Almost a decade after the original lawsuit was filed and three years after the trial was completed, U.S. District Court Judge Adalberto Jordan has ruled that the Florida Medicaid program violates federal law. The lawsuit was brought by the Florida Chapter of the American Academy of Pediatrics and the Florida Academy of Pediatric Dentistry. See the article below by Dr. Bicuspid as well as additional background on the case. Pediatric dentist and Medicaid dental expert Dr. James J. Crall was a critical expert witness in the case. The judge’s opinion relied heavily on Crall’s analysis:
"I also agree with Dr. Crall’s opinion that Florida’s Medicaid dental rates are not sufficient enough to provide equal access . . . "
"Based on the evidence in this case, I conclude that while reimbursement rates are not the only factor determining whether providers participate in Medicaid, they are by far the most important factor, and that a sufficient increase in reimbursement rates will lead to a substantial increase in provider participation and a corresponding increase in access to care."
The AAPD applauds this court decision and hopes that policymakers will make reforms in Medicaid dental programs to improve patient utilization and provider participation, as has occurred in states like Connecticut, Maryland, and Texas (albeit in two of those states as a result of lawsuit settlements and the other due to the death of a child from a tooth infection). See this recent ADA Health Policy Institute Report for more details on how Medicaid dental fees are far below commercial insurance averages in most states.
The case Florida Pediatric Society/The Florida Chapter of the American Academy of Pediatrics v. Levine, No. 05-23037-CIV-HUCK (S. D. Fla., was originally filed in the U.S. District Court, Southern District of Florida on Nov. 21, 2005. The class action complaint was filed by the Florida Academy of Pediatric Dentistry (FAPD), the Florida Chapter of the American Academy of Pediatrics, and the families of six children on Medicaid. It is based on alleged violations of the federal Medicaid law, including the equal access, EPSDT, and reasonable promptness requirements. The lawsuit alleges that Florida has failed in its legal duty to provide 1.6 million children of low-income families with adequate healthcare, because the state does not inform their families of the basic healthcare services they are entitled to, sends them to HMOs too full to accept them, and refuses to pay physicians and dentists at a rate that covers their expenses. There is a legal requirement under the federal Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program that children must have access to care from doctors that is equal to the access to care received by privately insured children, and such children must receive preventive health services.
In January 2007, the court ruled that the lawsuit could proceed. The court rejected the state’s motion to dismiss. Attorneys for the State of Florida argued that pediatricians, pediatric dentists, and parents of children on Medicaid do not have the right to sue Florida officials to enforce federal law, because the federal statutes under which this suit was brought do not allow individuals to bring such a lawsuit. In his 6-page decision, Judge Adalberto Jordan rejected that argument and stated that the lawsuit can proceed because "the statutes under which the plaintiffs bring suit confer individually enforceable rights."
The case featured a long trial that lasted from December 2009 to January 2012. Several Florida pediatric dentists testified in the trial as well as national Medicaid children’s dental program expert (and pediatric dentist) Dr. James J. Crall.
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