Nelson, Castor Demand Federal Intervention Over Sick Kids' Health Care

U.S. Senator Bill Nelson and Tampa Congresswoman Kathy Castor are asking the federal government to step in after thousands of kids were kicked off a state Medicaid program. The two Democrats sent a letter to Health and Human Services Secretary Tom Price earlier this week.

The lawmakers want a federal investigation into why over 13,000 kids were taken off an insurance plan called Children's Medical Services, or CMS, and placed on privately managed Medicaid plans in 2015.

CMS cares for Florida’s sickest children, whose conditions ordinary plans may not be as adept at handling. A CNN report that spurred Nelson and Castor’s request for intervention cited pediatricians and parents of kids removed from CMS who struggled to find specialists to care for them under other plans.

The kids were removed from CMS due to a screening process a judge ruled was unlawful later that year. But Senator Nelson says the state Department of Health only recently notified families they were eligible again.

"Why did you wait two years for these very, very sick children, to contact their parents to tell them they can enroll?” he said.

The CNN report includes suggestions from parents and doctors that the real reason the state switched the kids’ health plans was to financially reward private insurance companies that donated millions of dollars to Florida’s Republican Party.

The Department of Health is disputing a number of claims made about how it handled the situation. It issued a statement on Thursday:

“DOH completed reaching out to all appropriate families in July – weeks before the Senator and Congresswoman wrote their letter,” read the statement. “DOH is 100 percent focused on making sure the programs we manage are providing quality care – especially to children. Any assertion that children have been denied care or are not receiving services is absolutely false.”

The statement was accompanied by a copy of an Aug. 18 release issued in response to the original CNN article in which DOH outlines what it says are inaccuracies in the news outlet’s reporting:

“CNN’s reporting demonstrates a misunderstanding of Florida’s Medicaid system, the health insurance industry and the ethical standards of the State of Florida … Additionally, it is completely inaccurate for CNN to assert that Florida health officials made decisions based on politics. This claim is 100 percent false.”

Neither Senator Nelson nor Representative Castor would comment on whether they believe DOH’s actions were politically motivated.

But as to the department’s argument that kids did not fail to receive care, Castor says, “All you have to do is go to some of these families [in the CNN report] and ask them, and talk with the pediatricians who say they’re no longer able to see these kids.”

The lawmakers said they have not received a response from federal health officials yet, though are not surprised as they only sent the letter Tuesday. As to whether he’s confident HHS will take action, Senator Nelson didn’t answer directly.

“I can tell you I voted against Secretary Price,” he said. “I did not feel like he was qualified nor would he look out for the interest of poor people who were sick. And I think we’re finding that especially when he proposed the repeal and replace plan [of Obamacare] that took $800 billion out of Medicaid over a decade – that would have eviscerated Medicaid as we know it for poor people, for disabled people, for children and for senior citizens in nursing homes.”

Representative Castor says she hopes “HHS will take their responsibility seriously.”

“They have [done so] in the past, because we’re talking again about the children with the most complex medical conditions in their families really just trying to get through the day,” Castor said. “And think about what that has meant to have that consistent pediatrician and specialist and doctor with them, sometimes for years at a time. And to think that bond has now been broken inexplicably makes no sense, so we really do need answers here.”

The state Department of Health says all appropriate families of kids who were taken off CMS in 2015 were notified that they were eligible to reenroll as of July. It says the screening process that led to those removals was replaced with new protocol in January 2016, and that the department has made strides since then to improve the CMS plan.

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