State loses round on Medicaid physician pay

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  • | 12:00 p.m. March 26, 2013
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A judge has ruled that the federal Affordable Care Act does not shield the state from key parts of a lawsuit alleging that Florida's Medicaid program has provided inadequate care to children.

The lawsuit, which has been led by the Florida Pediatric Society, contends that many physicians will not treat children in the Medicaid program because the state's payment rates are too low. The state argued that most of those issues are moot because the Affordable Care Act in 2013 and 2014 boosts pay for primary-care physicians who treat Medicaid patients.

Miami federal Judge Adalberto Jordan, who heard arguments March 15, issued a two-page opinion last week rejecting the state's arguments. 

Though the higher payment rates legally took effect Jan. 1, Jordan wrote that the state has not received federal approval to boost physician pay. When that approval comes, the state says it will retroactively make the higher payments. The higher payments would be to the rates paid in the Medicare program.

"Without this approval, qualified and eligible medical providers in Florida have not been paid, and will not be paid, the higher Medicare reimbursement rates," wrote Jordan, who has already held a lengthy trial in the overall case but has not ruled.

"These providers, therefore, are still being paid the rates that the plaintiffs are challenging in this case, and everything remains the same as it was at trial," he wrote.

Jordan added that the state could again raise the arguments when it receives approval of the higher rates from the federal Centers for Medicare & Medicaid Services. He indicated that the state likely will not succeed because the rate increases — which are fully funded by Washington — are only scheduled for 2013 and 2014.

"(The) defendants will have a difficult burden to overcome," Jordan wrote. "If, as everyone agrees, there is speculation about what Florida will do with respect to Medicaid rates on or after January 1, 2015, and what CMS (the federal agency) will do with respect to Florida's decision, it would appear that the defendants will have a hard time showing that their eventual payment of Medicare rates to certain providers — because of a federal mandate which lasts for only two years — moots any part of this case," he said.

Doctors have long complained about the state's low payment rates. That is not the only issue in the lawsuit, which dates to 2005, but rates play an important role.

In a document filed in January, attorneys for the state argued that the Affordable Care Act gives physicians what they have wanted.

"Throughout trial, plaintiffs argued over and over that they should (have) received Medicare rates for their services,'' the document said. "This was their stated desired relief. Therefore this issue is moot."

Attorneys for the pediatric society and other plaintiffs, including children, questioned the state's commitment to paying higher rates.

"Florida has implemented the increase only to the extent required by federal law, only for so long as federal law requires the increase and only to the extent the federal government is paying 100 percent of the cost,'' the plaintiffs' attorneys wrote.