Lawmakers Seek Changes In Children's Health Program Eligibility

Jan 12, 2016

After months of controversy, the Florida Department of Health on Monday resumed eligibility screening for the Children's Medical Services program, which serves kids with serious and chronic health conditions.

But critics say the screening process is still flawed --- and that a new legislative proposal will fix it.

The dispute has played out since May, when a new eligibility screening process for the Children's Medical Services Network went into effect. The Department of Health used the process to re-screen 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.

The new rule went into effect Monday, allowing enrollments in the program.

"There was a ripple in the screening process that has been ironed out," Surgeon General John Armstrong told the Florida Children and Youth Cabinet on Monday.

Armstrong said 13,074 children "transitioned" out of the Children's Medical Services Network because "they did not meet the clinical eligibility criteria. And the top diagnoses there were singular: attention-deficit disorder and diabetes. … We worked with these families to transition these children into (managed-care) plans that met their needs."

Armstrong said the children who had left the program were getting the same standard of care in managed-care plans. He added that although the Department of Health had set up a hotline for potential complaints from families whose children were deemed ineligible, it only received 121 calls.

But Senate Children, Families and Elder Affairs Chairwoman Eleanor Sobel, D-Hollywood, took issue with Armstrong.

"There's been a lot of turmoil at CMS," she said. "Nine thousand children have been taken off the rolls. … The parents are extremely upset, and they're in limbo. … Many of them want to go back to CMS."

Sobel also wanted to know how parents were supposed to find out about the hotline. Armstrong said they were told during the transition.

The dispute centers on the state's transition to Medicaid managed care, which was completed in 2014. Under the system, the Children's Medical Services Network became a "specialty plan" serving Medicaid beneficiaries.

Sobel is the Senate sponsor of a measure (SB 1240 and HB 1117) that would broaden wording that helps determine whether children are considered eligible for the program. Currently, that wording requires a "chronic and serious" medical condition, along with certain financial requirements. Sobel's bill would change that to "chronic or serious" conditions.

"If you've got to meet one criteria versus two criteria, you'll end up with more people participating in the program," said House sponsor Mia Jones, D-Jacksonville. "We kicked people out. It would have been one thing if you said, 'For those that are coming into the program, we're going to look at these situations differently.' But to kick someone out of a program that has needed it, the doctors have said they needed it, and they have been doing well with those services --- doesn't make a whole lot of sense for me."

The screening process that went into effect Monday uses a two-part approach. The old screening tool consisted of a five-question survey taken by parents over the phone. Critics said the questions were confusing, especially to non-English speakers. But no input from physicians or other medical professionals was allowed. Now, however, in addition to the parent survey, physicians can attest to children's eligibility using diagnostic codes for chronic and serious conditions.

Sobel noted that the physicians do not have the option to "attest" to conditions of attention-deficit disorder or childhood diabetes. But Armstrong said the parent survey could be used to establish eligibility for children with those conditions.

That didn't satisfy everyone.

"I remain particularly concerned that the Department of Health sees no obligation to inform the parents of the roughly 9,000 children who were dropped from CMS that they had the opportunity to appeal that decision," said pediatric cardiologist Louis St. Petery. "It is now the department's responsibility to tell these parents that CMS acted in error and that they may now seek re-screening, if they wish to have their children reconsidered for readmission."