Jacksonville Federal Court Forces Florida to Fix Medicaid Notices After Years of Complaints

A federal judge sitting in Jacksonville's Bryan Simpson U.S. Courthouse has forced Florida to overhaul its Medicaid termination notices after finding the state sent constitutionally deficient letters to hundreds of thousands of low-income residents, many of whom lost health coverage without understanding why.

U.S. District Judge Marcia Morales Howard ruled in January 2026 that Florida's notices were so confusing and vague that they violated due process rights, barring the state from terminating anyone else over income until it fixed the system. Within months of that order, the Department of Children and Families and the Agency for Health Care Administration sent nearly 1 million corrected notices by spring — a timeline that raised questions about why the state spent years claiming such fixes would be difficult and expensive.

What the court found

Judge Morales Howard's January 6, 2026 ruling followed a class-action lawsuit filed in August 2023 by the Florida Health Justice Project and the National Health Law Program on behalf of nearly 500,000 people enrolled in family-related Medicaid — children, pregnant women, and parents or caretakers of minors who were cut off for income reasons but received notices that didn't explain how the state calculated their household earnings.

The letters, the judge 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." Families frequently couldn't tell who in the household had been terminated, what information the state used to make the determination, or how to appeal, according to the ruling.

The court found the state had known since at least 2018 that its notices were inadequate. Morales Howard also cited problems with the state's call center, where confused Medicaid recipients turned for help but encountered outdated technology that blocked hundreds of thousands of calls.

The ruling barred Florida from terminating anyone else over income until its notices met constitutional standards — a pause DCF told the court took effect February 23, 2026. The injunction also required corrective notices to people already cut off, explaining the household size and income used to determine eligibility, a link to a clear explanation of income limits, and information on how to appeal.

How Northeast Florida families lost coverage

The termination wave began after March 31, 2023, when a federal law that kept people enrolled in Medicaid during the Covid-19 pandemic ended. A 2020 provision had given states billions of dollars nationally to maintain coverage even for recipients who might otherwise have been removed from the rolls. Once that deal expired, Florida began rechecking eligibility and sent hundreds of thousands of termination notices, many citing income as the reason.

For Jacksonville-area families, the consequences were immediate and concrete. Amy LeBlanc's 11-year-old daughter Adelynne, who has cerebral palsy, asthma, sleep apnea and other conditions, sees as many as ten specialists at Nemours Children's Hospital in Jacksonville, sometimes several times a month. When LeBlanc received the first termination notice in 2024, it never mentioned income as the reason for the cutoff.

A corrective notice sent this year listed the monthly income figure the state used — $3,727.75 — along with household size, but still didn't explain how Florida arrived at that number. LeBlanc says the state omitted deductions her family is entitled to because of her husband's gig work driving for Amazon and Doordash. A year later, Adelynne still has no Medicaid coverage. LeBlanc is paying $256 a month for a private plan, plus copays for specialist visits that can number five a month, and has stopped the physical and occupational therapy her daughter once received because she can no longer afford it.

South Florida resident Maria Joseph, a hospice nurse pregnant with her fourth child, received an eight-page notice as late as January 2, 2026 — four days before the judge's ruling — that 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, but the only indication was a single line buried in another section. She missed a scheduled ultrasound while waiting for her pregnancy Medicaid to be reinstated.

What corrective notices revealed about the system

By May 1, DCF and AHCA had sent roughly 1 million corrective notices, though the actual number of people affected is lower because the state often sends duplicates within a household, according to Lynn Hearn, legal director of the Florida Health Justice Project. How many people requested hearings and how many regained coverage remains unclear; the state is expected to provide a status report in August.

The speed of the corrective notice rollout — accomplished within months of the court order — raised questions about the state's long-standing position that fixing the underlying system would be complex and costly. "If they could generate the corrective notices with relative speed," Hearn said, "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 given earlier in the litigation, that repair could come any day now. Multiple systems interact to generate the notices, and the state told the court that rewriting them is complex.

DCF's own witnesses testified during the case that they couldn't consistently interpret the letters. The court heard that software problems had wrongly stripped some new mothers of postpartum benefits they were legally entitled to receive. Hearn said there was no indication during litigation that DCF conducts regular audits or post-determination reviews that would show how often its eligibility decisions are incorrect.

Impact on low-income health care access across the region

The constitutionally deficient notices created a cascading effect on health care access for low-income families throughout Northeast Florida and statewide. When people couldn't understand why they lost coverage or how to appeal, many went without care or delayed treatment. The flawed system also overwhelmed the state's call center, where people trying to get answers were frequently blocked from reaching anyone who could help.

Advocates say the problem extended beyond the nearly 500,000 people in the lawsuit's class. Federal class action rules forced the plaintiffs to narrow their case to family-related Medicaid recipients terminated for income reasons, but Hearn said flawed letters were sent to groups in other Medicaid categories as well. "The truth is that all Medicaid enrollees were receiving constitutionally deficient notices," she said.

For families, the stakes are immediate. Medicaid provides health coverage to low-income children, pregnant women, parents, elderly adults, and people with disabilities. In Florida, income limits for family-related Medicaid are among the most restrictive in the nation. When people lose coverage because they can't understand or respond to a notice, they face the choice of going without care or paying for private insurance that often costs hundreds of dollars monthly, plus copays and deductibles that can run into thousands of dollars annually.

The financial burden on the state of complying with the injunction — continuing to cover people whose benefits would otherwise have been cut off — gives Florida incentive to fix the system quickly, Hearn noted. "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," she said.

What happens next in the federal case

Florida is continuing to fight the ruling even as it carries out much of what Judge Morales Howard ordered. The state filed an appeal, and oral arguments before the appellate court are set for August 2026. In court filings, state lawyers have argued that the injunction is financially burdensome and "problematic" because Florida must keep covering people whose benefits it otherwise would have cut off.

The state acknowledged in those same filings that once the systems are permanently fixed, Florida will be able to resume what Hearn called "the ordinary course of terminations." Hearn said that for the most part, she is seeing state compliance with the injunction in terms of no terminations of family-related Medicaid due to income since February, but some errors are still slipping through. Some of the Florida Health Justice Project's clients are still losing access to pregnancy Medicaid before the end of their full 12 months of continuous coverage that federal law requires.

The Department of Children and Families did not respond to multiple requests for comment. The Agency for Health Care Administration deferred questions to DCF. How many people have regained coverage through the corrective notice process, how many requested hearings, and how often those hearings result in reinstatement are questions that remain unanswered pending the state's August status report to the court.

Hearn describes the court-ordered notice changes as one of few bright spots in what she calls an otherwise grim picture of health care access for low-income Floridians. She 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. "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."

The Jacksonville federal courthouse ruling highlights a broader challenge facing Florida as population growth strains public services. As families move to Northeast Florida seeking affordability and opportunity, access to health care for low-income residents — including the clarity of communications from state agencies — becomes part of the infrastructure that determines whether growth is sustainable and equitable. The question of whether Florida will permanently fix a system it managed to patch in months under court order now moves to the appellate level, with statewide implications for hundreds of thousands of residents who depend on Medicaid for basic health care access.