Already facing sharp criticism over policies that have resulted in the rationing of care to severely disabled children, Florida healthcare regulators are challenging a federal judge’s order that the state provide a costly — but potentially life-changing — treatment to children with autism.
Last spring, U.S. District Judge Joan Lenard struck down the state’s refusal to pay for applied behavior analysis (ABA) for autistic children, calling the state’s policy “arbitrary, capricious and unreasonable.”
The court case involved three autistic youngsters — then-5-year-old K.G., 2-year-old I.G. and 4-year-old C.C. — whose efforts to obtain behavioral therapy had been denied by the state’s Medicaid insurance program for needy and disabled people. Lenard ordered that the three children be given the care they sought — and that the state provide such care to other autistic children, as well.
The state Agency for Health Care Administration has appealed the order, and, in a pleading submitted in November, argued that the ruling strips the state of its ability to weigh requests for the therapy on a case-by-case basis to ensure the treatments are “medically necessary.”
“There is no evidentiary support for the district court’s conclusion that [behavior analysis] services are medically necessary for all autistic Medicaid recipients under 21,” the brief said. “In fact, the evidence established that ABA treatment is not medically necessary, or even effective, in all cases. Some children do not respond to ABA treatment at all, and, in all other cases, the efficacy of ABA treatment diminishes rapidly after early age.”
Autism, typically diagnosed around age 2, is one of the most common developmental disabilities, afflicting about one in 88 children, according to the U.S. Centers for Disease Control and Prevention.
The neurological disorder often affects a child’s ability to speak, learn and interact with others.
In her March order, Lenard described as “outrageous” AHCA’s position that the behavioral therapy is not widely accepted by experts in the field. Though AHCA had for years refused to pay for the treatment for impoverished families, state law already requires commercial carriers to provide it to Floridians with private insurance — meaning children from poor families were being denied services to which more-affluent families had access.
Behavioral analysis is designed to improve the behavior, language and cognitive development of autistic children so they can lead more-normal lives.
“It is imperative,” the Miami judge wrote, “that autistic children in Florida receive [behavior therapy] immediately to prevent irreversible harm to these children’s health and development.”
Florida’s system of care for disabled and medically fragile children has generated significant controversy in recent months.
In September, the U.S. Justice Department accused the state of systematically cutting in-home nursing care for disabled children, resulting in hundreds of youngsters being warehoused in geriatric nursing homes.
On Monday, about nine state lawmakers will attend a “town hall” meeting in Sunrise to hear from families that have complained that AHCA and a sister department, the Agency for Persons with Disabilities, have so poorly funded services for disabled children that they feel they are being forced to institutionalize their loved ones.