By Laura Brennaman, PhD RN CEN
The Miami Herald report about the Florida Department of Health purging frail children from the Children’s Medical Services (CMS) network designed for their needs shines the spotlight on a travesty. Our state is prioritizing tax cuts and corporate welfare above caring for our sickest and most vulnerable children.
The exposé points the finger at the administrators at the Department of Health, but lawmakers in Tallahassee created this catastrophe. Lawmakers imposed an unquantifiable threshold of “serious” conditions for eligibility and restricted enrollment in the CMS network specialty plan to no more than 10 percent of children in Medicaid or Healthy Kids. There is no gold standard for defining “serious” conditions for children. Indeed, numerous attempts to quantify the word serious among professional clinicians and parents have been unsuccessful.
The Department implemented a “screening tool” to weed out children enrolled in CMS by interpreting a valid and research-based tool in a non-evidenced based way to meet the political demands of the legislature. In a misguided attempt to apply the “serious” standard that the law imposes, the department determined that the phrase requires parents to report that their child has a significant functional limitation that makes her or him different from other children. However, with appropriate care and support services, most children with special health care needs will not experience significant functional limitations.
The parents whose children require the services to maintain function will not report limitations — until those services are withheld and their children’s conditions deteriorate. That is why the Department of Health and CMS must use the research-based screening tool in the manner it was designed and validated through rigorous research. For example, a child with diabetes who receives appropriate medication and services through a network of specialized diabetes service providers will live a life that appears ordinary. She will play, learn, and grow among her peers — she will thrive. But remove any aspect of the complex coordinated diabetes care system that includes nutritionists, durable medical equipment providers, pharmacists, care-coordinators, certified diabetes educators, and specialized endocrinology physician services and what is left that the child’s capacity to play, learn, and grow is, at best, hampered and at worst, could be destroyed.
National experts from the Agency for Healthcare Research and Quality and from the Maternal and Child Health Bureau at the Health Resources and Services Administration agree that children with special health care needs are not always readily identifiable. This means that casting a wide net to ensure all fragile children, whose lives would be forever changed by obstructions or delays to specialized services, is imperative. It is only through comprehensive screening and eligibility determinations that our most delicate children will receive the appropriate services in the timeliest fashion.
No one understands a child and their health care needs better than a parent or primary care provider. It is critical that providers and parents have the ability to report the child’s chronic need for special health care services to qualify for a full evaluation for eligibility for enrollment in the CMS network.
In spite of the outcry by families whose children were purged from the CMS network rolls, Governor Rick Scott this month proposed cutting more than 700 positions at the state health department even though economists expect state revenue to exceed existing expenditures by $635 million next year. In a state where these children need all the help they can get to achieve their life potential, the Scott administration continues to turn a blind eye to those most in need.
Vulnerable children should never be on the chopping block to help pass the next round of tax cuts. Reducing state spending on the backs of sick kids demonstrates a shameful lack of compassion that Florida families do not deserve. As lawmakers prepare to convene the annual legislative session next month, it is incumbent on them to stand up for voiceless children and remove the 10 percent cap on enrollment, and the unquantifiable requirement of serious from the CMSN eligibility guidelines, to protect our most vulnerable children.
Dr. Brennaman is the Policy and Research Director at Florida CHAIN. Florida CHAIN is a member of the KidsWell Florida collaborative.