Judge rules against Florida in dispute over placement of children in nursing homes

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

US District Judge Donald Middlebrooks, along with the US Department of Justice, ruled that Florida violated the Americans with Disabilities Act and the rights of children “who depend on the provision of vital Medicaid services and try, in vain, to avoid growing up in nursing homes.”

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

Middlebrooks criticized the state for not doing more to ensure services such as private nursing that could enable children to live outside nursing homes and to help children at risk of institutionalization. The case focuses on children on Medicaid who have conditions that often require around the clock care that includes needs such as ventilators, feeding tubes, and breathing tubes.

“Those who are institutionalized spend months, and sometimes years of their youth cut off from family and the outside world,” Middlebrooks wrote. “They don’t need to be there. I am convinced of this after hearing the evidence, listening to the experts, and touring one of these facilities myself. If the right services are provided, most of these children can thrive in their own home, cared for by their families. Or if not at home.” , then in another community setting that would support their mental and emotional health, while also caring for their physical needs.”

The Justice Department filed the lawsuit in 2013, after an investigation concluded that the state’s Medicaid program was unnecessarily institutionalizing children in nursing homes. The state has vehemently disputed the allegations and the suit, with the US Supreme Court last year declining to hear a formal appeal intended to prevent the case from moving forward.

About 140 children on Medicaid are in three foster homes in Broward and Pinellas counties, according to Friday’s ruling. It also said more than 1,800 children were considered at risk of being placed in institutions.

Middlebrooks writes that the Americans with Disabilities Act requires the state to provide services in the most “integral and appropriate environment” to meet the needs of people with disabilities. He also cited a key 1999 US Supreme Court ruling that said the “undue institutionalization” of people with disabilities is a form of discrimination.

Most Medicaid beneficiaries in Florida receive services through managed care organizations. A key part of the Middlebrooks ruling was that Medicaid and managed care organizations did not provide sufficient private duty nursing that could enable children to receive care in their family homes or communities.

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“When the evidence ended, I was convinced that the deficit in PDN (private nursing) in Florida was causing the institutionalization of the system,” wrote Middlebrooks, a South Florida judge appointed by former President Bill Clinton. .

As part of the ruling and accompanying order, Middlebrooks ordered that Medicaid provide 90% of the children’s nursing hours. He also ordered the state to improve what are known as “care coordination” services and take steps to improve children’s transition out of nursing homes.

Middlebrooks, who held a two-week trial in May, has also criticized state oversight of managed care organizations and ordered a probationer to help enforce the order.

“One of the most vexing aspects of this case is the state’s apparent unwillingness to enforce its contracts,” he wrote. “The state has contracted with managed care institutions to create complete networks of medical providers to serve the needs of children with medical complications. Part of the required network is to provide home health care to eligible members in an appropriate and timely clinical manner. Managed care institutions have contracted to provide, not seek to provide, medical treatment to their members “.

In a court document dated April 28, the state’s attorneys contested that Medicaid was not properly providing services to children.

“The United States claims that parents claim the return of their children, but cannot bring them home because Florida failed to provide Medicaid,” the state’s attorneys wrote. “This assertion finds no basis in evidence. Every child’s circumstances are different, and every child lives in a nursing home for reasons that seemed compelling to their parents. The ADA (Americans with Disabilities Act) does not entitle the court to second-guess those decisions—even if the U.S. Don’t agree to it.”

By Jim Saunders, News Service of Florida

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