This story was originally published by the Florida Trib.

For years, Florida’s lawyers told a federal judge that fixing its Medicaid termination notices — letters the court found so confusing they violated the Constitution — would be difficult and costly. But within months of a court order requiring the fix, the Department of Children and Families and the Agency for Health Care Administration, agencies that determine and issue eligibility, were able to send out nearly 1 million corrected notices by the spring.

How they managed to do it so quickly is now its own question.

“If they could generate the corrective notices with relative speed,” said Lynn Hearn, legal director of the Florida Health Justice Project, which sued the state over the notices, “why couldn’t that coding or technology also be used to fix the notices on a more permanent basis?”

The underlying system, managed under a state contract with Deloitte Consulting, still hasn’t been permanently repaired; by the state’s own four- to six-month estimate, that repair could come any day now. Florida, meanwhile, is still appealing the ruling that forced the change even as it gets closer to meeting the terms of the court order.

AHCA deferred questions from The Florida Trib to DCF, which did not respond to multiple requests for comment.

A 2020 federal law gave states billions of dollars nationally to keep people enrolled in Medicaid coverage during the Covid-19 public health emergency, even recipients who might have otherwise been booted off the rolls. After that deal ended on March 31, 2023, Florida, like other states, began rechecking eligibility requirements, and sent out hundreds of thousands of termination notices, many on the basis of income.

Those letters, mailed by the Department of Children and Families, were so vague and disorganized that families frequently couldn’t tell who in the household had been terminated or what information the state had used to make the determination, said U.S. District Judge Marcia Morales Howard in a federal ruling issued on Jan. 6.

The notices, she wrote, “can be described in many ways—confusing, vague, convoluted, antiquated, contradictory, inaccurate, and ambiguous—but they are unequivocally not an objectively reasonable form of notice.”

The court found the state had known since at least 2018 that its notices were inadequate, leaving low-income people unable to tell whether they’d been wrongfully dropped from coverage or how to appeal. Morales Howard also said the state’s call center, where confused Medicaid recipients turned, was saddled with outdated technology and blocked hundreds of thousands of calls.

“For years, even before Medicaid redetermination, advocates warned that the notices were confusing and people were losing coverage just because they couldn’t understand what they were getting in the mail,” said Erica Li, a policy analyst at the Florida Policy Institute.

In August 2023 Hearn’s organization, along with the National Health Law Program, filed a class-action lawsuit on behalf of people enrolled in “family-related Medicaid” — children, pregnant women, and parents or caretakers of minors who were found ineligible because their income exceeded the state’s limit and then received notices that didn’t explain how the state reached that figure. That class included nearly 500,000 people.

Hearn said flawed letters were sent to groups in other Medicaid categories as well, but federal class action rules forced them to narrow the case. “The truth is that all Medicaid enrollees were receiving constitutionally deficient notices,” she said.

Morales Howard agreed that Florida’s notices violated due process, but ordered a narrower remedy than plaintiffs sought, declining to automatically reinstate all terminations in the class since the lawsuit was filed.

Instead, the ruling barred the state from terminating anyone else over income until its notices met constitutional standards. DCF told the court it paused those terminations as of Feb. 23, 2026.

The injunction also required the state to send “corrective notices” to people already cut off, explaining why and on what basis; the household size and income used to determine eligibility; a link to a clear explanation of income limits; and a pathway to appeal case by case.

Letters still stress and confuse

The corrective notices were supposed to answer those questions.

Amy LeBlanc’s corrected Medicaid termination from the state met the requirements Morales Howard ordered, but it remained a dizzying and confusing document.

Her daughter Adelynne, 11, has cerebral palsy, asthma, sleep apnea and a range of other conditions that send her to as many as ten specialists at Nemours Children’s Hospital in Jacksonville, sometimes several times a month. When LeBlanc received the first notice in 2024 terminating Adelynne’s coverage, she assumed she’d done something wrong. The letter didn’t say otherwise — it never mentioned income.

A corrective notice, sent this year, listed the figure the state used to find the family over the limit — $3,727.75 a month — along with the household size and coverage group the ruling now requires notices to include.

