After more than a year of litigation, the Florida Agency for Health Care Administration (AHCA) has settled with four Plaintiffs who challenged AHCA’s management of the Medicaid Long-Term Care (LTC) Program. As of December 1, 2016, this Program had more than 94,000 enrollees, all of whom are elderly or disabled. About half of the enrollees are in nursing homes, while the remaining half, like all of the Plaintiffs, have chosen to receive care in their homes or community rather than enter a nursing home. The Plaintiffs were represented by the Law Office of Nancy E. Wright (Lead Counsel), Disability Rights Florida, and Southern Legal Counsel.
Under the Settlement Agreement, health plans that administer Medicaid long-term care services will be “required to provide an array of home and community-based services that enable enrollees to live in the community and to avoid institutionalization.”
The Settlement Agreement also states, among other things, that AHCA will:
- Adopt rules that set out requirements for coverage of long-term care services;
- Require a new assessment procedure that takes into account the availability, willingness, and ability of voluntary caregivers;
- Amend their contract with health plans to assure compliance with these rules;
- Require changes to health plan member handbooks to clarify enrollee rights and how to file consumer complaints;
- Train (or retrain) health plans, hearing officers, AHCA staff, and others on the new requirements;
- Monitor case managers on how assessments are being done; and
- Use enrollee surveys that ask about sufficiency of services.
The agreement impacts all six health plans now operating in Florida to provide Medicaid services through the Long-Term Care Program: Coventry/Aetna, Humana, Sunshine Health, Molina, United Healthcare, and Amerigroup.