Medicaid providers ask circuit court to protect them from $15 minimum wage-related lawsuits

Florida losing lawsuits (Large)
Medicaid-contracted providers not paying their direct care staff $15 an hour can get sued beginning Jan. 1, 2023.

Three Florida health care organizations and a Largo-based provider sued the state on Tuesday, arguing that state legislators illegally opened them up to class-action lawsuits if they fail to pay employees at least $15 an hour as required in the new state budget.

The lawsuit, filed in circuit court in Leon County, asks a judge to issue a temporary injunction and block the enforcement provision from taking effect. The main argument is that the Republican-controlled Legislature “logrolled” substantive issues in the annual budget, which is supposed to be limited to just budgetary matters.

The groups that filed the lawsuit against the state and the Agency for Health Care Administration (AHCA) include the Florida Ambulance and Florida Assisted Living associations, Home Care Association of Florida and assisted living facility Heather Haven III.

The legal action targets language included in several areas of the Fiscal Year 2022-23 budget that impacts health care providers participating in the Medicaid managed care and Medicaid fee-for-service delivery systems. That language states that any employee who does not get paid $15 an hour can sue starting in January. The budget language allows employees to file class-action lawsuits.

Florida’s minimum wage currently is $10 an hour and will increase to $11 on Sept. 30. The wage will continue to increase annually by $1 until 2026 when it reaches $15 an hour. No other employer in the state can be sued for failing to pay an employee $15 per hour.

Attorneys for the plaintiffs also argue lawmakers may not have included enough money in the budget to cover the $15 wage mandate and that the risk of lawsuits could have health care providers withdrawing from the Medicaid program.

“Such an injunction will … prevent the Plaintiffs’ members and other Medicaid providers from facing the potentially crippling legal liability of class action lawsuits associated with increased pay for “direct care employees,” Tallahassee lawyer William Dean Hall III wrote in a Sept. 27 court filing.

“Ensuring that the plaintiffs Members and other Medicaid providers can reasonably continue to provide care to Floridians on Medicaid will ensure continued access to quality care for such citizens going forward.” 

In addition to the temporary injunction, the plaintiffs also are seeking declaratory relief, noting that “an actual controversy has arisen and now exists between Plaintiffs and the Defendants regarding whether the Challenged Sections are unconstitutional,” Hall wrote.

“The Plaintiffs require a judicial determination of their rights and duties in this area, specifically regarding whether the Challenged Sections amount to improper substantive lawmaking in an appropriations bill.”

Florida Politics reported the Florida Assisted Living Association sent a letter to Gov. Ron DeSantis imploring him to intervene on their behalf as the Oct. 1 minimum wage deadline for direct care providers inches closer. The Home Care Association of Florida followed with its own letter asking DeSantis to delay the $15 minimum wage requirement.

The associations noted that while they will be required to pay their direct care staff $15 an hour effective Oct. 1, the Medicaid managed care companies have not increased their reimbursement rates to offset the increased salary costs.

AHCA did not immediately respond to Florida Politics’ request for comment.

Christine Jordan Sexton

Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.


8 comments

  • Patricia Pearson

    September 27, 2022 at 3:41 pm

    $15 an hour at 168 hours a week = $2,520 a week which equals $10,080 a month. That does not include what people paying for food utilities all the taxes all the cleaning products and all the stuff that we asked to provide for these residents and we’re only bringing in 13,000 a month is the governor going to give us some money

  • Harsh Truths

    September 27, 2022 at 6:09 pm

    Just use tipping.

  • Dale

    September 28, 2022 at 10:36 am

    The employees deserve to make a fair wage. I have no problem paying $15 per hour. My issue is the increased reimbursement from the managed care companies and the state. Wages requirements increased 33%, but the increase is less than half that. Increase the funding, don’t surpress the wages. Governor is talking about $1 billion in tax relief next year while underfunding Medicaid and expecting small businesses to cover it. Not far.

