Florida DOH removed 13,000 children from Medicaid health care plan in 2015

Pediatricians claim more than 13,000 ill children in Florida have been deprived of essential treatment after the state moved them onto a different healthcare plan that doesn’t cover their procedures.

During the spring and summer of 2015, the Florida Department of Health changed the healthcare plan of over 13,000 children with long-term health conditions to another plan that most doctors don’t accept.

Image credit: Simone D. McCourtie / World Bank / Burness

The healthcare plan from which the children were taken off is called Children’s Medical Services, a part of Florida Medicaid. The program particularly focuses on children with long-term ailments.

Over 13,000 children were taken off specialized health care plan in Florida

The Florida Department of Health has been heavily criticized for the decision, as many children are now unable to receive treatment for conditions such as heart disease, diabetes, and HIV. WGBO talked to a mother whose son, LJ, had a tooth emerge on the roof of his mouth. LJ was born with severe cleft lip and palate, so her mother arranged for surgery to remove the tooth. However, days before the procedure, the surgeon’s office called her to cancel it, as LJ had been moved out of the health care plan that covered such a procedure.

These children were moved off their healthcare plan because a Florida DOH survey concluded they do not need specialized health care, as allegedly they are not limited by disability. The study involved Florida DOH representatives telephoning the guardians of the children to ask them whether they thought their child was restricted in the ability of what they could do. Some pediatricians even referred to that reason as a “perversion of science.”

Many children are now unable to receive treatment for conditions such as heart disease, diabetes, and HIV. Image credit: Sebastian Rose / Getty Images / NPR
Many children are now unable to receive treatment for conditions such as heart disease, diabetes, and HIV. Image credit: Sebastian Rose / Getty Images / NPR

One in five of the children who had CMS were moved to another insurance plan that doesn’t specialize in treating kids with long-term health care needs, which means the doctors can’t treat them.

Mara Gambineri, a spokeswoman for the Florida DOH, told CNN that at no time “did children go without medically necessary services.” She stressed the DOH’s top priority was to protect the health and well-being of all Florida residents, particularly children with special health care needs.

DOH spokeswoman says children taken off CMS can be rescreened

However, despite Gambineri’s remarks, several experts believe the survey question doesn’t adequately assess if children need the specialized health care plans covered under CMS. The study asked parents and guardians, “Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do?”

But there are gray areas with that question. Some of these kids have diseases that don’t limit what they can do, as some can go to school, and even play or perform activities typical to other children their age. However, regardless of that, some of their diseases need specialized care and treatment.

“These are the sickest and most vulnerable kids, and [changing their insurance]can mean life or death for them,” Joan Alker, executive director of the Center for Children and Families at Georgetown University told CNN.

Most of the children who ended up without healthcare in 2015 are still without the healthcare they require. Gambineri told the Daily Mail that all families with children previously in CMS who remained financially eligible were informed that they could be rescreened for clinical eligibility at any time.

“A new screening process for CMS Plan clinical eligibility has been in place since January 2016 which was developed by working collaboratively with the CMS medical providers to make sure all children who require the specialized care provided by CMS are eligible for the plan,” said Gambineri.

Some people argue the measure was actually taken to financially reward insurance companies that donated millions of dollars to the Republican Party of Florida.

Source: Daily Mail


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