1. Health

Romano: State fails ill children, then fights a court order telling it to do better

Published Sep. 29, 2015

She had a house full of adopted children, and a heart full of hope.

So in 2005, Rita Gorenflo was eager to join a lawsuit accusing Florida of failing to provide children on Medicaid with proper medical care.

For nearly 10 years, the state denied, finagled and fought. Yet when the ruling finally came down last December, the judge was emphatic: Florida's neediest children were in danger, and the state was in violation of federal laws.

That was it. Victory. Salvation. Hope. Except the state refused to give in. It sought nearly $3 million in additional funding to appeal and continue fighting the ruling.

"The politicians don't listen, and they don't care," said Gorenflo, a former ER nurse from Palm Beach Gardens who has adopted seven medically needy children. "I don't know what else we can do. You can't legislate integrity."

It is a cruel hypocrisy that state leaders steadfastly refuse to provide basic care under the banner of Medicaid, and then cite those type of failures as an excuse to not expand Medicaid in connection with the Affordable Care Act.

The problem is the state provides such a low reimbursement rate that many specialists have dropped out of the program because they say they're losing money. That means chronically ill children either travel great distances or wait interminably long to get appointments with doctors.

The state has argued the judge's ruling was outdated because care has greatly improved since Florida moved to managed-care programs for medically needy children.

This would be a fine argument except the judge said there was no evidence it was true, and physicians involved in the state's Children's Medical Services concur.

More than a dozen CMS medical directors and assistant medical directors signed a letter last month complaining that the managed-care rollout hasn't worked, and the state is trying to weed out too many sick kids.

"I spend my entire day working with this nonsense, fighting to get the proper medicine and to get these kids back into the system," said Dr. Patricia Blanco, CMS medical director for Florida's southwest region. "It's just very sad. We're trying to hold this broken system together with a bunch of rubber bands.

"And the worst part is (the state is) not listening. They don't want to hear anything negative. We go to these meetings, and they talk about how well everything is working, and I look at them and think, 'Are you insane?' "

Last week, an administrative law judge directed the state to stop using a screening technique to dump chronically ill and impoverished children out of the system.

The state responded with a bureaucratic hissy fit. Officials said if the screening technique was illegal, the state would stop admitting any new kids into the system.

Since Florida officials have made it abundantly clear they are unwilling — or incapable — of fixing the problem, U.S. Rep. Kathy Castor, D-Tampa, has turned to Washington for help. Castor has written to the U.S. Department of Health and Human Services seeking intervention.

"It's inexplicable to me that, presented with the evidence from the lawsuit and the judge's ruling, the Legislature and the governor would respond by hiring more attorneys and continuing to fight this," Castor said. "It really is unconscionable."

Times researcher Caryn Baird contributed to this report.