More than a decade ago, Rita Gorenflo of Palm Beach Gardens signed on as a plaintiff in the class-action lawsuit against the state of Florida on behalf of nearly two million poor and disabled children on Medicaid.
Through a lengthy Miami trial and the appeal of the judge’s scathing findings against the state, Gorenflo lost a son, while she raised six other adopted disabled children to adulthood.
Last week, the state and plaintiffs settled the class-action case with Florida agreeing to increase enrollment efforts that have left children off of Medicaid.
“It is, at least, an admission from the state that issues exist and need to be dealt with,” said Gorenflo, her son Thomas’ care becoming a prime example of the state failing disabled children.
One of the biggest victories in the multifaceted settlement is that the state agreed to increase reimbursement rates for doctors and pediatricians – one of the lowest in the country. The aim is that more doctors will now participate in the Medicaid program, increasing care and cutting travel times for families.
“It’s been 30 years since physicians were able to increase their reimbursement,” Gorenflo said. “You want to know why pediatricians were reluctant to take Medicaid patients? It was way beyond pathetic. Hopefully, it will be better.”
Gorenflo’s son, Thomas, died of his birth defects in 2011 at age 12. He became emblematic of the lawsuit. Despite his lungs being crushed by the curvature of his spine due to progressive scoliosis, the child had to wait 18 months for vital surgery while Gorenflo battled the state.
The registered nurse praised the lead attorney Stuart Singer and his firm Boies, Schiller & Flexner, which handled the case pro-bono. The case was settled after a federal judge ruled for the plaintiffs in December 2014, finding the state was low-balling doctors. Florida, however, appealed the decision.
Singer said there is a belief the state agency that administers Medicaid — the Agency for Health Care Administration — will act in good faith. “There is also the ability to go to court and seek injunctive relief if the agreement is materially breached and that is not remedied,” he told The Post.
Dr. Tommy Shechtman, president of the Florida Chapter of the American Academy of Pediatrics, noted that there is still work to be done as there are approximately 377,000 uninsured children in Florida — more than 28,600 living in Palm Beach County.
“We have the unfortunate distinction of being one of the nation’s top 20 counties for having the highest number children without health insurance,” Schechtman said. “This is alarming. However, I remain encouraged that through FCAAP’s collaboration with the state we can and will strive for significant improvement.”
Tallahassee pediatric cardiologist Louis St. Petery, who was highly involved in the lawsuit, said the effects of the settlement will take some time to implement.
“I don’t see any change in access tomorrow compared to today just because the settlement agreement is in place,” he said. “The settlement agreement meters this out over one year, two years, three years, depending on which category of physicians and dentists you’re talking about.”