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Court Sides With State In ‘Medically Fragile’ Kids Case

Courtroom bench

A federal appeals court this week upheld a judge’s decision that would end a long-running legal battle about whether Florida’s Medicaid program properly provided services to “medically fragile” children. 

The case centered on allegations that the state violated the Americans with Disabilities Act and other laws by failing to provide services that would allow children with severe medical conditions to stay in their homes and communities. It was filed on behalf of children who had been placed in nursing homes or who were considered at risk of going into such facilities.

But a federal district judge in 2017 said the case was effectively moot because the state Agency for Health Care Administration had made changes to address the issues.

Attorneys for several children appealed to the 11th U.S. Circuit Court of Appeals in Atlanta. But a three-judge panel issued an 18-page ruling Wednesday that upheld the lower-court decision. The case dealt, in part, with a standard that the state used in determining whether children would be provided private-duty nursing services.

The state argued in court that it had discarded what was known as the “convenience” standard in making the private-duty nursing decisions, according to the appeals-court decision.

“Since the plaintiffs filed suit, the state of Florida formally adopted a new administrative rule exempting PDN (private duty nursing) services from the convenience standard,” said the appeals-court ruling by judges Jill Pryor, Elizabeth Branch and Danny Boggs.

“The state also has long since removed all subordinate policies that could be construed as applying pressure to parents to provide skilled nursing services to their children by deleting statements in the AHCA Handbook requiring caregivers ‘to participate in providing care to the fullest extent possible’ and by authorizing PDN services only to ’supplement’ caregiver-provided care. Those changes in Florida’s regulations and policies rendered the plaintiffs’ challenge moot.”