Judge Approves Settlement in Medicaid Class Action Over Incontinence Supplies

A federal judge on Tuesday agreed to settle a class action lawsuit that requires Florida’s Medicaid program to provide incontinence pads to adults with disabilities.

U.S. District Judge Patricia Barksdale issued a six-page order approving the settlement reached by attorneys for the state Agency for Health Care Administration, two women with disabilities and the advocacy group Disability Rights Florida.

The settlement had been in the works for more than a year, with the Agency for Health Care Administration going through a rulemaking process to provide adults with “medically necessary” incontinence supplies, court documents show.

“Through the proposed settlement, plaintiffs will receive the relief for which they sued,” Barksdale wrote in Tuesday’s order. “Without a settlement, litigation will resume with its attendant costs, delays, and risks. The proposed method of providing relief to the class is effective; specifically, the normal process for obtaining Medicaid benefits and providing provider and plan notices of the policy change.”

A joint motion filed on January 17 requesting a preliminary investigation into the proposed settlement noted that the Agency for Health Care Administration had adopted a final rule on the provision of incontinence supplies in December.

“In short, AHCA (the agency) intends to amend all AHCA policies, fee schedules, and administrative rules as necessary … to provide coverage for incontinence supplies,” the joint motion states. “If the rulemaking process and AHCA’s amendment of all policies, fee schedules, and administrative rules result in coverage for incontinence supplies, the parties agree that they will file a joint motion to voluntarily dismiss this lawsuit, and, upon order of the court, AHCA will pay plaintiffs $50,000 in full satisfaction of attorneys’ fees and costs.”

Barksdale on Tuesday ordered the agency to pay $50,000 in attorney fees to the plaintiffs by Oct. 3 and said the parties must file a joint motion to dismiss the case by Sept. 10.

The lawsuit, filed in July 2022, alleged that the Medicaid program violated federal law by denying coverage for incontinence supplies to adults with disabilities. The lawsuit was filed on behalf of Duval County resident Blanca Meza and St. Johns County resident Destiny Belanger, who are incontinent and unable to care for themselves, with Disability Rights Florida also listed as a plaintiff.

U.S. District Judge Marcia Morales Howard certified the case as a class action in March 2023. Morales Howard’s decision cited an estimate that at least 480 Medicaid beneficiaries each year turn 21 and lose coverage for incontinence supplies they received as children. The state has provided the supplies, such as briefs, diapers and underpads, to Medicaid beneficiaries under 21 and to certain adults, including people in nursing homes.

The lawsuit alleged that the state’s policy of not providing incontinence pads to other adults violated federal Medicaid law and laws including the Americans with Disabilities Act. It said the state stopped providing the supplies to Meza and Belanger after they turned 21, even though they were incontinent and unable to care for themselves.

As an example of their disabilities, the lawsuit states that Meza “has been diagnosed with spastic quadriplegic cerebral palsy, muscle spasticity, neuromuscular scoliosis, and partial epilepsy.”

“Plaintiffs are medically vulnerable adults with bladder and bowel incontinence,” the lawsuit states. “As low-income Florida residents with significant disabilities, they receive their health care through Florida’s Medicaid program. Plaintiffs’ physicians have prescribed certain incontinence supplies, including briefs and pads, as medically necessary to treat Plaintiffs’ incontinence, keep their skin dry and clean, prevent skin breakdown and infection, and maintain their ability to live in the community.”