Pediatricians claim thousands of critically-ill children are being deprived of life-saving healthcare after the state moved them onto a different plan that doesn’t cover their specialized procedures.
In the spring and summer of 2015, the Florida Department of Health switched the healthcare plan of more than 13,000 children with long-term health problems to something their doctors don’t accept.
These children were taken off out of a highly respected program called Children’s Medical Services, a part of Florida Medicaid.
The Florida DOH is being slammed for the change, with many claiming these children are now unable to receive treatment for conditions such as diabetes, heart disease, and HIV.
Children were switched after a survey concluded they do not need specialized healthcare because they are not limited by disability.
Some doctors have even gone so far as to call that justification a ‘perversion of science.’
In the spring and summer of 2015 the state switched more than 13,000 children with serious health problems out of a highly respected program called Children’s Medical Services (stock image)
One in five of the children who had CMS were moved to another Medicaid insurance plan that doesn’t specialize in serving children with long-term healthcare needs, meaning the doctors can’t serve them.
The Florida DOH justified the switch based on a telephone survey issued to the guardians of these children that asked them whether or not the child was limited in the ability of what they could do.
And Mara Gambineri, a spokeswoman for the Florida DOH told CNN that ‘at no time did children go without medically necessary services’.
She said the DOH’s top priority is ‘protecting the health and well-being of all Florida residents, especially children with special healthcare needs.’
But multiple experts said the question doesn’t adequately determine if children need the extensive and specialized healthcare plans covered under CMS.
These are the sickest and most vulnerable kids, and [changing their insurance] can mean life or death for them
Joan Alker, Georgetown University
The question asked parents and guardians, ‘Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do?’
Often these children have diseases that don’t limit what they can do – they can still go to school, they can play with their friends, and they can engage in other activities common of people their age.
The question lead to many children being disqualified even they do require extensive and specialized medical care.
In fact many parents were able to answer no to the question because of the services that CMS provides, which allow their children to live a relatively normal life.
And some Florida doctors are angry and worried about the children that were taken off of their insurance plan.
‘These are the sickest and most vulnerable kids, and [changing their insurance] can mean life or death for them,’ Joan Alker, executive director for the Center for Children and Families at Georgetown University told CNN, explaining she found the news to be ‘troubling.’
Stephen Bloomberg, the associate director for Science at the National Center for Heath Statistics explained that the question was worded in a way that purposely disqualified children who have the medical needs from a program that was specifically designed to help them.
‘You would get false negative,’ Bloomberg told CNN. ‘Your conclusion would be that a child does not have special healthcare needs when, in fact, he does.’
He explained often children with diseases like cleft lip and palate, HIV and diabetes can do the things other children do, but still require special medical attention.
Some of the parents of these children were able to sue the state and have their child put back on CMS, but not all had that ability or knew it was an option.
In fall 2015 an administrative judge in the state ruled the DOH should stop using the screening method, calling it unlawful.
But following that decision the department didn’t automatically re-enroll the children who were kicked off CMS or tell their families that re-enrollment was an option.
Two years later, many children are still without the healthcare they require.
Following the controversial decision parents and Florida doctors have raised questions about the motivation behind the government-run department switching the healthcare plans in the first place.
Some have said it was to financially reward insurance companies that donated millions to the Republican Party of Florida, who are currently the majority.
‘This was a way for the politicians to repay the entities that contributed to their political campaigns and heir political success, and it’s the children who suffered,’ Dr Louis St Petery, former executive vice president of the Florida chapter of the American Academy of Pediatrics told CNN.