Florida ignores ruling on kids’ care
Judge: About one-third of kids on Medicaid not getting preventive care.
Rita Gorenflo of Palm Beach Gardens a decade ago lent her name to a class-action lawsuit claiming the state failed an estimated 1.9 million poor and special-needs children in providing them mandated medical care through Medicaid.
The impetus for Gorenflo was the suffering of her adopted children — especially Thomas, whose spine was so curved by progressive scoliosis, his lungs were being crushed. Yet, he had to wait 18 months for vital surgery as she battled the state.
Today, Thomas is no longer alive, succumbing to his birth defects in 2011 at age 12. But Florida is still fighting the lawsuit despite a federal judge’s long-awaited findings in December that the state was in violation of federal law.
“It makes absolutely no sense,” Gorenflo said. “Yet, you know the state is going to delay any way it can. This just boils down to money and the fact that children do not vote.”
So as the state Legislature meets in a special session this month to hammer out a budget centered on expanding Medicaid to encompass adults without health insurance, advocates for poor and disabled children will head back to court once again to fight for declaratory judgment and injunctive relief that would
force the state to address the problem.
“Hundreds of thousands of Florida children are still not receiving preventive health care screening. They are not receiving prompt access to specialty care when needed,” said Fort Lauderdale attorney Stuart Singer, representing the plaintiffs with Boies, Schiller & Flexner, which took on the case pro bono.
Judge Adalberto Jordan of the 11th U.S. Circuit Court of Appeal presided over the case when he was a federal trial court judge in Miami but refused to give it up when he was promoted to the appellate court. He issued a scathing 153-page findings of fact, finding the state low-balled pediatricians and children’s health specialists, resulting in doctors opting out of the insurance program for the needy.
“Approximately onethird of Florida children on Medicaid are not receiving the preventive medical care they are supposed to receive,” Jordan wrote.
The Agency for Health Care Administration, the Department of Health and the Department of Children and Families are trying to persuade Jordan not to issue a declarato- ry judgment that would force the state to make changes. It said the findings by Jordan made in December are moot.
“While the mere passage of time might not render the record in this case stale, numerous significant changes in the Florida Medicaid program have done so,” wrote Stephanie Daniel, the chief assistant attorney general.
The state argues that since the trial phase closed three years ago, all but a very small number of Medicaid recipients now receive their services through managed medical assistance plans. As a result, AHCA significantly has changed its oversight, monitoring and compliance that were at the heart of the complaint filed by parents and their supporters along with the Florida Pediatric Association and Florida Academy of Pediatric Dentistry.
Doctors testified during the 94 days of a fractured bench trial — held when Jordan had time on his docket over several years — that they couldn’t even break even with what the state reimbursed them with Medicaid, which is partly financed by the federal government.
As a result, parents in rural areas had to travel hundreds of miles to take their children to specialists. Dentists willing to take the Medicaid reimbursement were equally hard to find, with Florida ranking dead last among all 50 states with 79 percent of children enrolled in Medicaid getting no preventive services as required by federal law.
The plaintiffs argued that the state, by virtue of taking Medicaid reimbursements from the federal government, didn’t have the power to nickle and dime doctors. It was required, attorneys argued, to adequately pay doctors to provide care for needy children.
Singer said legislative committees have estimated it would take $200 million to $250 million to bring the reimbursement rate for physicians and dentists to adequate levels. At trial, his team presented to Jordan evidence that when the federal government temporarily increased Medicaid money, Florida decreased its contribution.
“The state can easily fix this,” he said. “You would have more doctors and dentists able to participate.”
In April, Singer told Jordan that nothing has changed. The state’s solution to move all children into managed care organizations does nothing to solve the doctor reimbursement crisis that still leaves a scarcit y of specialists, excessive wait times and travel distances and lack of dental care.
And Jordan concluded children were still falling through the cracks under the state’s managed care solution, adding that most infants from poor families did not receive one checkup during the first 18 months of their lives.
The state witnesses indicated in declarations after trial that assessing whether the managed care program had solved the problem would not be known until July 2016.
Dr. Jonathan Phillips, a pediatric orthopedist in Orlando, is one of several physicians and dentists who gave sworn statements in April contradicting the state’s position that poor children are receiving adequate medical care.
“Often by the time they reach me, such children have gone days or a week or more without the care they need,” he wrote. “They were unable to find an orthopedist near where they live who was willing to accept Medicaid. This delay sometimes results in more complications and a greater risk of permanent injury.”
He said a boy with a broken elbow came to see him so late that the bones had nearly healed in the wrong position.
Gorenflo saw her son Thomas’ spine get worse to the point that even surgery could not straighten it completely. Now the four special needs children she cares for are reaching adulthood and the lawsuit will become moot for her.
And the lawsuit Gorenflo helped launch has long outlived her son.
“Hopefully, some place along the way it will make a difference for some kids,” she said.