What it still didn’t explain was how the state arrived at that number. LeBlanc says the state omitted deductions she later found her family is entitled to because of her husband’s gig work driving for Amazon and Doordash.

“I didn’t know I was supposed to give it,” she said. Her calls with a DCF agent, she added, left her stressed and confused.

A year later, Adelynne still has no Medicaid coverage.

LeBlanc is paying $256 a month for a private plan, along with copays for specialists visits that can number five a month. She’s stopped the physical and occupational therapy her daughter once received for free because she can no longer afford it. Her credit card, she said, is more than $1,000 deep from premiums alone while she waits for a hearing with the state.

Florida continues to fight ruling

By May 1, DCF and AHCA had sent roughly 1 million corrective notices — though the real number of people is far lower, Hearn said, because the state often sends duplicates within a household.

How many asked for hearings, and how many got coverage back, remains unclear. The state is expected to provide a status report in August.

The state’s lawyers have framed the injunction as financially burdensome. In court filings, they argued that pausing income-based terminations for family-related Medicaid enrollees would be expensive and “problematic,” because the state must keep covering people whose benefits it otherwise would have cut off.

“The injunction prohibits the termination of coverage,” Hearn said. “So they’re providing Medicaid coverage for tens of thousands of individuals a day that they would have otherwise terminated coverage for.”

But the same filings acknowledge that once the systems are fixed, Florida will be able to resume what Hearn called “the ordinary course of terminations.” The state has every reason to move quickly, she said, and its ability to produce 1 million corrective notices by May 1 suggests it can.

“From a financial perspective, it is advantageous to the state, to say nothing of the other benefits of reduced confusion, reduced call volume, reduced inquiries, reduced churn,” Hearn said.

Multiple systems interact to generate the notices, and the state told the court that rewriting them is complex. DCF’s own witnesses testified they couldn’t consistently interpret the letters and that software problems had wrongly stripped some new mothers of benefits they were owed postpartum.

Florida is continuing to fight the ruling in court, even as it carries out much of what Morales Howard ordered. The case is now before an appellate court, with oral arguments set for August.

Long-running problem

In the meantime, Hearn said some of FHJP’s clients are still losing access to “pregnancy Medicaid” before the end of their full 12 months of continuous coverage.

“For the most part, I am seeing state compliance with the injunction in terms of no terminations of family-related Medicaid due to income since February,” she said. “But we are still seeing some errors slip through.”

Maria Joseph’s case shows how long the problem has persisted. As late as Jan. 2 — four days before the ruling — the Homestead-based hospice nurse, pregnant with her fourth child, received an eight-page notice that denied food assistance, enrolled her family in a program with a $9,198 monthly share of cost, and assigned her unborn baby a Medicaid number.

Her own coverage was ending too, but the only indication was a single line buried in another section: “Maria Joseph Ineligible,” although it’s not clear in the letter what Joseph was ineligible for.

“I realized when my midwife told me ‘Hey, you’re not covered’ that I did not have Medicaid anymore,” Joseph said, adding that she was forced to miss a scheduled ultrasound while she waited for her pregnancy Medicaid to be reinstated.

Hearn’s office has been able to fix those mistakes when people find their way to them, she said, “but it would be so much better to resolve this on a systemic basis.”

Yet during litigation, she said, there was no sign that DCF conducts regular audits or post-determination reviews that would show how often its eligibility decisions are wrong.

All of this is unfolding against a broader backdrop of growing coverage gaps in Florida. Hearn said she is hearing from more families whose children are losing Medicaid and who can’t afford marketplace plans once they are deemed over-income.

In that context, she describes the court-ordered notice changes as one of the few bright spots.

“This is something good the state can do for Floridians,” Hearn said. “It’s unfortunate that a court had to order the state to do it, but regardless, it’s a very, very good news story for Floridians on Medicaid in an otherwise very grim picture of health care for consumers.”

Sharmila Venkatasubban is The Trib’s senior editor and health reporter. You can reach her at sharmila.venkatasubban@floridatrib.org.