Already facing sharp criticism over policies that have resulted in the rationing of care to
severely disabledchildren, Florida healthcare regulators are challenging a federal judge’s
order that the state provide a costly — but potentially life-changing — treatment to children
with autism.
Last spring, U.S. District Judge Joan Lenard struck down the state’s refusal to pay for
applied behavioranalysis (ABA) for autistic children, calling the state’s policy “arbitrary,
capricious and unreasonable.”
The court case involved three autistic youngsters — then-5-year-old K.G., 2-year-old I.G.
and 4-year-old C.C. — whose efforts to obtain behavioral therapy had been denied by
the state’s Medicaid insurance program forneedy and disabled people. Lenard ordered
that the three children be given the care they sought — and thatthe state provide such
care to other autistic children, as well.
The state Agency for Health Care Administration has appealed the order, and, in a
pleading submitted inNovember, argued that the ruling strips the state of its ability to
weigh requests for the therapy on a case-bycase basis to ensure the treatments are
“medically necessary.”
“There is no evidentiary support for the district court’s conclusion that [behavior analysis]
services aremedically necessary for all autistic Medicaid recipients under 21,” the brief
said. “In fact, the evidenceestablished that ABA treatment is not medically necessary,
or even effective, in all cases. Some children do not respond to ABA treatment at all, and,
in all other cases, the efficacy of ABA treatment diminishes rapidly after early age.”
Autism, typically diagnosed around age 2, is one of the most common developmental
disabilities, afflictingabout one in 88 children, according to the U.S. Centers for
Disease Control and Prevention.
The neurological disorder often affects a child’s ability to speak, learn and interact
with others. In her March order, Lenard described as “outrageous” AHCA’s position
that the behavioral therapy is not widely accepted by experts in the field. Though AHCA
had for years refused to pay for the treatment for impoverished families, state law already
requires commercial carriers to provide it to Floridians with private insurance — meaning
children from poor families were being denied services to which more-affluent families
had access. Behavioral analysis is designed to improve the behavior, language and cognitive
development of autistic children so they can lead more-normal lives.
“It is imperative,” the Miami judge wrote, “that autistic children in Florida receive [behavior
therapy] immediately to prevent irreversible harm to these children’s health and development.”
Florida’s system of care for disabled and medically fragile children has generated significant
controversy in recent months. In September, the U.S. Justice Department accused the state
of systematically cutting in-home nursing care for disabled children, resulting in hundreds
of youngsters being warehoused in geriatric nursing homes.
On Monday, about nine state lawmakers will attend a “town hall” meeting in Sunrise to
hear from families that have complained that AHCA and a sister department, the Agency
for Persons with Disabilities, have so poorlyfunded services for disabled children that they
feel they are being forced to institutionalize their loved ones. The meeting was organized by
newly elected state Rep. Katie Edwards, D-Sunrise, who says she witnessed first-hand
the plight of such families while volunteering at a daycare center for children with
complex medical needs.
Medicaid serves 3.3 million recipients statewide, with a $21 billion budget.
In its pleading, AHCA argues the judge overstepped her authority by ordering the treatment
for all disabled children — rather than just the three named in the lawsuit. Those three are
now receiving behavioral therapy. “Plaintiffs did not seek class-wide relief, the district court
did not certify a class, and the case was not tried as a class action,” the state argued.
AHCA’s other objection: Because Lenard, in her order, determined that behavioral analysis i
s medically.
Tony Paulauski Executive Director
The Arc of Illinois
20901 S. LaGrange Rd. Suite 209
Frankfort, IL 60423
815-464-1832 (OFFICE)
815-464-1832 (CELL)
Tony@www.thearcofil.org
