Appeals court upholds order requiring Florida to explain income-based Medicaid terminations

The 11th U.S. Circuit Court of Appeals on Nov. 4 upheld a permanent injunction that stops Florida from ending Medicaid for a class member over finances unless a written notice clearly says coverage will end, names each person affected and explains why.¹

Circuit Judge Barbara Lagoa wrote the 23-page opinion for a panel with Judges Adalberto Jordan and Robin Rosenbaum.¹²

What the injunction requires

The case covers Family-Related Medicaid, which serves groups including parents and caretakers, pregnant women, infants and children. The class is enrollees who have been or will be found over the income limit on or after March 31, 2023, and whose notices left out the income used or the standard applied.¹

For an income-based termination, the notice must give, at a minimum, the household size and countable income the state used and the eligibility category the person had been in, with the reason for any change. It must also let the person determine which categories were tested and which income limits applied.¹

The panel wrote that the injunction does not dictate how Florida designs its notices.¹

What the court found

The ruling draws on a six-day bench trial in 2024. After a pandemic-era federal enrollment requirement ended, the Department of Children and Families redetermined the eligibility of more than 4 million people between April 2023 and March 2024.¹

The panel agreed with the trial court that the notices did not clearly convey the decision, the reason or the person it applied to. It described one plaintiff’s 11-page notice with eight health-benefit sections, in which one section listed her newborn as ineligible and a later one said the baby remained eligible. The second statement matched the department’s decision, and a department call-center agent who read the notice gave the wrong answer.¹

In another case, the department used a household size of six rather than eight, which lowered the monthly income limit from $6,110 to $4,868, and counted monthly income of $6,456.99 when the family had reported $4,727.10. The notice did not show those inputs. The department later restored coverage.¹

The panel also rejected the state’s argument that other sources filled the gap. It cited April 2024 figures showing 744,000 calls, or 53.9% of those asking for a live agent, were blocked by the department without reaching a queue. The opinion notes those numbers count calls, not people. It said a supervisor’s fuller explanation came only after a person had asked for a hearing.¹

Florida argued that two earlier 11th Circuit decisions did not require individualized calculations and that the trial court went beyond the certified class claim. The panel rejected both arguments.¹

Where things stand

U.S. District Judge Marcia Morales Howard issued the ruling in January. The Florida Phoenix reported then that it ordered notices sent to roughly 500,000 people whose benefits had ended for financial reasons and who were not re-enrolled.³ Florida Health Justice, whose attorneys helped file the suit, said in an April release that the 11th Circuit had refused to put the ruling on hold.³⁴

A May 7 state filing says the state suspended income-based terminations of Family-Related Medicaid effective Feb. 23 until new notices are in place and sent corrective notices by May 1, and that the department and its IT vendor, Deloitte Consulting, will work on the new notices.⁵ The Florida Trib reported in August that about 1 million corrected notices went out.⁶

What the records do not show

• The opinion does not say how many people lost coverage in error, and it does not put a number on the class.¹
• The latest status report on the docket, filed Nov. 2, was listed without its text, so this story does not say whether new notices have started or terminations have resumed.⁷
• The records reviewed do not show whether Florida will seek further review. No state comment on the ruling was found Thursday.