Tag: State News

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[MM Curator Summary]: 140 kids stuck in 3 nursing homes in Florida should get to go home now that the judge has ruled in their favor.

 
 

 
 

Clipped from: https://news.wgcu.org/section/health/2023-07-17/judge-rules-against-state-on-children-in-nursing-homes

 
 

TALLAHASSEE — After a decade-long legal fight, a federal judge Friday ordered Florida to make changes to keep children with “complex” medical conditions out of nursing homes and help them receive care in their family homes or communities.

U.S. District Judge Donald Middlebrooks, siding with the U.S. Department of Justice, ruled that Florida has violated the Americans with Disabilities Act and the rights of children “who rely upon the provision of vital Medicaid services and are trying, in vain, to avoid growing up in nursing homes.”

“Unjustified institutionalization of individuals with disabilities is unacceptable, especially given the advances in technology and in the provision of home-based care,” Middlebrooks wrote in a 79-page decision. “Any family who wants to care for their child at home should be able to do so.”

Middlebrooks criticized the state for not doing more to ensure services such as private-duty nursing that could enable children to live outside of nursing homes and to help children who are at risk of being institutionalized. The case centers on children in the Medicaid program with conditions that often require round-the-clock care involving such needs as ventilators, feeding tubes and breathing tubes.

“Those who are institutionalized are spending months, and sometimes years of their youth isolated from family and the outside world,” Middlebrooks wrote. “They don’t need to be there. I am convinced of this after listening to the evidence, hearing from the experts, and touring one of these facilities myself. If provided adequate services, most of these children could thrive in their own homes, nurtured by their own families. Or if not at home, then in some other community-based setting that would support their psychological and emotional health, while also attending to their physical needs.”

The Justice Department filed the lawsuit in 2013, after conducting an investigation that concluded the state Medicaid program was unnecessarily institutionalizing children in nursing homes. The state has vehemently fought the allegations and the lawsuit, with the U.S. Supreme Court last year declining to take up a state appeal aimed at preventing the case from moving forward.

Friday’s ruling said about 140 children in the Medicaid program are in three nursing homes in Broward and Pinellas counties. It also said more than 1,800 children are considered at risk of being institutionalized.

Middlebrooks wrote that the Americans with Disabilities Act requires the state to provide services in the most “integrated setting appropriate” to meet the needs of people with disabilities. He also cited a major 1999 U.S. Supreme Court ruling that said “undue institutionalization” of people with disabilities is a form of discrimination.

Most beneficiaries in Florida’s Medicaid program receive services through managed-care organizations. A key part of Middlebrooks’ ruling was that the Medicaid program and managed-care organizations were not providing adequate private-duty nursing that could enable children to receive care in their family homes or communities.

“By the close of the evidence, I was convinced that the deficit of PDN (private-duty nursing) in Florida is causing systemic institutionalization,” wrote Middlebrooks, a South Florida-based judge who was appointed to the bench by former President Bill Clinton.

As part of the ruling and an accompanying injunction, Middlebrooks ordered that the Medicaid program provide 90 percent of the private-duty nursing hours that are authorized for the children. He also ordered the state to improve what are known as “care coordination” services and to take steps to improve the transition of children from nursing homes.

Middlebrooks, who held a two-week trial in May, also criticized the state’s oversight of managed-care organizations and ordered a monitor to help carry out the order.

“One of the most perplexing aspects of this case is the apparent unwillingness of the state to enforce its contracts,” he wrote. “The state has contracted with managed care organizations to establish complete medical provider networks to service the needs of children with medical complexity. Part of the required network is to provide home health care to eligible members in a clinically appropriate and timely manner. The managed care organizations have contracted to deliver, not endeavored to deliver, medical treatment to their members.”

In an April 28 court document, attorneys for the state disputed that the Medicaid program was not properly providing services to the children.

