Judge blasts Florida for depriving children of needed healthcare

By Carol Marbin Miller

A federal judge Wednesday declared Florida’s healthcare system for needy and disabled children to be in violation of several federal laws, handing a stunning victory to doctors and children’s advocates who have fought for almost a decade to force the state to pay pediatricians enough money to ensure impoverished children can receive adequate care.

In his 153-page ruling, U.S. Circuit Judge Adalberto Jordan said lawmakers had for years set the state’s Medicaid budget at an artificially low level, causing pediatricians and other specialists for children to opt out of the insurance program for the needy. In some areas of the state, parents had to travel long distances to see specialists.

The low spending plans, which forced Medicaid providers for needy children to be paid far below what private insurers would spend — and well below what doctors were paid in the Medicare program for a more powerful group, elders — amounted to rationing of care, the order said.

“This is a great day for the children in this state,” said Dr. Louis B. St. Petery, a Tallahassee pediatrician who is executive vice president of the Florida Pediatric Society and helped spearhead the suit. “This action was taken because we found that children weren’t being treated properly if they were on Medicaid. Our position as pediatricians,” he added, “is that children do not choose their parents. They don’t have a choice to be born into a rich family or a poor family.”

“We feel all children are of equal value,” St. Petery added.

The three state agencies named in the suit authored a short statement Wednesday afternoon: “The Judge’s outdated observations pertain to a Medicaid program that no longer exists. Florida’s new Statewide Medicaid Managed Care (SMMC) program is cost-effective and a working success.” The statement was issued by the Agency for Health Care Administration, or AHCA.

The low billing rates, Jordan wrote, exacerbate a long-standing problem: There is a shortage of pediatricians overall. “The shortage gives pediatricians the ability to treat higher paying patients and either not treat, or limit, the number of Medicaid patients they do treat,” Jordan wrote. “The shortage of pediatricians in rural areas is especially acute.”

Enrollment in the Medicaid program increased from 1.2 million in 2005 to 1.7 million in 2011 — though the number of primary care doctors for children apparently has not risen at all, he added.

Among Jordan’s findings:

▪  Almost 80 percent of children enrolled in the Medicaid program “are getting no dental services at all.”

▪  By squeezing doctor payments, Florida health regulators left one-third of the state’s children on Medicaid with no preventative medical care, despite federal legal requirements — and this was true for both children paying fee-for-service or under managed care. “In addition,” Jordan wrote, “an unacceptable percentage of infants do not receive a single well-child visit in the first 18 months of their lives.”

▪  Florida health regulators sometimes switched needy children from one Medicaid provider to another “without their parents’ knowledge or consent.”

▪  The number of needy Florida children able to get a potentially life-saving blood screening for lead is “extremely low, notwithstanding the fact that part of Florida has an aging housing stock, which means children are more likely exposed to lead-based paint.”

▪  Thousands of children are “terminated” — or kicked out of — the Medicaid program each year, sometimes due to nothing more than bureaucratic error. For every budget year from 2003 to 2007, at least 25,000 youngsters below age 5 were removed from the Medicaid rolls before they had received a year of insurance. One study found that close to 30 percent of terminations or coverage denials for both children and adults “were erroneous.”

▪  The scarcity of doctors who accept Medicaid insurance in some parts of the state means “children on Medicaid have to travel to other areas of the state and/or wait for several months to obtain care.”

Some specialists received a rate increase of 24 percent for treating children on Medicaid in 2004, Jordan wrote, but that was the only fee adjustment in a decade, and it still left such specialists with reimbursements substantially below the rates for equivalent care under Medicare, the program for seniors. More here. 

The three state agencies named in the suit authored a short statement Wednesday afternoon: “The Judge’s outdated observations pertain to a Medicaid program that no longer exists. Florida’s new Statewide Medicaid Managed Care (SMMC) program is cost-effective and a working success.” The statement was issued by the Agency for Health Care Administration, or AHCA.

The low billing rates, Jordan wrote, exacerbate a long-standing problem: There is a shortage of pediatricians overall. “The shortage gives pediatricians the ability to treat higher paying patients and either not treat, or limit, the number of Medicaid patients they do treat,” Jordan wrote. “The shortage of pediatricians in rural areas is especially acute.”

Enrollment in the Medicaid program increased from 1.2 million in 2005 to 1.7 million in 2011 — though the number of primary care doctors for children apparently has not risen at all, he added.

Among Jordan’s findings:

▪  Almost 80 percent of children enrolled in the Medicaid program “are getting no dental services at all.”

▪  By squeezing doctor payments, Florida health regulators left one-third of the state’s children on Medicaid with no preventative medical care, despite federal legal requirements — and this was true for both children paying fee-for-service or under managed care. “In addition,” Jordan wrote, “an unacceptable percentage of infants do not receive a single well-child visit in the first 18 months of their lives.”

▪  Florida health regulators sometimes switched needy children from one Medicaid provider to another “without their parents’ knowledge or consent.”

▪  The number of needy Florida children able to get a potentially life-saving blood screening for lead is “extremely low, notwithstanding the fact that part of Florida has an aging housing stock, which means children are more likely exposed to lead-based paint.”

▪  Thousands of children are “terminated” — or kicked out of — the Medicaid program each year, sometimes due to nothing more than bureaucratic error. For every budget year from 2003 to 2007, at least 25,000 youngsters below age 5 were removed from the Medicaid rolls before they had received a year of insurance. One study found that close to 30 percent of terminations or coverage denials for both children and adults “were erroneous.”

▪  The scarcity of doctors who accept Medicaid insurance in some parts of the state means “children on Medicaid have to travel to other areas of the state and/or wait for several months to obtain care.”

Some specialists received a rate increase of 24 percent for treating children on Medicaid in 2004, Jordan wrote, but that was the only fee adjustment in a decade, and it still left such specialists with reimbursements substantially below the rates for equivalent care under Medicare, the program for seniors. More here.