By Ashley Lopez
Florida Center for Investigative Reporting
Florida is in hot water again for the way it treats medically needy children in the state.
The Miami Herald reported a federal judge last week “declared Florida’s healthcare system for needy and disabled children to be in violation of several federal laws.”
For years, child advocates in the state have been asking Florida officials to reimburse pediatricians more for health care. The state’s low Medicaid reimbursement rates have kept many doctors from taking on these patients and has kept many needy children from 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.”
…The three state agencies named in the suit authored a short statement Wednesday afternoon: “The Judge’s outdated observations pertain to a Medicaid program that no longer exists.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.
This lack of coverage affects all types of health care. For example, a 2013 study from The Pew Research Center found that Florida had the highest percent of children on Medicaid that did not receive any dental care in 2011 at 76 percent.
Experts have blamed the problem on the dwindling number of dentists in Florida who serve Medicaid patients.
According that same report, in 2010, only 15 percent of dentists in Florida even accepted Medicaid patients. Those numbers keep getting worse.
I reported back in 2013 that many experts blamed the state’s Medicaid reimbursement rates.
Frank Catalanotto, who chairs the Department of Community Dentistry and Behavioral Science at the University of Florida, said state lawmakers are to blame.
“Florida has some of the lowest Medicaid reimbursement rates in the country to dentists in the United States,” she said. “I don’t blame the dentists for this. It’s no wonder that only 8 to 10 percent of Florida dentists participate in the Medicaid program, which makes the access issue even more difficult for these patients.”
Catalanotto said this lack of access costs the state millions. He said 115,000 adults and children visited emergency rooms in 2010 for preventable dental pain and infection.
“It cost the state, either Medicaid or private insurers or self-pay, $88 million,” he said. “That’s crazy. That’s just absolutely crazy.”
Besides the cost, children are also living with dental pain and problems that could have been avoided.
And this is just one issue Florida has been criticized for when it comes to the medical needs of children.
Right after this ruling, the Herald reported that the state also got in trouble for denying psychiatric treatment to children in its care.
According to the newspaper,
A child welfare judge in Miami has accused the state of denying necessary psychiatric treatment to abused and neglected children in its care, and has ordered Florida social service administrators to appear before him and explain why they have “no duty” to help sick foster kids.
The blistering order by Miami-Dade Circuit Judge Michael Hanzman comes in the case of two siblings, identified only as L.S. and D.S, who are in the state’s care after being removed from their parents. Though Hanzman has ordered the Department of Children & Families to send the two to an in-patient mental health facility for treatment, the siblings remain without treatment.
“This court’s orders are routinely ignored, and children with severe mental health needs are denied critical care,” Hanzman wrote in the Dec. 29 order.
The judge’s order comes at a sensitive time for state healthcare and child welfare administrators: On New Year’s Eve, a federal appeals court judge in Miami released an equally scathing order saying the state had systemically, and for many years, rationed care to impoverished and disabled children insured by the Medicaid program. The failure to provide adequate healthcare to needy children, the judge wrote, violates federal law.
Furthermore, in the summer of 2013, the U.S. Department of Justice filed a lawsuit against the state of Florida in Fort Lauderdale for allegedly violating the Americans With Disabilities Act by “warehousing” hundreds of disabled children in nursing homes.