“The United States claims that parents are demanding the return of their children, but cannot take them home because Florida fails to deliver Medicaid services,” the state’s attorneys wrote. “That assertion finds no basis in the evidence. Each child’s circumstances are different and individualized, and each lives in a nursing home for reasons that seemed convincing to their parents. The ADA (Americans with Disabilities Act) does not entitle the court to second-guess those decisions — even if the United States disagrees with them.”

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Reminder- NC did not expand Medicaid.

 
 

 
 

Clipped from: https://ncnewsline.com/2023/07/12/nc-house-democrats-criticizes-budget-delay-final-plan-may-be-weeks-away/

 
 

House Democratic Leader Robert Reives criticizes Republicans for the delayed state budget. (Photo: Lynn Bonner)

Republican legislators’ failure to agree on a state budget is delaying Medicaid expansion, teacher and state employee raises, and state retiree cost-of-living increases. 

House Democrats criticized the lack of a new spending plan at a news conference Wednesday. The new budget year started on July 1, but negotiations between legislative Republicans may drag on for another month. 

Republican leaders have said that they are working to negotiate a compromise on tax cuts. Potential expansion of casino and video gambling could also be in the mix. 

Rep. Jason Saine, senior chairman of the House budget committee said Wednesday it may be the middle of August before the state has a budget.

 
 

Rep. Jason Saine, senior chairman of the House budget committee (Photo: NCGA screen grab)

The Senate and House had different ideas on how big a boost employees should get, making raises one of the issues under negotiation. 

The Republican budget impasse has left school districts in limbo, Wake County Democratic Rep. Julie von Haefen said at the news conference. Year-round schools are already beginning and traditional schools are set to open in six weeks.

“How can we possibly ask our administrators to begin operating our schools when they don’t even know what the state appropriation is going to be to their districts,” she said.

The budget impasse adds to difficulties recruiting teachers because potential new hires won’t know how much they’ll earn. “Would you accept a contract to start a job with an undefined salary? That is exactly what Republicans are asking our teachers to do at this point. Accept jobs for uncertain pay,” she said. 

Once the budget passes, teacher and state employees’ raises will be retroactive, so state workers will eventually receive their money. At this point, they don’t know how much. 

Medicaid expansion remains on hold as unwinding begins

Last March, North Carolina became the 40th state to adopt Medicaid expansion, but Republicans made expansion contingent upon passing a budget. That means initiation of a plan that could offer up to 600,000 more North Carolinians health insurance is also delayed. 

Last week, Gov. Roy Cooper urged Republicans to decouple Medicaid and the budget. House Democratic leader Robert Reives repeated the call to separate expansion from the budget. 

In the meantime, states including North Carolina are dropping people from Medicaid programs. A federal mandate that prevented states from removing people from Medicaid has expired. Thousands of North Carolina residents who were able to remain insured during the pandemic are likely to lose their health insurance coverage.  Some of those people would be able to stay insured under Medicaid expansion. 

“This month alone, we have 9,000 people who will lose Medicaid coverage that would otherwise keep it,” Reives said. 

“I want to echo Governor Cooper’s urge to decouple Medicaid expansion from the budget, because we’re looking at a prolonged stand-off it seems,” Reives said. “We need to keep in mind that everybody in this state is waiting for something in this budget, especially state employees, and we owe it to them to provide the best that we can.”

 
 

Everybody in this state is waiting for something in this budget, especially state employees.

– House Democratic leader Robert Reives

Saine, a Lincoln County Republican, said Democrats were grandstanding, and most of them won’t vote for the budget anyway. Budgets have been late before, he said. 

“This is about us being very pragmatic and working through a very complicated multi-billion budget that sets our state on course,” he said. “These things do take time and being intentional and pragmatic means we get the best deal we can get. At this point, we’re not there yet.”

Saine said he understands that Senate Republicans want to include as part of the budget allowing more casinos, but he has not seen a final offer in writing. 

Western North Carolina has three casinos in its part of the state. Two are owned by the Eastern Band of Cherokee. The Catawba Nation owns one in Kings Mountain. 

