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IU Northwest professor serves as nationally recognized expert witness in Medicaid cases

Professor Samuel Flint, associate director for the School of Public and Environmental Affairs, teaches health administration


Professor Samuel Flint, associate director for the School of Public and Environmental Affairs, teaches health administration and is also a nationally recognized expert witness in Medicaid cases.

IU Northwest File Photo
Professor Samuel Flint, associate director for the School of Public and Environmental Affairs, teaches health administration and is also a nationally recognized expert witness in Medicaid cases.

Balance is key to Dr. Samuel Flint’s life. He works hard to find equilibrium between serving as the associate director for the School of Public and Environmental Affairs (SPEA), teaching classes in health policy and management, and researching, preparing and presenting as a plaintiffs’ expert witness on behalf of Medicaid beneficiaries in federal court cases.

And, while balance is important to his own life, Dr. Flint also diligently works to ensure that equity, balance and fairness are present throughout the fifty state programs that make up the national Medicaid program.

Since joining IU Northwest in 2005, Flint has had several opportunities to use his advocacy research expertise in federal court. His experience stems from years of involvement in the public health policy realm including several years serving as the associate executive director for the American Academy of Pediatrics.

“To date, I have worked on nine Medicaid cases in four states - Florida, Illinois, New York and Oklahoma - with eight different public interest, legal services and private law firms,” Flint said. “The work that I’ve done has affected one-sixth of the U.S. population.”

Medicaid began in 1965 and since its inception it has sought to provide prompt access to medical care for those most in need: low-income children and families, seniors, and the disabled. The national health program was created to help the poor finance their medical expenses.

Expertise put to use

Flint’s expertise focuses on the rights of Medicaid-enrolled children to access health care services as equals with privately insured children and the costs associated with delivering this care.

Flint spent three days in August on the witness stand on a Medicaid lawsuit in Florida in which the equal-access issue was central to the case. (Florida Pediatric Society et al. v. Agwunobi, et al….No 05-23037CIV, Southern District of Florida).

“Currently, this particular case is the largest class-action lawsuit going on in the United States, with respect to the number of people involved in the class,” Flint said. “In Florida, Medicaid serves 1.6 million annually.” 

Flint, a health economist, was tasked with researching whether the state pays its physicians, who care for Medicaid beneficiaries, sufficiently to ensure there is no discrimination against children based on their health insurance status. 

One of the key questions was, “Are the same doors open for Medicaid beneficiaries as they are for privately insured children?” Flint said.

Flint testified to the centrality of Medicaid fees as the prime determinant in whether a physician would participate in Medicaid, and the extent of their participation.

“I did an analysis that demonstrated that Florida’s Medicaid program is the fifth-worst paying state in the country,” he said. “The state pays roughly 60 percent of what the federal Medicare program pays for the same services delivered in the same settings, and pays even less than that compared to private insurance.”

Since physician participation in Medicaid is not mandatory, the program must be appealing enough to enlist sufficient providers to offer care or else the state is out of compliance with federal law.

The Florida case is currently in trial. Flint expects to return to testify as a rebuttal witness in the near future to critique the report of the defense’s experts.

Another victory

Once decided, Flint is hopeful the Florida case will lead to another victory. So far, he holds a most impressive track record: undefeated.

“There have been rulings in seven of the nine cases in which I’ve served as expert witness,” Flint said. “And, all seven have been decided in favor of the plaintiffs.”

Flint said he takes great personal satisfaction from this type of advocacy work.

“Expert testimony has a clear, powerful and direct impact on the outcome of these cases,” he said. “It’s very gratifying to use social science methodologies in court, and be able to clarify issues for the judge with hard data.”

Off to New York

Flint is already looking forward to his next opportunity. He has been asked to serve in a case in the state of New York. In this suit, the state’s Medicaid program is resisting moving patients with mental disabilities from institutional settings to small-group homes. New York alleges that doing so would generate costs that would fundamentally alter its Medicaid program.

“In September, I will see the state’s defense expert’s report and then I will evaluate their cost projections,” Flint said. “My role as the rebuttal witness will be to challenge the projected costs and offer alternative expenditure estimates.”  

When asked Flint what he thinks the outcome will be, he stated, “I’m not sure; we will see. But I was involved in a similar case in Illinois (Radaszewski), and I successfully demonstrated to the court that the state’s estimated Medicaid cost for ADA (Americans with Disabilities Act) compliance was actually between zero and $6.5 million, hardly an unreasonable burden.”

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School of Public and Environmental Affairs