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State agencies on trial today

By Sammy Mack
2/9/2010 © Health News Florida

A landmark lawsuit that seeks to rewrite Florida's Medicaid policy resumed today in Miami, with plaintiffs charging that state agencies'  tendency to switch plans without notice often leaves children with no access to care.
Also, the suit alleges that Florida’s Medicaid reimbursement rates are so low, and its bureaucratic webs so tangled, that doctors are disinclined to participate.

As a result, said attorney Carl Goldfarb, Florida’s Medicaid-eligible children are not receiving the recommended number of health screenings, blood lead tests or dental visits.

"We’re trying to fix the system," said Goldfarb, whose firm is donating its time. As it stands, he added, "It’s very difficult for doctors and very trying for parents."

The closely watched hearings, which broke off in January, are part of a class-action lawsuit claiming Florida’s Medicaid program does not meet federal standards for childhood preventative health services. Plaintiffs include the Florida Pediatric Society and the Florida Academy of Pediatric Dentists on behalf of Florida’s Medicaid-eligible children.

Tallahassee pediatric cardiologist Louis B. St. Petery, who will take the stand again today, maintains that the Florida Department of Children and Families "frequently improperly terminates a child’s Medicaid eligibility."

Also, he said, Florida’s Agency for Health Care Administration (AHCA) often switches a child’s designated plan or provider without notifying the family. St. Petery says this leads to dangerous delays in care.

The defense has questioned St. Petery's authority in early testimony, saying his "training, education and experience as a pediatric cardiologist do not make him an expert" on the "administrative hassles" of Medicaid. St. Petery is also the executive vice president of the Florida Pediatric Society.

Goldfarb's firm, Boies, Schiller & Flexner, is representing the plaintiffs pro-bono.

Plaintiffs also plan to dissect conflicting statements from Dr. Andrew Agwunobi, former AHCA secretary. Video from a 2007 industry conference shows Agwunobi bemoaning Medicaid’s shortcomings. But during his deposition for this case he insisted he could not remember criticizing the system.

The case is unusual in that it seeks policy changes, rather than damages. As a result, it's being heard as a “bench trial” -- without a jury -- before U.S. District Court Judge Adalberto Jordan. The court proceedings are arranged around the judge and attorneys’ schedules, which has meant month-long gaps between hearings.

Plaintiffs filed the suit in 2005, but entered the hearing stage only in December. It is expected to continue for several months.

On Wednesday, plaintiffs are scheduled to call two mothers to the stand in a bid to demonstrate how low physician participation in Medicaid translates into disparities in care, especially when compared with children who are privately insured.

The mothers will describe the obstacles they encountered getting care for their children, said Alison Preece, a spokesperson for the plaintiffs.

Several parents have already testified in this case. At January hearings, a mother identified as "SC" to protect her son’s identity told the court how her adopted son survived neglect and abuse—including poisoning—by his birth family, only to struggle at every step to receive services from his Medicaid-assigned healthcare providers.

In one example, SC said she tried to schedule dental exams for her son, and also his older brother, who had private coverage. Even though their dentist accepted Medicaid, she said, there was an appointment available for the privately insured son, but not for the Medicaid-covered boy. When SC moved her adopted son onto her private carrier, an appointment immediately opened up.

"I could see the disparity between the two (plans)," said SC. 

--Sammy Mack is an independent journalist in Miami. She can be reached by e-mail.