CNN reports political favors led to 13K kids losing coverage; Chris King calls for probe

Democratic gubernatorial candidate Chris King is calling for an independent investigation after CNN report Friday alleging the Florida Department of Health used faulty processes and political motives to kick 13,000 chronically sick children out of the state’s Children’s Medical Services program.

“I’m calling for an independent investigation into the Florida Department of Health and the administrative actions that led to this systematic decision to rip CMS health coverage away from more than 13,000 sick children and what influenced this decision,” King said in a news release issued by his campaign.

The Florida Department of Health responded Friday by contending the cable news network used misunderstanding and outdated information to inaccurately characterize the program, and that the claims that politics  played any role “is 100 percent false.”

“CNN’s reporting demonstrates a misunderstanding of Florida’s Medicaid system, the health insurance industry and the ethical standards of the State of Florida,” the DoH statement said.

Yet the department’s response largely defends what has happened since 2015, not responding much to what happened in 2015. What appears to not be at issue is that in 2015 Florida removed more than 13,000 children from the Children’s Medical Services program, a state-run Medicaid program set up for chronically-sick children, and referred them to other, private, Medicaid insurers.

The CNN report contends that the CMS program was nationally respected and designed to handle the sickest of kids, but claims those transferred off included many children with serious health problems including birth defects, heart disease, diabetes and blindness. It network reports that many of them were unable to find services under the new insurance plans which did not specialize in severe and chronically-sick children, which and which were not accepted by certain pediatric specialists.

CNN then cited experts and researchers in children’s health programs who said the data analysis, screening tools, and processes the Florida Department of Health used to decide which children would be dropped from CMS were deeply flawed, “completely invalid” and “a perversion of science,” in two comments.

The report then cites experts, including Dr. Louis St. Petery, former executive vice president of the Florida chapter of the American Academy of Pediatrics, who allege the children were switched to the private Medicaid insurers to reward Republican contributors. CNN also breaks down campaign contributions from the private insurance carriers to the Republican Party of Florida and other Republican political committees.

“Local and national experts in the medical field have expressed concern that this may have been done for political reasons, which, if true, would be deeply troubling,” King stated, first on Facebook, and then in a news release from his campaign. “The bottom line is that these children went without critical and oftentimes life-saving medical treatments and services because the state of Florida dropped them from CMS.”

King, a Winter Park developer, faces former U.S. Rep. Gwen Graham of Tallahasse and Tallahassee Mayor Andrew Gillum for the Democratic nomination to run for governor in 2018. Agriculture Commissioner Adam Putnam of Bartow and state Sen. Jack Latvala of Clearwater are running for the Republicans.

The Department of Health addressed CNN’s allegations one-by-one, dismissing them all. Yet the DoH’s overriding concern is the argument that the processes and tools used in 2015 were discarded and in 2016 new and better tools were used. The department said all of the families of children removed from the program in 2015 were sent letters encouraging them to re-screen their kids for possible re-enrollment in CMS.

The department argued there would be no benefit to the private insurers to pick up the chronically sick children, so it clearly was no reward for anything.

“According to the state’s Medicaid agency [Agency for Health Care Administration,] it is not true that health insurers benefit from having higher risk patients on their plans,” the DoH statement said. “This is a claim CNN makes and then contradicts with the fact that sick children are costlier for insurance companies because of the care they need. There was no financial impact or plan profit from any change. Plans do not receive an individual rate for each enrollee, but rather one overall rate for the entire plan.”

At least since early 2016, the screening tools CNN reported on, which were used for about two years, were no longer in use, the department stated.

“Beginning on January 11, 2016, the department resumed clinical eligibility screening using the process defined by Rule 64C-2.002, Florida Administrative Code. The process includes a two-part approach to clinical eligibility screening – a physician-based, auto-eligibility process using diagnostic codes for chronic and serious conditions and a parent-based survey to ensure that all financially eligible children with special health care needs are given the option to enroll in the CMS Plan,” the DoH reported. “At any time, a parent or physician can request that a child be screened or rescreened for the CMS plan – a fact CNN omits from their story.”

And finally, the department contended, “Since the time CNN is speaking of, more than two years ago, there have been multiple changes in department and CMS Plan leadership.”