State records suggest the cuts are targeted at families with the greatest need. In 2011, the percentage of Medicaid recipients who got an average of 16 hours or more per-day of nursing care dropped from 23.percent to 19.6 percent. The percentage that received an average of 12 hours or more per day declined from 37.7 percent to 33 percent.

As part of a federal lawsuit, Juliet Duncan, nursing director at Broward Children’s Center, a home health service for 18 families in South Florida, wrote in a declaration that she had “seen AHCA routinely and consistently reduce or deny home care services and private duty nursing to all of our children.”

“These reductions are made when there is no change in the child’s medical condition. In fact, in many instances, the children’s conditions have worsened or their families’ condition has changed. Many parents have had to terminate employment to care for these children when private duty nursing hours are reduced or denied,” Duncan wrote.

Dudek told lawmakers Florida was in full compliance with a federal law, called the 1987 Nursing Home Reform Act, designed to protect against inappropriate institutionalization by requiring the state to medically evaluate every child before he or she is sent to a nursing home. But the state’s records show that, among 575 children whose cases were provided to a civil rights attorney suing the state , nearly half have had not been evaluated for nursing home diversion.

At the committee meeting, Dudek also touted proposals by Gov. Rick Scott’s assisted living facility workgroup and told lawmakers she would bring them proposals to streamline regulations for the ALF industry and increase credentialing requirements for administrators.

Scott formed the workgroup in response to a two-year Miami Herald series that exposed systemic abuse and neglect for elderly and disabled people in ALFs. Critics accused Scott of stacking the panel with industry representatives, and said several of the proposals would deliver breaks to the powerful ALF industry.

“Let’s focus on the poor-performing providers to bring them up or get them out of the system,” she said.