When Florida Surgeon General John Armstrong goes before a Senate committee Tuesday for a confirmation hearing, two members of the panel will be waiting with questions about thousands of sick kids who were dropped from the Children's Medical Services program last year.
Armstrong oversees the state Department of Health, which came under fire after changing its eligibility screening process for the Children's Medical Services Network. The program provides services to children with "chronic and serious" medical conditions.
Last month, Armstrong told the Florida Children and Youth Cabinet that 13,074 children had "transitioned" out of the program in 2015 because they did not meet the clinical eligibility criteria. He said the Department of Health had worked with those families to ensure that the children got the same standard of care in Medicaid managed-care plans.
But now, Senate Health and Human Services Appropriations Chairman Rene Garcia, R-Hialeah, wants to know why the department hasn't told the families that their kids could be rescreened and perhaps readmitted to Children's Medical Services.
"That's the goal that the (Health and Human Services Appropriations Subcommittee) wanted to achieve, to ensure that these families were contacted to let them know that there was a rescreening process, that there was the opportunity to do that," Garcia said. "And I think it's imperative that that happens."
The conflict has played out since May, when the new eligibility screening process for Children's Medical Services went into effect. The Department of Health used the process to rescreen children who were receiving services, and thousands were found to be ineligible.
In September, an administrative law judge ruled that the department had been using its screening tool without first properly going through a rule-making process. The department then suspended the screenings and began a new round of rule-making, which resulted in a new rule last month.
Since the new rule went into effect Jan. 11, more than 6,000 children have been screened for Children's Medical Services using the revised process, the department said Friday. Of those children, 85 percent were found to be eligible for the program. However, the department currently does not know how many of those children had lost their eligibility and were being rescreened, as opposed to being screened for the first time. A spokeswoman said the data will be available in April.
Meanwhile, Senate Children, Families and Elder Affairs Chairwoman Eleanor Sobel, D-Hollywood, is sponsoring a bill aimed at expanding eligibility to more youngsters by changing wording that helps determine whether they qualify for the program. Currently, that wording requires a "chronic and serious" medical condition, along with meeting certain financial requirements. Sobel's bill would change that to "chronic or serious" conditions.
The Senate Health Policy Committee, which includes Sobel, unanimously passed her measure (SB 1240) this week. She said her "motivating factor" was the 13,000 children who had lost their Children's Medical Services coverage.
"CMS gives a much better and supportive system of care for children with chronic health care needs than the current (Medicaid managed care) programs," Paul Robinson, a Tallahassee pediatrician, told the panel. "Certainly children get a lot more support."
Still, the Senate committee meeting was the first time Sobel's bill had been heard during the annual legislative session, which reached its halfway point this week. The House version (HB 1117), filed by Rep. Mia Jones, D-Jacksonville, hasn't gotten a hearing.
Armstrong will go before the Senate Health Policy Committee on Tuesday for a confirmation hearing and is expected to face questions from Sobel and Garcia about the Children's Medical Services issue.
The issue centers, at least in part, on Florida's transition to a statewide Medicaid managed care system, which was completed in 2014. Under the system, the Children's Medical Services Network became a "specialty plan" serving Medicaid beneficiaries.
"This was a major cultural change," Armstrong told The News Service of Florida last week. "We worked steadfastly with a whole host of stakeholders to really get input, and in the end met some resistance from those who don't like managed care. My commitment is to see that the children with serious and chronic medical conditions receive the services that they need."
Children's Medical Services is also now a managed-care plan. As a result, Armstrong said, the Department of Health cannot contact families directly to advise them that their children may be rescreened and, perhaps, re-enrolled.
"The direct answer is that CMS is a managed-care plan," he said. "That would be perceived as marketing. We're prohibited from marketing."
But Joan Alker of the Georgetown Health Policy Institute said the federal ban on advertising only applies to the managed care industry, not to the state.
"The intent of those rules to not have direct marketing is so that plans wouldn't direct-market to beneficiaries," Alker said, adding that the rules are flexible. "The entity cannot distribute marketing materials without first obtaining state approval. So it's not even that they can't do direct marketing; they have to have state approval."
Garcia said that's his take as well.
"My understanding is that as the state, as a government entity, we can," he said. "I just don't know where in rule or in statute it says that (the state) can't contact the families. We do it all the time."
Amy Guinan Liem of Florida Legal Services, said the Department of Health or the state Agency for Health Care Administration could issue an alert to all Medicaid families who might be affected by the eligibility dispute.
