1. Opinion

Editorial: Saving money by hurting sick kids

The state of Florida should not balance its budget on the backs of sick children. But that is exactly what state health officials have done since May, when they kicked about 9,000 children out of a health care program by using a deceptive screening tool.
Published Dec. 11, 2015

The state of Florida should not balance its budget on the backs of sick children. But that is exactly what state health officials have done since May, when they kicked about 9,000 children out of a health care program by using a deceptive screening tool. Department of Health officials should reinstate eligible children immediately. It is unconscionable that the state would abandon some of its most vulnerable residents to cut costs.

Children's Medical Services is a state-funded collection of programs for children with special needs from low-income families. Typically, children became eligible for the services through Medicaid or Kidcare, a low-cost health insurance program. According to a recent report in the Miami Herald, CMS was essentially a victim of its own success. The program's Medicaid claims grew by nearly $100 million from 2010 to 2014, from $713.3 to $811.1 million. To control costs, lawmakers in 2011 changed CMS from a fee-for-service plan, in which insurers paid doctors for treating sick children, into state-run managed care, where a predetermined pot of money was divided by insurers.

In May, Health Department officials determined that they could cut costs and comply with state law by eliminating children from CMS. The department introduced a screening tool that included a trick question about participating children's limitations. Many parents' hopeful answers for their children's future or their belief the question referred only to life-threatening injuries resulted in an answer of "no." The state responded by booting them from the program, a callous move that even some of the Johns Hopkins University doctors who created the questions say violates their original intent.

Tallahassee's Reema Shabaneh's two children were kicked out of CMS. The children, 6 and 9, are nearly blind and have severe retinal detachment. Other children ejected from the program include some with HIV/AIDS, severe facial deformities and patients with liver transplants who will need anti-rejection drugs for life. In all, about 9,000 children lost the state aid. Shabaneh's children were reinstated after she sued the state with the help of a law clinic at Florida State University. Good for them. But who will stand up for the others?

The Health Department denies it has intentionally used the screening tool or other means to save money by reducing access to health care for sick children from poor families, but the results are clear. An administrative law judge ruled the Health Department could not use the screening tool without adopting it through a rulemaking process, and the state has been working on a revised screen and expects to reopen the program next month. The department needs to figure out which children are truly eligible for CMS programs, but it shouldn't use trickery to do it.

It is bad enough that the state turned its back on sick kids who have no other reasonable options for specialized care. But what's worse is the state is resorting to such unconscionable measures at a time when Florida is enjoying a modest budget surplus. Gov. Rick Scott is asking lawmakers for $1 billion in tax cuts that primarily benefit businesses while the state scrimps on health care to poor and needy families.

Senate President Andy Gardiner, R-Orlando, has a son with Down syndrome and is a longtime advocate for children with special needs. He has asked the state to explain its actions. While we wait for an answer, lawmakers should find a way to restore CMS's funding and revisit the 2011 law that changed its payment structure. Keeping Floridians healthy, especially its neediest children, is a responsibility the state should honor rather than shirk in the name of dollars and cents.


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