  • Adis Perez

    September 28, 2022 at 11:17 am

    Far beyond increasing minimum wages to $15 per hour is the issue that only increasing 15% of current rate taking $16 dollars an hour as the minimum actually reimbursement that will represent an increase of approximately $2.48, which is much less than what we have to increase to employees if we were paying $11-12 per hour that represents $3.00. -$4.00), this will cause many agencies to close their doors, not to say that most MCO’s are taking advantage of the “retroactive payment” and are promising to amend contracts by at least January 2023, and then they pay retrospectively, that will be a disaster. On the other hand there are many home health aides asking for more money other wise they will request their patient to ask the case managers from the plan to transfer our patients to other home health agencies which are already proposing to Home Health aides that if they bring their patients they will pay them $16-17 per hour, and of course, these vulnerable patients will follow their aides, and will tell the case manager that the agency is terrible with the services and that is their right to chose the provider, when in reality all the services they received from the provider is from the aide that is taking them somewhere else. This business have become a joke, a Circus, we have no power, and if Home Health/Home Care providers don’t get together, this will not change, it will only get worse, we will continue to see less money as the government continues to cut reimbursement for Medicaid and Medicare recipients, while inflation continues to rise, and while giving the reins of our business to last link in the chain, the home health aides, they run our businesses.

    • Jhon Doe

      September 28, 2022 at 12:31 pm

      The Law does not apply to Home and Community Based services. If you look at the General appropriations act (Florida’s Budget) http://laws.flrules.org/2022/156 on page 72 you will see that under “Medicaid Long Term Care” there is the “special category” of ASSISTIVE CARE SERVICES for which they are mandating the $15 minimum wage. Then look at the next “special category” of “HOME AND COMMUNITY BASED SERVICES” and there is no requirement under that special category, it goes on to the next “special category” INTERMEDIATE CARE FACILITIES/
      INTELLECTUALLY DISABLED – SUNLAND CENTER
      FROM MEDICAL CARE TRUST FUND for which there is no requirement and then the next one INTERMEDIATE CARE FACILITIES/
      DEVELOPMENTALLY DISABLED COMMUNITY for which there is a $15/hourly minimum wage requirement.

      Furthermore, if you go to the questions and answers page https://ahca.myflorida.com/Medicaid/Finance/finance/enh_wage/ew_faq.shtml
      go to General question #1 and then follow the link to the fee schedule. Once on the fee schedule listing look for Home Health Services and click on the updated fee schedule. You will see that there are no LTC home and community based CPT codes there. If you go the “personal care services” fee schedule you will not find any LTC home and community based CPT codes either.

      in Terms of Home Health Care they are only mandating the minimum wage to home health aide services (and nursing if they make less than $15/hr) being provided to Original Medicaid, APD, MMA, and CMS members.

  • Xiomara lugo

    September 28, 2022 at 1:15 pm

    The increase made to the home health providers is a joke. When the providers have the overhead of rent fees, permit fees, license fees, supplies and etc!
    Im not against the increase of $15 but it needs to be beneficial for the providers as well. Right now the providers are at loss while the aides will be taking up the profit.
    Home Health Agencies are a pro-profit organization. Many providers will close because of the awful increase of $2 or $3 increase of the mco’s addendum contract of rates
    This is a disgrace to the providers who have the overhead of expenses
    While medicare and Medicaid are paying less for reimbursement

  • Xiomara lugo

    September 28, 2022 at 1:25 pm

    And adding to my earlier comment

    The new way of billing Medicaid thru hhaexchange and net smart is another huge problem. Many claims don’t get paid , many claims don’t get exported
    This is a huge problem
    Less money coming in for services provided
    It’s a whole mess!!
    The system before billing the healthplan directly was better , no problems
    Why change a system when it wasn’t broken or had any failures.
    But now with this system of hhaexchange and netsmart it’s a disaster to the providers.
    Instead of making things easier , things have been made difficult.
    When we the providers have a overload of work flow
    Things needs to run smooth so money flows in smoothly and we can move forward with the increase of minimum wage !!

    I ask someone (politician) please look into this complexity of billing, exporting and reimbursements
    There has to be a easier flowing way so business money can flow in easier

  • Bobbie Adams

    October 5, 2022 at 5:14 pm

    Has there been any movement on this issue?
    For quite of few of us ALF owners, this will put us out of business.
    It’s a shame that we’ve worked so hard for over 40 years and this will be the straw that broke the camel’s back and closes our doors.

Comments are closed.


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