Eleventh Circuit backs Florida Medicaid notice ruling
A federal appeals court ruled that Florida’s termination letters failed to clearly explain why families lost health coverage.
By Sanjay Caldwell ·
The United States Court of Appeals for the Eleventh Circuit ruled on Thursday that the DeSantis administration failed to provide adequate notice to people removed from Florida Medicaid. The court upheld a permanent injunction issued earlier this year by U.S. District Judge Marcia Morales Howard in Jacksonville.
Judge Barbara Lagoa, who authored the 23-page decision, agreed with the lower court that the termination letters did not unambiguously communicate the state’s decision, the reason for that decision, or who the decision applied to. Lagoa wrote that other available sources did not cure these deficiencies.
The legal battle began after the end of the public health emergency declared during the COVID-19 pandemic. The federal government had increased Medicaid funding by 6.2% and required states to keep enrollees on the program until the emergency expired. That deadline passed on March 31, 2023. Florida began unwinding its Medicaid rolls the next day.
By 2024, the Florida Department of Children and Families had redetermined the eligibility of more than 4 million people. The initial lawsuit focused on the family-related Medicaid category, which includes children, parents, pregnant women, and former foster children under age 26. Judge Howard described these beneficiaries as some of the state’s most vulnerable citizens.
The court reviewed specific cases to illustrate the flaws in the state’s process. One plaintiff, identified as 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. One section stated neither was eligible due to household income, while another section advised that her son was eligible. The notice did not list the family size or the specific income limit applied.
Another plaintiff, A.V., received an eight-page termination notice that did not specify the family size used in the calculation. The state had assigned a family size of six to A.V. instead of the actual family of eight. This error lowered the allowable monthly income for the Medically Needy program. The state also incorrectly inflated A.V.’s reported monthly income.
Florida Health Justice attorney Lynne Hearne said in a written statement that the ruling confirms the standard for all Medicaid termination notices. She noted it took three years to confirm that enrollees must be informed of the grounds for ending coverage. Katherine DeBriere of the National Health Law Program added that states are preparing for eligibility changes under the One Big Beautiful Bill Act. She urged states to heed the decision to avoid confusing notices.
It is not yet clear if the state will seek review by the U.S. Supreme Court. Any such request must be filed before Gov. Ron DeSantis leaves office in early January. The Department of Children and Families and the Agency for Healthcare Administration did not immediately respond to requests for comment on the ruling.
