A federal Judge ruled this week that Florida violated the constitutional rights of hundreds of thousands of people it had removed from the Medicaid rolls following the end of the COVID public health emergency, when it sent beneficiaries “vague, confusing and often incorrect and misleading” termination letters.

In a 273-page ruling in the class action, U.S. District Judge Marcia Morales Howard ordered the state in the next two months to send appropriate Medicaid termination notices to roughly 500,000 low-income people whose benefits the state terminated for financial reasons following the pandemic and were not subsequently reenrolled in the safety-net health care program.

The notice must advise the people of the court’s ruling and, at a minimum, must include “an unambiguous statement” explaining the financial reasons behind the terminations and to whom the decision applies.

“Such notice will ensure that all Class Members have the information needed to determine whether the State’s decision to terminate their Medicaid benefits was correct,” she wrote. “Class Members who believe the State made an error may then pursue the available administrative remedies to correct that error.”

Those “remedies” include an opportunity to request an administrative appeal of their termination, which would enable someone to temporarily be reenrolled in Medicaid pending the outcome of the hearing. The notice must include information about administrative procedures permitting the payment of past medical bills if an error is found.

Howard in her ruling also barred the Department of Children and Families (DCF) — the Florida agency that determines whether people qualify for Medicaid — from terminating someone’s benefits for financial eligibility unless it provides proper notice.

At a minimum, that notice must include the enrollee’s household size, the state-determined countable household income, the eligibility category in which the enrollee had been receiving benefits, and, if it changed, the reason for the change.

DCF did not immediately comment on the ruling or whether it plans to appeal the decision.

‘Welcome news’

Center for Children and Families Executive Director Joan Alker said Thursday she still was reading the lengthy ruling but that she wasn’t surprised by the Judge’s conclusions.

Alker, who has spent more than 20 years studying Florida’s Medicaid program, said the state has a “really complicated” Medicaid eligibility system for children, which includes the optional Medicaid expansion called KidCare. The more complicated the system, she said, the more important it is for termination letters to be easily understood.

“I think it’s welcome news for families here, the Judge recognized that this was a very serious problem that families were facing,” she said. “And again, I’ll say I found the notices extremely difficult to understand and, obviously, I’m a health policy professor who’s been working on this stuff for decades.”

Medicaid is a safety net health care program jointly administered and paid for by the state and federal governments. Just under 4 million people were enrolled in Medicaid in Florida as of Nov. 30, 2025, the latest available data.

During the COVID pandemic, the federal government increased by 6.2% its contributions to the Medicaid program. The increased funding came with the caveat that states couldn’t disenroll people during the pandemic.

The policy ballooned Florida’s Medicaid caseload from 3.8 million people in March 2020, before the pandemic, to more than 5.75 million in March 2023.

Congress agreed the continuous eligibility requirement would end March 31, 2023, and that, post-pandemic, states could return their Medicaid programs to their normal operations. That process was known as Medicaid “unwinding.”

Florida started its Medicaid unwinding on April 1, 2023, and by the following year DCF redetermined the Medicaid eligibility of more than 4 million people.

Attorneys for Florida Health Justice Project and the National Health Law Program filed the lawsuit in Jacksonville in 2023 on behalf of people who erroneously lost benefits. Howard agreed to certify it as a class action in 2024.

“This ruling is a victory for the millions of Floridians who rely on Medicaid for essential health care. Medicaid agencies inevitably make mistakes when deciding eligibility. Clear, easy-to-understand notices are essential to catch and correct those mistakes before someone loses health care. The Court’s decision will ensure that Floridians have that critical protection from now on,” Sarah Grusin, senior attorney at the National Health Law Program, said in a prepared statement Thursday.

“It also underscores that states cannot shirk their constitutional obligations. Florida has known about the problems with their notices for years but has not addressed them, citing the cost and complexity of making changes to the computer system that generates notices. But as the Court emphasized, state officials cannot justify violating the constitutional rights of their citizens because they claim the fix is too expensive.”

‘Poorest of the poor’

There are two broad category groups: “SSI-Related Medicaid” for people who are aged, blind or disabled in the community, and “Family-Related Medicaid” for children, parents and other caretakers of children, pregnant women, and former foster children under the age of 26.

The lawsuit focuses on “Family Related Medicaid” beneficiaries, whom Howard described as some of the state’s “most vulnerable citizens.”

“They are primarily pregnant and postpartum women, infants, and children. And as is evident from the applicable income standards, these individuals are the poorest of the poor,” Howard said. “Prior to terminating the Medicaid benefits on which these individuals depend, the Constitution requires the State of Florida to provide them with adequate notice. The State of Florida is violating this constitutional requirement. “

Regardless of the eligibility group, residents also must meet certain income requirements, which vary by, among other things, age and household composition.

The complicated details of how household income is derived are laid out in policy manuals which, Howard noted in her ruling, are “plainly designed for internal use by those who have been taught how to use it.”

Howard’s lengthy ruling also touches on the DCF call center operations and its website.

Using April 2024 as an example, Howard noted, the call center received more than 1.9 million phone calls, of which 593,923 were resolved with an interactive voice response system through which people can self serve.

Another 1.38 million-plus callers asked to speak with an agent for a variety of reasons, including long wait times and abandoned phone calls; only 32% (444,319 callers) who requested to speak with a live agent succeeded. Upon reaching an agent, those interactions lasted for an average of nine minutes and 28 seconds, including the time the agent spent working on the case after the call ended.