Allowing casinos outside tribal lands was not in the House or Senate budget. House Speaker Tim Moore and Senate leader Phil Berger spoke to WRAL about a potential casino bill as  the legislature was approving online sports betting. 

The bigger issue holding up the budget are the accelerated tax cuts and “how quickly we get to a lower number on tax reform and whether there are going to be triggers,” Saine said Wednesday. Most House Republicans want tax-cut triggers based on state revenues, a plan where tax rates would drop if revenues reach certain targets. 

It’s harder to sell faster tax cuts without knowing if more money will be coming in, he said.  

“We could do tax reform, we could do casinos, we could do them both, but until we know exactly what they’re going to look like, it is a little difficult,” Saine said. 

Updated at 10:00 pm to correct spelling of Julie von Haefen. 

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: One state funds Medicaid payments for a children’s hospital in another as part of a specific item in their own budget.

 
 

 
 

Clipped from: https://www.nj.com/politics/2023/07/nj-giving-delaware-hospital-20m-to-cover-kids-on-medicaid-but-theres-no-guarantee-it-will.html

 
 

Elias Del Collo of Upper Deerfield has been a patient of Nemours Children’s Hospital in Delaware since he was four days old. His family fears he will lose his treatment team in a dispute between the hospital and the Medicaid managed care carrier that covers his extensive treatment.

By

• Susan K. Livio | NJ Advance Media for NJ.com
  

State lawmakers took the unprecedented step last month of earmarking $20 million in the new state budget for a pediatric hospital in Delaware, anticipating the cash infusion would halt the facility’s plans to leave New Jersey’s Medicaid managed care program on Aug. 1.

But it’s been nearly two weeks since Gov. Phil Murphy signed the $54.3 billion spending plan into law, and officials from Nemours Children’s Health have not announced whether the facility will remain an in-network hospital for families insured through NJ FamilyCare.

MM Curator summary

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

[MM Curator Summary]: Florida says no thank you, we are fine.

 
 

 
 

Clipped from: https://wusfnews.wusf.usf.edu/health-news-florida/2023-07-07/florida-declining-federal-waivers-help-medicaid

 
 

The waivers aim to reduce the risk of eligible families losing Medicaid coverage due to procedural errors.

Federal health officials are urging states like Florida to make it easier for people to renew their Medicaid coverage as a mass unwinding following the COVID-19 public health emergency continues.

Thousands of Floridians have been disenrolled from Medicaid since the state began redetermining eligibility in May, after a federal directive that states suspend such efforts during the pandemic was lifted. Florida began its process earlier than some others, but committed to spreading out renewals over the course of a year.

Health care advocates have been raising the alarm about large numbers of people in Florida and nationally who are losing coverage not because they no longer qualify but because of procedural issues, such as failing to respond to renewal notices or submitting information incorrectly. They say it suggests states are not doing enough to communicate with families about the renewal process and help them navigate it.

RELATED:
‘Trying to survive’: Families suddenly dropped from Medicaid seek reinstatement

Advocates and health officials say they are especially concerned about children, who are more likely to remain eligible for Medicaid than adults. Kids make up the majority of Florida’s Medicaid population, so coverage losses due to red tape could threaten their access to care.

The feds are offering help. Florida hasn’t taken it yet

The Centers for Medicare and Medicaid Services set minimum standards for states to follow to reduce the risk of people wrongfully losing coverage, but has also offered states some flexibilities to assist in the unwinding, including a series of policy waivers that Health and Human Services Secretary Xavier Becerra outlined in a June 12 letter to governors. But Florida is one of two states that has so far declined to take advantage, along with Montana.

“We really are at a moment here where we have the potential for millions of people to lose health care coverage,” CMS deputy administrator Dan Tsai said during a virtual meeting with reporters this week. “We need everybody, and that includes our state partners, to go far above and beyond the minimums and to do everything in their power to keep eligible people covered.”

The waivers allow states to do things such as automatically renew people who appear to have no or very little income, partner with Medicaid managed care plans to assist people with completing renewal forms, or delay administrative terminations for one month while the state conducts additional outreach.

