A class-action trial challenging how Florida terminates Medicaid benefits began Thursday with a Jacksonville woman testifying that she lost her health care coverage because of a process that was too vague and confusing.

If she and other plaintiffs are successful, the trial could potentially restore Medicaid to hundreds of thousands of Floridians and force a system overhaul at a potential cost of a billion dollars.

Only one of the named plaintiffs in the case, 34-year-old Kimber Taylor, took the stand at the federal courthouse in Jacksonville to open the trial on Thursday. The bench trial will continue with more witnesses beginning July 29 and will ultimately be decided by U.S. District Judge Marcia Morales Howard.

Attorneys from the National Health Law Program and the Florida Health Justice Project filed the class action lawsuit against Florida’s government in August 2023. They’re representing five named plaintiffs: two mothers and two young children who live in Jacksonville and a one-year-old child who lives in Miami-Dade County.

The case focuses on how Florida informs Medicaid recipients — or, as the plaintiffs argue, how it fails to inform them — that their benefits are being terminated based on how much money the state believes they make.

Howard’s ruling will hinge on one central question: Has Florida violated the constitutional rights of these Medicaid patients by terminating their coverage without giving them a fair notice or a chance to appeal its decisions?

Background

Taylor, her son and the other named plaintiffs represent a class of Floridians that exceeds 100,000 people and may total closer to a million people.

Specifically, the class these plaintiffs represent includes anyone Florida has cut from Medicaid since March 31, 2023, based on a claim that their income is too high. An official count of class members hasn’t yet been determined in court, but all of these members could be eligible for relief if Howard rules as the plaintiffs hope she will.

The lawsuit focuses on terminations after March 2023 when a so-called “unwinding” of Medicaid rolls began nationwide, sparked by the end of a COVID-era emergency rule that the federal government used to stop states from redetermining peoples’ eligibility for three years.

As of March, Florida had kicked people off Medicaid at the 14th-highest rate of all U.S. states since the start of the unwinding, according to a KFF compilation of the latest state-by-state data.

There were 1.3 million fewer people on Florida’s Medicaid rolls at the end of May than when the unwinding began, according to the state’s Agency for Health Care Administration.

During the three years in which it paused eligibility redeterminations, Florida didn’t fix long-known problems with its termination notices, the plaintiffs argued in their lawsuit.

“As a result,” they state in an amended complaint filed in January, Floridians “are losing Medicaid coverage without meaningful and adequate notice, leaving them unable to understand the agency’s decision, properly decide whether and how to contest their loss of Medicaid coverage, or plan for a smooth transition of coverage that minimizes disruptions in necessary care.”

The plaintiffs have asked Howard to mandate the reinstatement of Medicaid coverage for everyone removed from the program for allegedly making too much money since the unwinding began. They also want the state to stop cutting off more people until it sets up a clearer notification process that includes a proper explanation for how they can appeal their eligibility determinations.

Kimber Taylor’s testimony

Taylor first submitted a Medicaid application to Florida’s Department of Children and Families in November 2022 while pregnant with her first son. The state granted her coverage, then prompted her to file for a renewal in March 2023, according to her testimony.

On April 26, 2023, she got a notice that stated she was eligible for continued coverage and her son would be eligible upon his birth and would remain so “from June 2023 ongoing.”

Taylor and her son both met the requirements under Florida law for one year of continuous Medicaid coverage after childbirth, the plaintiffs argued in their complaint.

Taylor testified on Thursday that she informed the state she would be taking an unpaid maternity leave from the time she gave birth to her son in May until Aug. 1.

Nearly a month into that leave, on June 8, she got another notice from DCF, one that contradicted the department’s earlier message.

“I was really confused, quite set back and frustrated,” Taylor testified.

The notice said her income was too high, even though she made no money.

A separate section said, without explanation, that her Medicaid benefits would end because she was eligible for a “different Medicaid coverage group.”

It said her son, but not Taylor herself, was eligible for the Medically Needy program. It functions differently from traditional Medicaid, requiring participants to pay a share of expenses before the state covers the rest. But another section said she and her son were ineligible because “you are receiving the same type of assistance from another program.”

Taylor didn’t know what other program she purportedly was “receiving the same type of assistance from.”

One of the Medically Needy sections stated that her son alone was enrolled in this program with a share cost of $3,644 without any explanation of what a share cost was. “I assumed it was maybe an amount I couldn’t go over” in medical expenses, she testified.

The notice didn’t detail why Taylor and her son had lost the Medicaid eligibility they’d been granted a month prior. It also didn’t state the income that DCF believed Taylor had earned or how that amount was calculated.

“I didn’t really understand it” because, Taylor testified, we were “already approved for Medicaid. With him being born two months earlier, I didn’t understand.”

Her son had an upcoming doctor’s appointment and a circumcision appointment scheduled at the time. He also struggled with stomach problems that have continued and hindered his ability to walk, for which she said he remains in physical therapy.

The notice also included boilerplate language that read: “If you ask for a hearing before the effective date of this notice, your benefits may continue at the prior level until the hearing decision. You will be responsible to repay any benefits if the hearing decision is not in your favor.”

The boilerplate statement that she would be responsible to repay her benefits if she lost on appeal – which the plaintiffs argue isn’t true – discouraged Taylor from challenging her loss of Medicaid. She called DCF’s support center, and a representative simply repeated the notice’s claim that she made too much money. The representative didn’t give her specifics, such as the actual income limit she allegedly failed to meet, but implied that she would fail if she tried to appeal the termination, Taylor testified.

Out of fear of facing new debt that she wouldn’t be able to pay off, Taylor chose not to appeal. She and her son lost Medicaid coverage on June 30, 2023.

The next month, a pediatrician agreed to see her son and give him necessary vaccines even though he didn’t have health insurance, according to the plaintiffs’ complaint. “Taylor received a bill for $555.00 from that appointment,” the complaint states. She has received other bills in the time since after necessary appointments that she said she is still paying off.

Taylor reapplied for Medicaid in January of this year, which DCF approved for her and her son. She testified Thursday that, based on electronic notices she later received from DCF, she believes that her Medicaid coverage ended a week and a half ago, on June 30.

“I think the notices can be very confusing. The language can be very confusing because it says one thing and then does another,” Taylor said from the stand. “It makes people very uneasy, especially when you need services for your child.”

James Timothy Moore Jr., a GrayRobinson attorney hired to represent Florida, only briefly cross-examined Taylor.

He asked if she agreed that she didn’t read the June 2023 termination notice closely at the time, which she confirmed. On her call to DCF soon after that notice, he asked if she explicitly prompted the representative to tell her the income limits, which she did not. He asked if she followed a link for free legal services to appeal that was provided in the termination notice, which she did not.

The rest of the trial will continue in a few weeks, starting on July 29. But the court scheduled Taylor’s testimony early because she’s in late-stage pregnancy with her second child — at 38 weeks as of Thursday — out of concern that she may give birth and be unable to testify near the end of the month.

This story is published through a partnership between Jacksonville Today and The Tributary.