JACKSONVILLE, Fla. – Valuable services for children with disabilities are on the chopping block, affecting thousands of Florida's children on Medicaid.
The state health department's Children's Medical Services program, which provides coordinated care for children with "chronic and serious" medical conditions, has been transitioning to a new plan to cut healthcare spending. But the move has a lot of people upset.
Many say a new tool that determines eligibility for special needs care is leaving children without services they need.
Since May, when a new eligibility screening process went into effect, 9,000 children have been dropped from the program.
“Most of those children that were in the Pedicare Children's Medical Services program have since been removed -- many of them suddenly, most of them without any warning to families or any warning to us,” said Amy Buggle, executive director of DLC Nurse & Learn.
In September, an administrative law judge found that the department had been using the screening tool without first holding a rule-making process. The screenings stopped in late September, and rule-making began.
The department on Tuesday filed a new rule for the eligibility screening process, which will go into effect Jan. 11, spokeswoman Mara Gambineri said. That's when the state health department will resume screening and enrolling children in the program.
The dispute springs from the state's transition to Medicaid managed care, which was completed last year. Under the new system, the Children's Medical Services Network became a "specialty plan" serving Medicaid beneficiaries. In May, when its eligibility screening tool was introduced, it consisted of a five-question survey taken by parents over the phone. Critics said the questions were confusing, especially to non-English speakers. But no input from physicians or other medical professionals was allowed.
Now, parents and providers are pushing back for the sake of the children, like 3-year-old Ayden Walker, a boisterous, spunky, curious boy who has a condition that affects the movement in one of his legs.
His parents sent him to DLC Nurse & Learn, a school for children with disabilities, where a therapist works to combat the problems the disease causes.
But her services have now been cut, thanks to the state of Florida.
“We cannot afford to pay therapists,” Buggle said.
She said state health officials are cutting costs with their new screening tool, and many children, like Ayden, aren't making the cut.
The new screening process means DLC, which operates on grants and insurance reimbursement, is no longer getting paid for one-on-one treatments, like speech and physical therapy.
“The children are losing valuable, precious time. We all know that from birth to 3 -- there have been so many studies done -- that is when the majority of our brain develops,” Buggle said. “So if we are not treating these children as aggressively as we can from birth to 3, they are losing skills that they may never gain.”
The Department of Health contends that special-needs kids receive the same care whether they're in the Children's Medical Services program or were referred to Medicaid managed-care plans, but critics dispute that.
“We are just all waiting for Medicaid to get these issues resolved so that we can start treating these children again,” Buggle said. “And while we are waiting the children are losing out.”
DOH spokeswoman Mara Gambineri said in a statement that he department held several public meetings to receive input from parents, pediatricians, caregivers and other interested parties before filing the new rule for the clinical eligibility screening tool.
“The proposed rule, developed in partnership with the CMS regional medical directors, includes a two-part approach to clinical eligibility screening -- a physician-based, auto-eligibility process using diagnostic codes for chronic and serious conditions and a parent-based survey to ensure that all financially eligible children with special health care needs are given the option to enroll in the CMS Plan,” the statement said. “The department remains committed to serving Florida's children with special health care needs.”
The DOH has set up a hotline for parents with questions or concerns about their children's eligibility. It's staffed by nurses Monday through Friday from 8 a.m. to 5:30 p.m. The hotline number is 855-901-5390.
News Service of Florida reporter Margie Menzel contributed to this report.