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Florida Fourth DCA clarifies due process requirements for notification to Medicaid recipient of State Medicaid Fair Hearing on denial of Medicaid services

On March 27, 2019, in A.W v. Humana Medicaid Plan, No. 4D18-866, the Florida Fourth DCA reversed a final order of the Agency for Health Care Administration (“AHCA”) that dismissed the plaintiff’s administrative appeal of a denial of outpatient services. The plaintiff had administratively appealed the defendant’s determination that her request for outpatient services was not medically necessary.  When her appeal was denied, she was provided with notice of her right to request a State Medicaid Fair Hearing.  The plaintiff requested the hearing by telephone, but the subsequent notice of hearing allegedly was sent to her via email only.  After she failed to appear at the hearing and her appeal was dismissed, the plaintiff claimed that she had never received the e-mail. The Fourth DCA noted that the Florida Administrative Code requires service by mail unless a Medicaid recipient specifically elects service by e-mail.  See Fla. Admin. Code R. 59G-1.100 (2018). In this case, the plaintiff had allegedly provided her e-mail address during the phone conversation in which she requested the hearing, but the Fourth DCA concluded that the initial phone call to the AHCA did not constitute an “election” of e-mail service contemplated by Rule 59G1.100(5).

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