By summer 2015, Florida had removed 13,074 children from a specialized healthcare program that was covered under Florida’s Medicaid. The program was called Children’s Medical Services, or CMS. The plan was designed to care for children with particularly serious and urgent health problems – including, but not nearly limited to, diabetes, HIV, cystic fibrosis, asthma, and birth injuries or defects – making them the most vulnerable kids in the state.
We are now more than 2 years on and many of these vulnerable kids are still off the program. They’ve been switched to other Medicaid insurance plans, whose doctors, in some cases, refuse to risk their careers by performing the highly complicated procedures these young patients need. As described in a new CNN report, the consequences are devastating.
Other doctors are concerned and angry about the limitations put on children’s care by switching them out of CMS, which has served as a well-respected model for other states for over 40 years. But the state of Florida, in no hurry to rectify the system, seems utterly indifferent – even though changing a child’s health insurance means the difference between life and death.
Parents ‘Tricked’ by a ‘Perversion of Science’
It’s difficult to understand why on earth children would be taken off such a critical Medicaid program when no other programs in Florida specialize in pediatrics. Unfortunately, the Republican-run administration’s justifications do not clarify the matter.
The purge began with a telephone survey devised by officials at the Florida Department of Health in May 2015, which involved asking parents a seemingly simple question: “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?” For many families, the answer to this question changed everything.
Pediatric experts agree that though many children with serious and chronic medical conditions can lead relatively normal lives, this does not mitigate their need for extensive care. Yet this question, if answered “no,” was the sole basis for children losing their coverage.
“They’re the most vulnerable of our population, and that they can be booted off the plan that was designed to help them is just amazing,” said Dr. John Obi, an adjunct clinical professor of plastic surgery at the University of Florida.
The Department of Health no longer uses this terribly flawed screening process, described by experts as “duplicitous,” “a perversion of science,” “a scam job,” and “a complete dereliction of Florida’s responsibility to children,” and ruled unlawful by a state administrative law judge in 2015. However, as experts also point out, the state failed to reach out to parents about re-enrolling.
‘Bizarre’ Data Analysis Fixed against Obvious Health Needs
Rewind only a few months to December 2014, when health officials first hatched the idea of screening children off of the CMS program in a Department of Health meeting. The idea, they said, was based on new research suggesting about half of the children on the program did not qualify for coverage.
By Florida law, a child is considered to have special healthcare needs if he or she has a “chronic and serious” condition requiring care “of a type or amount beyond that which is generally required by children.”
Ignoring this, the Department of Health determined from a data analysis that too many children on CMS had lower than average health needs. Then, it turned out that the calculations used to mine that data were erroneous.
“It’s totally inaccurate,” said Todd Gilmer, co-developer of the software used for the analysis.
Meanwhile, some pediatricians who attended the meeting – and claim not only that their concerns were repeatedly ignored but that the state pressured them not to respond to media inquiries – say the discussion was fruitless. The approach, said Dr. Barbara Rumberger, a CMS regional director who attended the meeting, was more to declare “This is how we’re going to do it” rather than ask for input. The decision was already made.
Bribery and Corruption Lining Insurance Companies’ Pockets
Considering this suspicious timeline of events and that the switch to other Medicaid plans wouldn’t have saved taxpayers’ money, it’s a wonder why the state worked so quickly (and relentlessly) to implement this decision. But you need only look at the involved insurance providers for everything to click into place.
Of the 11 insurance plans to which children were switched, no fewer than 9 had donated a total of $8.6 Million to Florida Republican Party committees in the prior 5 years. It’s not unusual for national insurance companies to contribute to state political campaigns, but this is an abnormally large sum, according to research by the National Institute on Money in State Politics.
This leads experts to believe that children were switched out of the CMS only to benefit these generous contributors, who may have made these donations to sway the CMS transfer decision-making process.
“This was a way for the politicians to repay the entities that had contributed to their political campaigns and their political success, and it’s the children who suffered,” said Dr. Louis St. Petery, frequent critic of Florida’s health policy and former executive vice president of the Florida chapter of the American Academy of Pediatrics, which named him “a tireless advocate for children’s health and well-being.”
One such committee that has accepted suspicious donations in the past is Florida Governor Rick Scott’s political action committee (PAC) Let’s Get to Work. According to an investigative report published by CNN in 2016, Scott raised $4.1 Million for this initiative. $100,000 of the funding came from Tenet Healthcare, a for-profit healthcare services corporation that owned a hospital operating with inexcusably high death rates from open heart pediatric surgery. Not long after receiving this donation, Scott repealed the very state healthcare guidelines that this hospital failed to meet.
Political Agenda Gone Too Far in Harming Children?
Some children who were wrongfully taken off the CMS have managed to file lawsuits and were put back on the program. This cannot repair the damage these children suffered in the interim, though, nor the damage caused to thousands still confined to inadequate insurance plans.
“The department’s number one priority is protecting the health and well-being of all Florida residents, especially children with special healthcare needs,” said Mara Gambineri, DOH spokeswoman. “The department remains committed to providing quality healthcare services to Florida’s children with special healthcare needs.”
But the reality couldn’t be more different, according to Dr. Nancy Wright, a pediatric endocrinologist in Tallahassee. “It just comes back to money or power,” she said. “It’s not about healthcare for the children.”
What’s clear from recent decisions of Governor Scott and the Department of Health, experts argue, is their troubling alignment with the interests of big donors rather than those of critically ill children. For political reasons that have no place in healthcare, children have been forced to forgo the critical, even life-saving treatments they would have received from CMS.
Lida Sarnecky, a nurse manager at the University of Florida who cares for children with cleft lip and palate, said the situation makes her “want to puke.”
She added: “In my heart, what I want to do is go down to Governor Scott’s office and ask him, ‘What if this were your child or grandchild who couldn’t receive the care they needed? How would you feel then?’”