No new kids in program for sickest, most disabled, Florida says

Dr. Louis St. Petery
Dr. Louis St. Petery

For months, state health administrators have been in a verbal brawl with a score of doctors who administer Florida’s Children’s Medical Services program for the state’s sickest and most disabled children. The doctors have accused the state of imposing a “moratorium” on the enrollment of new children into care. The state has denied it.

If there wasn’t a moratorium before, there is definitely one now.

The health department’s decision on Wednesday to — officially and for the record — cease enrolling new children to the healthcare program comes in the wake of a stunning ruling by a Florida administrative law judge late Tuesday. Judge Warren A. Schwartz has forbidden the agency from continuing to use a controversial eligibility screening tool that was purging roughly one in four youngsters from the program. The screening tool was the equivalent of a new administrative “rule,” Schwartz wrote, though it had not been formally approved by the state.

In an email Tuesday evening, Cheryl Young, the director of CMS’s Managed Care Plan, wrote that Schwartz’s ruling meant that sick and disabled children “can no longer be screened into the Children’s Medical Services (CMS) Managed Care Plan by the department.” CMS, which was once a national model, provides healthcare and medical case management to about 60,000 children with heart and kidney disease, chronic respiratory conditions, cleft palates, sickle cell disease and the virus that causes AIDS, among other maladies.

A health department spokeswoman said Tuesday the agency would “immediately” begin the process of formalizing the screening tool into an administrative rule. A public workshop on the tool is scheduled for Oct. 16.

In the meantime, Young wrote in her email, health department workers will gather demographic information about needy children and “advise the callers they will be contacted at a future date and informed of next steps in the process for clinical eligibility screening.”

Mara Gambineri, a spokeswoman for the health department, said DOH had no choice but to suspend eligibility screenings. The screening tool used by Children’s Medical Services before the program unveiled a new one last May also had never been formally approved as a rule, Gambineri said, and therefore is equally invalid.

“The tool we used before did not go through rule-making either,” Gambineri said.

In the meantime, Gambineri said, CMS administrators will be working with other state leaders to ensure that children with the most critical medical needs will be eligible for the services CMS provides.

But Louis St. Petery, a Tallahassee pediatric cardiologist who spearheaded a decade-long legal challenge to the state’s healthcare program for impoverished children, said the state had other options than simply ceasing all new enrollments. Though it may be true that the screening tool CMS discarded in May also was an unapproved rule, St. Petery said, it had never been challenged, and children’s advocates long had accepted the screener as fair.

The new tool, he said, is widely believed to have been designed specifically to screen more children “out” of the program, which is why so many doctors, parents and children’s advocates opposed it. Had the health department reverted back to a prior eligibility tool, St. Petery said, children’s advocates would have accepted its use. Moreover, he said, the judge who tossed the new tool had made no rulings about earlier versions.

“Why punish special needs children by denying them admission to the only specialty [managed care program] suitable for their problems?” St. Petery asked.