Judge Deciding Special-Needs Children Dispute

Aug 26, 2015

An administrative law judge is considering a challenge to the Florida Department of Health involving the eligibility of children for a state program that provides specialized medical care.

Attorneys for children and the Department of Health filed proposed final orders Monday with Judge Darren Schwartz in the case, which focuses on a program known as the Children's Medical Services Network.

A final hearing had been scheduled for Aug. 14, but the parties agreed to instead submit proposed final orders to Schwartz. He has 30 days to rule in the case.

The dispute springs from the state's transition to Medicaid managed care, which was completed last year. Under the new system, the Children's Medical Services Network -- a program for kids with severe and chronic illnesses -- became a "specialty plan" serving Medicaid beneficiaries.

The case centers on a new eligibility-screening tool that the department is using to evaluate whether children still qualify for the CMS Network.

The plaintiffs, represented by the Public Interest Law Center at Florida State University's College of Law, contend that nearly 6,000 children lost their places in the program due to the screening tool.

They say the department should have adopted the instrument as a rule -- especially before using it to screen children out of the network. State agencies often have to adopt detailed rules to carry out broader policies.

"DOH's failure to adopt the screening tool as a rule operates to deprive petitioners and the 77,990 children with special health care needs the promise of a 'consistent medical home,' " the plaintiffs said in their proposed final order.

The petition, filed in June, seeks the reinstatement of all children in the network until the department puts the new eligibility-screening tool through a standard rule-making process with public input.

But the Department of Health contends that the eligibility-screening tool is exempt from the rule-making process. While the Department of Health oversees the Children's Medical Services program, the state Agency for Health Care Administration is in charge of contracts with Medicaid managed-care plans.

"(The Children's Medical Services Network's) eligibility screening tool is expressly required by and incorporated into the (Agency for Health Care Administration) contract," said the department's proposed final order. "In fact, CMSN would arguably breach its contract with AHCA if CMSN were unable to screen children using the contractually required screening tool because rulemaking procedures delayed (its) adoption."

The plaintiffs disagreed in a proposed final order submitted by Paolo Annino of the Public Interest Law Center and Matt Dietz of Disability Independence Group, Inc., which advocates for people with disabilities.

Some critics of the screening process say the CMS Network does more to help families struggling with severe and chronic illnesses than Medicaid managed-care plans.

However, supporters of the screening process say it weeds out children with conditions such as asthma, which they maintain can be adequately treated in managed-care plans.