“Maybe we need to go back into the facilities with them and see if they still have the concerns that they allege,” she said. “It’s been very, very difficult, because they’ve given us no specifics.”

The controversy began last September when the Justice Department sent Florida a 22-page letter accusing the state of systematically dumping frail children in geriatric nursing homes, where many of them receive little education or stimulation.

More than 220 children are in such homes, the DOJ wrote, because Florida Medicaid has made a policy of cutting in-home nursing care and other services to families, making it almost impossible for them to keep their children safely at home.

The Justice Department has threatened to sue the state, claiming it is violating the civil rights of severely disabled children.

While praising the nursing homes, Dudek acknowledged that a handful of the youngsters — maybe two or three at each of the six nursing homes that accept children in Florida — could return home for care, a position that is greatly at odds with the demands of the Justice Department.

The proposed settlement, apparently dated Dec. 14, is based, it says, “on the principle that all children should have the opportunity to grow up with a family, and in a setting that fosters their development to the fullest extent possible.”

Under the proposal, Florida “must promptly develop and implement effective measures to end and prevent unnecessary institutionalization of children with disabilities, and to provide adequate and appropriate services” in community settings for parents who wish to raise their disabled children at home.

The proposal says Florida must:

•  Stop insisting that parents, siblings and grandparents be required to provide care that commonly falls upon skilled nurses, such as suctioning breathing tubes and overseeing ventilators. The Miami Herald has reported that eQHealth Solutions, a private company under contract with AHCA to review in-home nursing prescriptions, has told parents to have, in some cases, teenage siblings provide nursing care. Such extended family members “may not be compelled” to do the work of professional nurses, the DOJ wrote.

•  Rein in the activities of eQHealth, which has been accused of arbitrarily denying nursing care to families with severely disabled children. The company boasted in its annual report that it saved the state $44.8 million by reducing or denying nursing and other caregiving claims from parents trying to care for their children at home, and its associate medical director acknowledged under questioning that he never saw, examined, read the medical files or sought the records of a woefully disabled girl whose care package he reduced.

•  Consult with children’s primary doctors before cutting services for them, and provide the treating pediatricians justification “through evidence documented by the state” why their requests for care were being denied. The state also must certify that cuts to care for disabled children won’t result in the child being forced into a nursing home.

•  Stop cutting in-home nursing care when neither the child’s condition nor the parent’s ability to provide care has improved.