Miami-Dade County

Agency seeks funds to fight ruling that slams state for depriving needy kids of healthcare

Gov. Rick Scott’s health care agency is asking for up to $2.7 million in additional funds to hire private lawyers to fight a judge’s ruling that the state has systematically deprived children on Medicaid of needed health and dental care.

U.S. Circuit Judge Adalberto Jordan ruled last week that Florida’s healthcare system for needy and disabled children was in violation of several federal laws because the state has chronically underfunded the state’s Medicaid program and improperly dropped children from the program.

A 2015 budget request from the Agency for Health Care Administration states that because Jordan plans a second trial to determine what the state must do to remedy its treatment of impoverished children, the state must hire lawyers to assist the attorney general in fighting to inject more money into the troubled system.

The low-reimbursement rates discouraged pediatricians and other specialists from taking needy children as clients, the judge concluded, essentially leading to a rationing of care.

Justin Senior, the state Medicaid director at the Agency for Health Care Administration, told the Senate Health and Human Services Appropriations Subcommittee on Wednesday that the state disagrees with the ruling, which came nearly a decade after a group of pediatricians first filed the 2005 lawsuit , and considers it moot.

Senior said Jordan’s ruling was an outdated because Florida has transformed Medicaid to a managed care-based program that provides incentives for quality care and accessible services.

“Everything around the program has changed,’’ Senior said. “Whether you agree with what the judge said or not, the ruling that came out involved a program that doesn’t exist anymore.”

He noted that the current system requires 95 percent of the Medicaid physicians to accept new patients, punishes doctors who don’t adhere to the requirement, is on a path to raise doctors fees in two years, offers lucrative incentives to doctors who meet quality performance measures and is reforming the marketplace.

Tallahassee physician Louis B. St. Petery, executive vice president of the Florida Chapter of the American Academy of Pediatrics, which brought the lawsuit, said that while the Medicaid changes look good on paper they have resulted in less — not more — access to care for needy children.

“From on the ground, those of us who are actually taking care of children on Medicaid, it really doesn’t work exactly like that,’’ St. Petery told the committee.

He said that too often children lose eligibility for the program before they should, denying them basic preventative care and as well as essential specialty care. He also said that the changes also haven’t stopped children from being switched form one provider to another without their parents consent, throwing already vulnerable families in confusion.

He challenged Senior’s statements that managed-care system will lead to fee increases for physicians, saying the fee hikes are not required and there are few sanctions for HMOs that don’t raise fees.

“These kids need care in a timely manner and it’s not happening,’’ he said. Low payments have long been a major issue in Medicaid, with many doctors saying it doesn’t make financial sense to care for Medicaid patients.

Senior did not mention that the agency is asking lawmakers for $2.7 million to finance the fight, as well as to defend the agency against other litigation in the 2015-16 budget year, but a document obtained by the Herald/Times details that request.

“Maintaining current resources is imperative and the AHCA would like to continue to address these matters with a combination of current [Office of General Counsel] legal staff, private law firms, [temporary] personnel as well as the Attorney General’s Office,’’ the request states.

The agency budget request was submitted to Gov. Rick Scott who will make his budget recommendation later this month. It does not appear to include the additional $200 million lawyers for the plaintiffs say it could cost the state to bring the program up the judge’s standards.

St. Petery also told lawmakers that AHCA officials “hide behind the lawsuit” and refused to meet with pediatricians to discuss their concerns and ideas for improving the new system.

Sen. Rene Garcia, R-Hialeah, chairman of the committee, defended the agency’s decision not to meet with pediatricians while the legal battle continues.

“I don’t blame the agency for not wanting to meet or rejecting these meetings until that litigation has been resolved,’’ Garcia said.

But St. Petery said after the meeting that he doesn’t buy that argument. “Either they want to do the right thing for kids, or they don’t,’’ he said. “It appears they don’t.”

Mary Ellen Klas can be reached at meklas @MiamiHerald.com and @MaryEllenKlas

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