Questions Raised As Children Moved Out Of Health Program

June 9, 2015

The state last month removed about 2,000 children from a specialized program that provides services to medically fragile kids, finding that they were no longer “clinically eligible” under a new screening process.

But the move by the Department of Health to re-evaluate children in the Children’s Medical Services Network is drawing criticism from pediatricians and some children’s advocates.

Department spokeswoman Tiffany Cowie said in an email that 7,424 children enrolled in the Children’s Medical Services Network under Medicaid were re-screened between May 4 and May 20. Of those, 2,065 were found to be “not clinically eligible,” while 5,359 were found eligible and kept in the program.

Critics say they’re troubled that the department has stopped enrolling new kids in the CMS Network — except for emergency cases — during a 90-day period while the state re-screens nearly 65,000 children using a new eligibility tool that went into effect last month.

“The CMS Network has a stronger support network for the family of a child with special needs,” said Karen Woodall, director of the Florida Center for Fiscal and Economic Policy and a member of the state’s KidCare Coordinating Council. “There’s likely to be more immediate attention than you would get with a regular health-care plan.”

During the three-month re-screening period, new applicants for coverage are being enrolled in Medicaid managed-care plans, as are the children who were re-screened and found to be ineligible for the CMS Network under the new criteria.

But some say the CMS Network, which was designed for children with severe and chronic illnesses, does more to help families struggling with such challenges than Medicaid managed-care plans.

“There are severe medical needs that require children to have feeding tubes and (tracheotomy) tubes, and cause their breathing to stop on a regular, intermittent basis,” said Cindy Arenberg Seltzer, chief executive officer of the Children’s Services Council of Broward County. “There are a lot of very scary issues with which parents of all socioeconomic conditions need support.”

The Department of Health, however, “is committed to providing quality care to residents, and especially children, through a number of programs, including Children’s Medical Services,” Cowie wrote in an email.

She said all the managed-care plans serving Florida children offer “at least the same services as the CMS Network,” with the exception of a program known as Partners in Care: Together for Kids, which serves children with life-threatening illnesses.

The 90-day re-screening period will end July 31, and critics are concerned about the lack of children being enrolled during that period.

Louis St. Petery, a pediatric cardiologist and executive vice president of the Florida Pediatric Society, said the delay means that “fragile children, like HIV-exposed newborns or kids newly diagnosed with leukemia, are put at considerable increased risk. …These decisions are being made by bureaucrats with little or no understanding of caring for children with special health-care needs.”

The Department of Health disputes such criticisms. In information offered to CMS providers, it said the department is doing the mass screening because, “We want to ensure we are reaching the intended population in the most expeditious way possible. The goal will remain to provide quality care and needed care coordination services throughout this process.”

Cowie said the CMS Network’s central office received 11 requests for urgent or emergency enrollment between May 4 and May 20. The department defines emergency as “a situation where the CMSN plan is uniquely capable of covering the child’s needs.”

“One child will be reviewed with (the Agency for Health Care Administration) this week,” Cowie wrote on Thursday. “The remaining 10 children will be able to be served appropriately and will not be considered for urgent/emergency enrollment.”

She said all 10 are receiving services from Medicaid managed-care plans — and that those services are the equivalent of what they would have received through the CMS Network.

Woodall, however, said there would be more emergency requests if families knew the CMS Network was an option.

“Families may not understand that they can make a special request to be considered as an emergency case,” she said. “And that could cause a delay in the specialized care that their child might need.”

Critics focus heavily on whether children will receive the same levels of services in Medicaid managed-care plans as they would in the CMS Network.

“As the state moves more and more populations into managed care, it’s particularly high-risk for children who have chronic and serious health conditions,” said Joan Alker, executive director of the Georgetown University Health Policy Institute. “And those are exactly the kind of kids we worry about going into managed care, because it’s hard to make money on those kids.”

House Children, Families & Seniors Chairwoman Gayle Harrell, R-Stuart, said she supports moving some children with conditions such as asthma and attention-deficit disorder from the CMS Network to Medicaid managed care.

But she also said she was watching the transition “very carefully.”

“I do have some concerns to make sure only appropriate children are moved,” Harrell said. “If the (managed-care) programs can handle them, that is fine, but I do have concerns that we make sure we don’t have our critically ill children moved, and it becomes an evaluation process as to what children are appropriate.”

Senate Health and Human Services Appropriations Chairman Rene Garcia, R-Hialeah, said he and Senate President Andy Gardiner were also monitoring the changes.

“Government’s role is to help those that can’t help themselves, and who better than these children?” Garcia said. “So we’re going to continue to look at these issues and hold the Department of Health accountable.”

by Margie Menzel, The News Service of Florida

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Written by William Reynolds · Filed Under News