This gives families more time to understand what steps they need to take to renew coverage, and also reduces the amount of resources states have to spend tracking down enrollees who are likely still eligible for coverage.

CMS has so far approved nearly 250 waivers for the remaining states and territories, and officials want to see Florida participate as well.

Some of the waivers allow for processes that Florida has already included in its state plan, according to Department of Children and Families spokesperson Tori Cuddy.

For example, some waivers let states use information about residents receiving benefits through the Supplemental Nutrition Assistance Program (SNAP) or Temporary Assistance for Needy Families (TANF) to determine Medicaid eligibility. Florida is already able to do this, Cuddy noted.

The state of Florida’s Medicaid unwinding

Medicaid enrollment reached record highs in Florida during the public health emergency, at more than 5 million people, but the state projected roughly 1 million were no longer eligible.

So far, the state has only been able to verify about 35% of the 303,000 Medicaid enrollees it’s estimated to have disenrolled during the process were ineligible, according to a Kaiser Family Foundation analysis of state unwinding dashboards and monthly reports submitted to CMS. The remaining 65% are due to procedural reasons.

That marks an improvement from the procedural termination rate during the first four weeks of redeterminations in Florida, which was closer to 80%. It is also lower than the current national average, which KFF lists as 71%, though the organization notes not all states have made data publicly available.

Calls for Florida to pause redeterminations

Still, the fact that the state has not been able to confirm ineligibility for a majority of enrollees that have lost coverage so far has CMS officials and other health care advocates concerned.

A coalition of 52 organizations sent a letter to Gov. Ron DeSantis and state health officials in late May asking them to pause the redetermination process, which in its first month resulted in a quarter-million Floridians losing Medicaid coverage.

In addition to the high rate of procedural terminations, advocates also cited long waits at state call centers as well as anecdotal reports of children with complex medical conditions, who were supposed to go last in Florida’s redetermination plan, experiencing disruptions in coverage as reasons to slow the process.

“As organizations that represent and advocate for the well-being of Florida’s families, we are deeply concerned about those with serious, acute and chronic conditions who will continue to lose access to their lifesaving treatments during this time, along with people who risk substantial medical debt, or even bankruptcy, as a result of coverage loss,” the groups, which include the Florida Policy Institute and Florida Health Justice Project, among others, wrote in the letter.

RELATED: About 250,000 Floridians were kicked off Medicaid. Experts say most were still eligible

CMS has asked some states to pause procedural terminations, Tsai said during Wednesday’s briefing, though he did not name which ones, nor did a CMS spokesperson upon follow-up inquiry.

“We are finishing discussions with states and will have more information to follow up with soon,” the CMS spokesperson said in an email.

There has been a “constant stream” of concerns that health providers and advocates have brought to CMS’ attention when it comes to challenges with renewals in Florida and other states, Tsai said. Staff are investigating individual cases and monitoring data.

But to take action against a state, CMS must find a “clear regulatory violation” occurred, which Tsai said is not always easy.

“Federal Medicaid regulations do not get very specific on some of the things including how understandable, say, a [renewal] notice is. That is an issue that we need to remedy, to be clear, but that is also why, in instances, we may not find a clear violation of a regulatory standard,” Tsai said.

The state touts its response

DCF officials tell Health News Florida that the state has implemented a variety of communication strategies to reduce the number of procedural terminations.

“The Department has implemented an extensive public outreach campaign, well exceeding federal requirements, including mail, email, texts, and call outs to Medicaid beneficiaries to encourage engagement in renewal,” said Cuddy.

More than 80% of recipients have responded to their redetermination requests compared to fewer than 50% pre-pandemic, she added. Recipients who don’t respond have 90 days to submit a late application and can get their coverage restored retroactively if determined eligible.

The department also notes thousands of residents who have been determined ineligible for Medicaid have been referred to other health insurance options, including Florida Healthy Kids, a program for children in families with low incomes, and plans available through the Affordable Care Act marketplace.