The meeting was organized by newly elected state Rep. Katie Edwards, D-Sunrise, who says she witnessed first-hand the plight of such families while volunteering at a daycare center for children with complex medical needs.
Medicaid serves 3.3 million recipients statewide, with a $21 billion budget..
In its pleading, AHCA argues the judge overstepped her authority by ordering the treatment for all disabled children — rather than just the three named in the lawsuit. Those three are now receiving behavioral therapy.
“Plaintiffs did not seek class-wide relief, the district court did not certify a class, and the case was not tried as a class action,” the state argued.
AHCA’s other objection: Because Lenard, in her order, determined that behavioral analysis is medically necessary as a treatment for children with autism — and not “experimental,” as the state had long maintained — AHCA no longer has discretion to approve the treatment on an individual basis, the state asserts.
Lenard’s ruling’s “broad and unqualified terms leave AHCA no room to determine medical necessity or to deny coverage where ABA services are medically unnecessary,” the state argues.
Critics of the Medicaid program insist such “medical necessity” determinations are used to artificially control the healthcare spigot for needy families — allowing Medicaid administrators to arbitrarily cut costs by declaring that services are not needed.
In a friend-of-the-court brief, advocates for disabled children accuse AHCA of trying to mount “serial rematches” against other disabled children.
Attorneys for autistic children say that nothing in Lenard’s order prevents the state from making medical-necessity determinations. Indeed, the lawyers say, they have already conceded the state retains that power.
“That’s a red herring,” said Miriam Harmatz, a senior attorney at Florida Legal Services in Miami, which is litigating the case. “Of course they can do that; that’s the law.”
Lawyers for autistic children also have argued that by refusing to pay for behavior therapy for impoverished children, while requiring private insurers to provide it, the state has institutionalized discrimination against poor families.
Doctors for the children, lawyers wrote in a pleading, “testified to the tragic and discriminatory consequences for their patients who rely on Medicaid. Essentially, their patients with insurance receive ABA [and] get better, while those on Medicaid do not.”
One of the three plaintiffs named in the suit, Karl Garrido, appeared to develop typically until he was a toddler. Then, he became aggressive, anti-social, and lost his ability to use words. He also stopped eating solid table food.
Karl, court records showed, exhibited “outbursts [and] extreme aggression” — kicking, hitting, biting and scratching himself, throwing things and banging his head against the wall. He also became irritable and isolated, frequently throwing tantrums.
The youngster improved, however, after just one month in a behavior analysis program, his mother, Iliana Garrido, testified as part of a four-day trial before the judge.
“I am seeing again the baby that I had, happy and smiling,” Garrido testified, “a baby that I lost.”
Though the state had insisted behavior therapy was “experimental,” agency administrators wrote an email to officials in Georgia shortly before the trial seeking help: “We have been unable to find an expert to testify on our behalf.”
The U.S. Centers for Medicare and Medicaid Services, the U.S. Surgeon General, the Centers for Disease Control and Prevention, the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the health departments of several other states all have endorsed behavior analysis as an evidence-based treatment for autism.