that Medicaid children have been struggling with for many years,” Dr. Louis St. Petery, past executive vice president of the pediatrics group, said in a statement.
The Agency for Health Care Administration said (PDF) all parties will now work together to improve access to medical and dental services for Medicaid eligible children. The agency said in a statement that the settlement follows the implementation of the Statewide Medicaid Managed Care program, under which most Medicaid services are now delivered through managed care plans. The participating plans are required to have networks of medical and dental providers large enough to avoid access problems.
The agency also noted that over the past two years, Florida has had a 13% increase in Medicaid eligible children receiving preventive dental services.
Agency Secretary Elizabeth Dudek called it a “new era” of working together to improve access, in a statement.
Among the terms of the settlement agreement, the agency must require managed care plans to offer pediatricians the opportunity to earn higher reimbursement rates by meeting access and treatment goals. The agency also committed to work toward meeting certain goals for access to preventive care and dental care in coming years.