The Miami Herald reported its findings December 5 of an extensive two-part investigation into Florida’s Children’s Medical Services Network (CMS), finding that the state has cut more than 9,000 children with disabilities from the program using a screening tool, which one court has already declared invalid.
In 2011, the Florida Legislature passed a bill overhauling the state CMS program, a specialized program for children with severe disabilities either enrolled in the state’s Medicaid program, or KidCare, a state-run program for low-income children who don’t meet Medicaid’s income eligibility requirements. The measure changed CMS from a traditional Medicare-type fee-for-service program into a state-run managed care network, with a cap on the amount of allotted funds for services.
Part I of the series, titled “Bitter pill: How Florida rations care for frail kids,” begins by featuring the story of 6-year-old named Aref Shabaneh, who is nearly blind, reads using Braille and is so sensitive to light that his parents must keep the lights off when he’s home.
For the previous two years, he had received services from CMS from a specialist to protect what left of his eyesight. However, in June his parents were informed he was no longer eligible for the program, and nor was their 9-year-old daughter, who also has a retinal attachment.
The month before, the state began using a five-question screening tool, which, as described in the Miami Herald story, was designed for survey purposes, not for determining medical eligibility questions. The third question on the survey, the one considered by critics a trap, asks “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?”
If parents answer “no” on the question, their children are automatically excluded.
In September, an administrative judge ordered the CMS to stop using the screening tool, on the grounds that the state was required to undergo a formal rule-making process before implementing such a change.
For the article, the Miamai Herald staff combed through nearly 800 emails and other documents via the state’s public records law. As detailed in the report, many of the comments make clear the agency is prioritizing cost savings over children’s health.
“The overhaul of CMS is a story about rationing of services for children who are poor and disabled, a long tradition in Florida,” the article states. “It is about the malleable nature of words like ‘moratorium,’ and about numbers on a balance sheet. It is also about individuals represented by those numbers — kids like Aref.”
Part II of the series, titled “Bitter Pill: Hard Lives of disfigured kids made harder still,” focuses on the state’s eight clinics for treating children with cleft lips and palates. With the changes at CMS, two clinics have closed, consistent with the explicit goals of the agency’s three-year strategic plan, namely to reduce “clinic utilization” and to “close clinics.”