(Note: Photo not of the actual clients.)
The Players Center for Child Health referred “Calvin” to JALA through the Northeast Florida Medical Legal Partnership (NFMLP) after a lapse in the Medicaid benefits of his medically fragile son, “Andy.” The Players Center had reestablished Andy’s Medicaid by helping the family with a recertification application.
However, his plan unlawfully disenrolled him and, after recertification, he was switched into Fee-For-Service Medicaid. His home nursing agency said he had to get back into his managed care plan immediately or they would have to stop providing services. Calvin re-enrolled Andy in his original health plan but was told the change would not take effect for two months, putting Andy’s home-health services at risk.
Upon referral, the NFMLP filed a grievance with the health plan and a complaint with the Agency for Healthcare Administration (AHCA) and then contacted the agency’s general counsel directly about the issue. Within the matter of a few days, the health plan agreed to AHCA’s request for retroactive enrollment on the plan. Andy was placed back on his original health plan immediately, and his home-health services continued without interruption.
In addition, the NFMLP attorney worked with AHCA to implement a rule change that would make such transitions among plans happen faster when “immediate risk of permanent damage to the enrollee’s health is alleged.”
(Note: Photo not of the actual clients.)
