Florida Medicaid offers adult incontinence benefits after the case is settled

Two Florida nonprofits are working to spread the word that the state’s Medicaid now pays for resources for seniors who can’t afford it when needed.

The Florida Agency for Health Care Administration agreed to the change after it was accused of violating the Americans with Disabilities Act and the Medicaid Act in a 2022 class action lawsuit filed in federal court by Florida Health Justice Project and Disability Rights Florida.

Previously, the state stopped paying for incontinence supplies like adult diapers, liners and bed linens when Medicaid recipients turned 21. There were exceptions for of citizens eligible for the government’s Home and Community Services program, but has a waiting list of tens of thousands.

Families caring for children with disabilities were shocked to find they were suddenly on the line for the cost of diapers and other supplies, said Katy Debriere, legal director of the Florida Health Justice Project.

After the lawsuit was filed, Florida voluntarily changed its Medicaid laws beginning this year. As part of the settlement, it also agreed to send about 120,000 notices to recipients who would have been denied or rejected. Judge Marcia Howard upheld the decision in September.

Debriere said: “Vacation aids are a basic need for people with disabilities who are unable to control their bladder or bowels. “These devices not only prevent serious infections and destroy ulcers, but they also improve quality of life and independence. allowing people to interact with family and friends, take care of basic daily needs and contribute to society.”

The class action lawsuit was filed on behalf of all Medicaid recipients in Florida whose “incontinence supply orders have been denied or will be denied.” It named two disabled Florida women as plaintiffs. Both 22, one is quadriplegic with cerebral palsy. One has encephalopathy and epilepsy.

According to the suit, about 96 Florida residents of Medicaid age because of incontinence supplies are covered each year.

Before agreeing to the settlement, attorneys representing the Centers for Health Care Administration raised concerns about the validity of the class action lawsuit. They also argue that Medicaid provides a “level of discretion” in how they implement the program.

Florida did not cover incontinence supplies for Medicaid children until a similar case in 2009. It was filed on behalf of a 17-year-old child who, due to cerebral palsy, was unable to defend himself and could not to tell caregivers when he needs to be changed or when he has grown up. a rash. Diapers would cost his family about $200 a month at the time.

The state argued that the case was false since the child was receiving diapers from the Florida Agency for Persons with Disabilities.

Judge Alan Gold in 2010 decided that the state’s denial of Medicaid benefits is an “irreparable harm” and ordered the state to cover the cost of the supply of incapacity for at least 20 years.

Medicaid coverage for incontinence devices

Family members, caregivers and those looking for help with paying for self-care costs can go online or call Disability Rights Florida (1-800-342-0823) or the Florida Health Justice Project (1-800-HELP-FLA) .

People who have problems getting supplies can file a complaint with the Agency for Health Care Administration.