Pediatricians say Florida hurt sick kids to help big GOP donors

......................


In the spring and summer of 2015, the state switched more than 13,000 children out of a highly respected program called Children's Medical Services, or CMS, a part of Florida Medicaid. Children on this plan have serious health problems including birth defects, heart disease, diabetes and blindness.

The state moved the children to other Medicaid insurance plans that don't specialize in caring for very sick children.

Stroud says that for her son, the consequences were devastating. Despite hours of phone calls, she says, she couldn't find surgeons on his new insurance plan willing to do the highly specialized procedures he needed. Over the next seven months, her son lost 10 pounds, quit the football team and often missed school.

"He was in pain every day," Stroud said. "I just felt so helpless. It's such a horrible feeling where you can't help your kid."

LJ filed a lawsuit against the state of Florida, and he was eventually placed back on Children's Medical Services and received the care he needed. But some Florida pediatricians worry about other children with special health care needs who, two years later, are still off the program.

The doctors aren't just worried; they're angry.

First, the data analysis the state used to justify switching the children is "inaccurate" and "bizarre," according to the researcher who wrote the software used in that analysis.

Second, the screening tool the state used to select which children would be kicked off the program has been called "completely invalid" and "a perversion of science" by top experts in children with special health care needs.

Third, in fall 2015, a state administrative law judge ruled that the Department of Health should stop using the screening tool because it was unlawful. However, even after the judge issued his decision, the department didn't automatically re-enroll the children or even reach out to the families directly to let them know that re-enrollment was a possibility.

Finally, parents and Florida pediatricians raise questions about the true reasons why Florida's Republican administration switched the children's health plans. They question whether it was to financially reward insurance companies that had donated millions of dollars to the Republican Party of Florida.

"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, former executive vice president of the Florida chapter of the American Academy of Pediatrics.

Experts outside Florida are also disturbed that the children were switched out of CMS, a program that's served as a model for other states for more than 40 years.

"CMS is well-known and well-respected," said Dr. James Perrin, professor of pediatrics at Harvard Medical School. "It's one of the earlier programs to build in assurances that these kids get the kind of care they need."

"These are the sickest and most vulnerable kids, and (changing their insurance) can mean life or death for them," said Joan Alker, executive director of the Center for Children and Families at Georgetown University. "This is really very troubling."

Dr. Rishi Agrawal, an associate professor of pediatrics at Northwestern University's Feinberg School of Medicine, agreed, adding that Florida should have more carefully considered how the insurance switch would affect the children's health care.

"The process in Florida was particularly abrupt and poorly executed," he said.

Mara Gambineri, a spokeswoman for the Florida Department of Health, said that "at no time (during the insurance switch) did children go without medically necessary services."

State officials, including a spokesman for Gov. Rick Scott's office, declined to comment directly on the pediatricians' and parents' concerns that the children might have been switched to benefit contributors to the Republican Party of Florida.

"The department's number one priority is protecting the health and well-being of all Florida residents, especially children with special health care needs," Gambineri wrote in an email. "The department remains committed to providing quality health care services to Florida's children with special health care needs."


http://www.cnn.com/2017/08/18/health/florida-sick-kids-insurance-eprise/index.html