A trio of federal judges Wednesday grilled an attorney representing the DeSantis administration over how the state terminated people from Florida’s Medicaid program in the aftermath of the COVID-19 pandemic.
Florida was first sued three years ago over how it disenrolled people from the safety net health care program — a process known as an “unwinding” — which resulted in hundreds of thousands of people losing benefits.
After losing before a lower court, the state appealed to the U.S. Court of Appeals for the 11th Circuit, a court that Gov. Ron DeSantis has pointed out often sides with him and his Republican administration.
That may not happen in this case, as lawyers representing the state got an earful from skeptical judges, with one judge even offering the comment, “This is pretty bad.”
Andy Bardos, representing the state health care agencies that have been sued, tried to defend the state’s handling of Medicaid termination notices, arguing Florida only needed to adhere to minimum due-process requirements. Those included notice of the intended action, the date when that would occur, and a statement of the reason why.
“With nothing else?” U.S. Circuit Court Judge Adalberto Jordan asked.
“We think that’s the minimum requirement of due process,” Bardos answered.
Jordan said the state perhaps could have included additional information in the notices steering people to a website where they could input their annual salary and any other source of income, their expenses, and the number of children they have.
They could be told whether they qualify for Medicaid and, if not, how much they earned above the qualifying threshold.
But the state didn’t offer that and didn’t include the information in letters to beneficiaries.
“This is pretty bad,” Jordan said.
Skeptical judges
U.S. Circuit Court Judges Barbara Lagoa and Robin Rosenbaum also seemed skeptical.
“If you don’t tell me what the basis is of the income determination that you’ve made, what you believe is the income, then how would I know what to challenge?” Judge Barbara Lagoa asked Bardos.
Lagoa, once a DeSantis appointee to the Florida Supreme Court, said “it’s clear” Medicaid notices must provide the recipient with meaningful notice and the opportunity to be heard.
“You cannot be heard if you don’t know what you’re objecting to,” Lagoa told Bardos. “Because, by the way, I don’t think you would like a trial judge to issue an order just telling you ‘denied’ and not tell you the basis. Correct? Because you wouldn’t be able to have meaningful appellate review.”
Rosenbaum grappled with the idea that the state wouldn’t provide the information it used to determine beneficiaries were no longer eligible.
“What is the whole point of hiding this information?” she asked.
State-federal program
Medicaid is jointly administered and paid for by the state and federal governments. During the COVID-19 pandemic, the federal government increased by 6.2% its contributions. The increased funding came with the requirement states couldn’t disenroll people during the pandemic.
Congress agreed the continuous eligibility requirement would end March 31, 2023, and that, post-pandemic, states could unwind their Medicaid programs to their normal operations.
Florida started Medicaid unwinding on April 1, 2023, and by the following year the Department of Children and Families redetermined the eligibility of more than 4 million people.
Attorneys for Florida Health Justice Project and the National Health Law Program filed the lawsuit in Jacksonville in 2023 on behalf of people who erroneously lost benefits.
U.S. District Judge Monica Morales Howard agreed to certify the lawsuit as a class action in 2024 and in 2025 issued a 273-page ruling finding that termination letters issued by the state were “vague, confusing and often incorrect and misleading” in violation of federal law.
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