1. Florida Politics

Senate chief wants 'full briefing' on cuts in care for sick, disabled kids

Published Dec. 9, 2015

The leader of the Florida Senate has asked state health administrators to explain recent changes to a health care program for sick and disabled children that purged thousands of kids from enrollment, saying he'd like to ensure that the state is "doing the right thing."

In a two-part series this week, the Miami Herald reported that the state Department of Health launched a "restructuring" of the Children's Medical Services program that resulted in about 9,000 children being dropped from the plan, and other children losing access to specialized clinics for kids with disfiguring cleft lips and palates. Two of 10 cleft palate clinics were shuttered, though one is expected to reopen this week, a year after the clinic's director began pleading with the state for permission to restaff it.

"We want a full briefing on that," Senate President Andy Gardiner told reporters. "That certainly would not be the scenario that I would want to see when I leave," he added, referring to the reduction of services for the state's sickest children. "Are we doing the right thing? It's always good to look at these programs, but you've got to make sure that …we're doing the right thing."

Referring to the series, Gardiner said: "You all do a good job covering these things, but there's always more to the story, and we specifically asked about that."

In a meeting with reporters Tuesday, Gov. Rick Scott denied that any children were being hurt by the recent changes to CMS, a program within the Department of Health that serves children with chronic medical conditions and disabilities. "There will be absolutely no interruption of service," Scott said. "What [the Agency for Health Care Administration] has been doing, I think, is good for those who need service in our state, but I can tell you there will be absolutely no interruption of service."

While AHCA does not administer Children's Medical Services, it does oversee Medicaid, the state's insurance program for impoverished families. AHCA sets the rates by which doctors who participate in the program are paid, and critics — along with a Miami federal judge — have charged the reimbursement rates are so low that they discourage doctors from accepting Medicaid patients, including kids served by CMS.

In an email that was sent to other media, though, apparently, not the Herald newsroom, health administrators denied much of what was published.

"The department is committed to ensuring that children with serious and chronic medical conditions in need of health care services receive them," the health department's communications office said.

"We care about all of Florida's children, particularly children and families dealing with serious and chronic medical conditions," said State Surgeon General and Secretary of Health Dr. John Armstrong. "Every child is precious, and we work every day to help children reach their full potentials through health. Our Children's Medical Services Managed Care Plan ensures that Florida's medically fragile children receive the health and developmental services that they need to fulfill their unique abilities."

Cuts to the health care program, though, are becoming a political issue. U.S. Rep. Kathy Castor, a Tampa Democrat, has tweeted out several statements in recent days, saying "cruel cuts to special needs kids must be stopped," and adding: "Florida is better than this!" On Sunday, Castor tweeted a link to one of the Herald's stories, referring to the CMS changes as an "unconscionable war on Florida's children with special needs."

State Rep. Jose Javier Rodriguez, a Miami Democrat, said it appeared the Scott administration was seeking to "cut the budget on the backs of very sick, poor people." The cost of indigent health care, he added, "is part of the equation. But cost is the only thing the administration cares about. It does seem heartless."

On Tuesday morning, the health department held a "workshop," or hearing, on a CMS eligibility screening tool, which a judge declared invalid in September because it had not been formally passed as an agency rule. Jennifer Tschetter, the health department's chief operating officer, said the agency plans to allow some children automatic entry into CMS if their doctors attest that their ailments are included among "certain conditions that warrant automatic eligibility."

"The inclusion code was simple," she said. "The condition had to be both chronic and severe."

A Tallahassee diabetes specialist, however, chided the health department in a letter for not including diabetes for automatic eligibility, though it is considered so dangerous to a child's health that the U.S. Social Security Administration automatically considers certain diabetic children to qualify for disability payments. "Diabetes in children is a life-threatening diagnosis," Larry C. Deeb wrote in a letter that was read to the panel. Failing to properly manage the disease, he added, can lead to "blindness, dialysis and amputations."

Children with diabetes cast out of CMS, Deeb wrote, are moved into Medicaid managed care plans that "offer no support, and, indeed, only deny services I request for the children."

One of Deeb's patients, a 6-year-old Tallahassee girl, was "dropped by CMS," her mother said, because the mom incorrectly answered the five-question screener the health department is working to implement. "We've struggled with receiving pump supplies [and] we just received [testing] strips" months after the girl was dropped," the mom, Charmin Pafford, wrote in an email, portions of which were read aloud. "All because my child isn't considered as sick as another."

The "inclusion codes" that allow some kids automatic access to CMS also don't mention autism, said state Sen. Eleanor Sobel, a Hollywood Democrat who is vice chair of the chamber's Health Policy Committee. Autism, which the Centers for Disease Control and Prevention says can affect one in 68 children, is a developmental disability that can lead to speech and language impairments, as well as cognitive deficits. "I was shocked that autism was left out," Sobel said. "That just blows my mind."

Sobel said she is sponsoring a bill to widen access to the CMS program by including a broader range of illnesses and disabilities, but has yet to find a House sponsor.

Laura Brennaman, a registered nurse who spoke to the panel on behalf of several children's and medical advocacy groups, including the Children's Movement of Florida, urged the health department to reinstate all 9,000 children who had been removed from the CMS program as a result of the screener. She also urged the agency to ensure children have "affordable health care" and access to a medical system that is "not predicated on limiting services to save the state money."

Times/Herald Tallahassee Bureau reporter Kristen Clark contributed to this report.