Meanwhile, termination letters referred residents to the DCF website to learn more about eligibility requirements, but Howard noted in her ruling that the webpage didn’t provide all the information people needed or the links to get the information. In some instances, information on DCF’s homepage was incorrect or incomplete.

“The length of this Order might suggest that the question before the Court — whether the State’s notices are constitutionally adequate — is overly complex or a razor close call. It is neither. The length of this Order is not reflective of the complexity of the legal issue, it is reflective of the complexity and unreasonably confusing nature of the notices. It is driven by the need to address the complete inadequacy and borderline incomprehensibility of the notices and the inadequacy of the other resources identified as remedying the failure of the NOCAs (notices of case action) at issue,” she wrote.

“As detailed in this Order, the Court’s review of the evidence and the notices — their structure, the confusing, contradictory, and often misleading reasons they provide, and the lack of alternate available sources for the necessary information — inescapably leads to the conclusion that the State’s notices are fundamentally insufficient to satisfy the requirements of due process.”

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Reporting by Christine Sexton. Florida Phoenix is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Florida Phoenix maintains editorial independence. Contact Editor Michael Moline for questions: [email protected].

A former Florida Department of Transportation (FDOT) employee is suing the agency for forcing her out of her job after she complained about her hostile boss who tried to control her and made sexual remarks.

Grace Rodriguez filed the lawsuit before the new year in the U.S. District Court’s Orlando division. She accused FDOT of sexual harassment, discrimination, creating a bad working environment and retaliation.

Rodriguez’s boss, Moataz “Mo” Hassan, an Operations Engineer in Central Florida’s District 5, “frequently displayed uncontrolled rage and intimidation in the workplace, including yelling at subordinates at the top of his lungs and slamming his phone on the ground in Plaintiff’s presence,” the lawsuit said.

Rodriguez said her boss continued to get more possessive and make sexual comments the longer she worked there. What she wore became a regular topic of conversation and he got jealous when she interacted with her male coworkers, the lawsuit said.

“Throughout Plaintiff’s employment, Hassan repeatedly told Plaintiff that she was ‘his’ and that she ‘belonged to him,’” the lawsuit said. “Hassan’s statements were not benign workplace expressions but assertions of sexual dominance and ownership over a female subordinate, reinforcing his control over Plaintiff’s body, conduct, and continued employment.”

Rodriguez says Hassan told her she was not allowed to close her office door, demanding she smile and “imposed the silent treatment when Plaintiff did not comply with his expectations,” the lawsuit said.

He told her in his native country, “women are considered second class citizens,” per the lawsuit.

“In or around March 2024, Plaintiff was not feeling well and asked whether she could be sent home, Hassan told Plaintiff that she could not leave, and when Plaintiff went to leave his office Hassan aggressively grabbed Plaintiff by the arm and told her not to leave.”

The lawsuit said a month later, Hassan “initiated unsolicited discussions with Plaintiff about his sex life, stating that he had not had sex in a long time and that he was seeking a woman who would do what he told her. Plaintiff reasonably perceived these statements as sexual propositions intertwined with Hassan’s supervisory authority.”

Once, he gave her a Quran and talked regularly about his religion even though Rodriguez said she was a Christian, according to the lawsuit.

“Even where Hassan’s conduct was not explicitly sexual, it imposed expectations of submission rooted in both Plaintiff’s sex and Hassan’s articulated religious beliefs, expectations that permeated Plaintiff’s daily interactions, were reinforced through intimidation and abuse of authority, and were never checked by FDOT,” the lawsuit reads.

The lawsuit only names FDOT as a defendant, not Hassan.

Rodriguez complained to human resources after the situation with her boss kept escalating and she became fearful for her safety when he aggressively waved a shovel at her, the lawsuit said.

FDOT Human Resources Manager Marisol Bilbao told Rodriguez “that if she wanted to survive at FDOT, she needed to ‘put a smile on (her) face and shut up,’” the lawsuit alleged.

Bilbao also suggested that Rodriguez change her clothing and attitude to avoid being perceived as being the one causing problems and said “harassment works both ways,” according to the lawsuit.

Then, Rodriguez said Bilbao went directly to Hassan on May 2, 2024, and briefed him on Rodriguez’s confidential concerns about him.

“Human Resources and management repeatedly reframed Plaintiff’s complaints as interpersonal or cultural issues and failed to take corrective action, while continuing to share Plaintiff’s concerns with Hassan,” the lawsuit said. 

The next day, Hassan told Rodriguez that he no longer trusted her because he knew that she had reported him to HR. He threatened to have Rodriguez removed from her job, the lawsuit alleged.

Another manager told Rodriguez if she recanted her accusations, “her job could be salvaged,” the lawsuit added. 

Rodriguez said she received a negative performance review, which was out of place given her previous good work history. “This off-cycle evaluation was initiated only after Plaintiff engaged in protected activity and was used to generate purported performance issues where none had previously existed,” the lawsuit reads.

On June 11, 2024, Rodriguez filed an official complaint with FDOT’s Equal Opportunity Office alleging sexual harassment and retaliation.

Her days at FDOT were numbered. So were Hassan’s, according to the complaint.

Rodriguez said she was pressured to resign under threat of termination the same day she filed the complaint.

“FDOT’s internal investigation formally concluded that Hassan had not committed violations of Title VII or the Florida Civil Rights Act. Nevertheless, shortly after the conclusion of that investigation, FDOT terminated Hassan’s employment,” according to the lawsuit.

Florida Politics requested a copy of FDOT’s internal investigation into Hassan in late December, but FDOT has not responded to a records request nor a request for comment on the litigation.

Rodriguez’s attorney and Hassan also did not respond to messages for comment.