Children's Health Program To Resume Eligibility Screenings

TALLAHASSEE (CBSMiami/NSF) - After months of legal wrangling, the Florida Department of Health in January will resume screening and enrolling kids with complex medical conditions into the specialized Children's Medical Services program.

The department has filed a new rule for the eligibility screening process, which will go into effect Jan. 11, spokeswoman Mara Gambineri said.

The move follows months of turmoil over the question of eligibility for the Children's Medical Services program, which provides coordinated care for children with "chronic and serious" medical conditions.

Since May, when a new eligibility screening process went into effect, 9,000 children have been dropped from the program. In September, an administrative law judge found that the department had been using the screening tool without first holding a rule-making process. The screenings stopped in late September, and rule-making began.

"Now the Department of Health has done the right thing," said Paolo Annino of the Public Interest Law Center at Florida State University, who filed the administrative complaint. "They've gone through rule-making, there's a new standard, and it's going to be used for the future --- prospectively.

"But we still have the issue of the 9,000 children who've been excluded."

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 became a "specialty plan" serving Medicaid beneficiaries. In May, when its eligibility screening tool was introduced, it 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.

Annino represents a handful of children who --- despite significant disabilities --- lost their eligibility under that screening tool. He contends that the Department of Health 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.

However, Annino praised the screening tool that will go into effect next month as "far superior" to the old one. It will include the five-question parent survey, but also what's called an "attestation form," for physicians to attest to a diagnosis, and a list of diagnoses that qualify children to enroll in the program.

Additionally, the Department of Health has pledged to revisit the screening tool and diagnosis list in three months.

But as Annino is trying to get the handful of kids he represents reinstated in Children's Medical Services, he's worried about others who lost their eligibility and were referred to Medicaid managed-care plans.

The Department of Health contends that special-needs kids receive the same care either way, but critics dispute that.

Annino is pushing the Department of Health to notify families that they might be able to get reinstated to the Children's Medical Services program.

"The agency has (all the children's) contact information," he said. "Even if the parent decides, 'No, I like my new doctor. I don't want to go back to CMS' --- well, that's their choice. But what I'm hearing from kids who've been denied (is) they do want to go back to the same providers they've been having for many, many years."

The Department of Health has established a Children's Medical Services hotline (855-901-5390) for parents. Also officials say the families of kids who lost eligibility should apply for reinstatement at local Children's Medical Services offices.

The News Service of Florida's Margie Menzel contributed to this report.