MIAMI (AP) — One of the state's top Medicaid official told a judge that Florida's health insurance program for poor children has no major problems, children are able to access care and any contrary statements other health officials have made to the Legislature were exaggerations.
Beth Kidder, testifying in a class-action lawsuit against the state, also told U.S. District Judge Adalberto Jordan this week that the state's Medicaid system is providing quality care for the 1.7 million children enrolled.
Kidder's testimony contradicted statements other state health officials have made to the Legislature, saying the Medicaid program needs more money and warning that patients faced a critical shortage of specialists. The state spends roughly $20 billion annually to provide Medicaid coverage, with about half the recipients being children. The program has added 500,000 children over the last two years as the state's economy went into a tailspin and unemployment soared into double digits.
The lawsuit claims 390,000 Medicaid children did not get a medical checkup in 2007 and more than 750,000 received no dental care.
"I did not say that we have a perfect system but children are getting the care they need right now," Kidder testified as the trial, which began two years ago, resumed after a three-month break.
The class-action lawsuit was originally filed six years ago on behalf of the Florida Pediatric Society, the Florida Academy of Pediatric Dentistry and all Floridians under age 21 who are in the Medicaid program or might be in the future. It alleges that the state is violating federal law by not providing adequate access to medical care for its young Medicaid enrollees.
It's unclear whether the case, which is being tried in chunks, will finish this year.
If the lawsuit succeeds, it could cost Florida taxpayers tens of millions of dollars, but the suing attorneys argue it will save the state money in the long run by avoiding costs for children who didn't get adequate care before health problems arose or got worse.
The state has spent roughly $4.6 million defending itself. The trial resumed Monday, six weeks after one of the nine children specifically named in the lawsuit died. The child's attorneys highlighted dozens of documents from the state's Agency for Health Care Administration, which oversees Medicaid, that paint a bleak picture of the program.
"We have a system growing by double digits where providers are paid less and less each year, access is limited, outcomes are not measured, racial disparities in health continue and participants are stigmatized. I'd say that's a bad system," former AHCA Secretary Alan Levine wrote in a 2005 email.
According to past budget requests from AHCA asking the Legislature to increase reimbursement rates, 20 of Florida's 67 counties have fewer than two Medicaid dentists who treat children and only 15 percent of the state's dentists actively participate in the Medicaid program. Less than 9 percent treat more than 100 patients a year, the requests said.
But Kidder testified those figures were incorrect.
"I believe there were very broad statements made that had no supporting evidence or little supporting evidence," Kidder said.
Yet in a 2008 deposition Kidder said there "was a critical access to care problem in the specialty types" and that the "situation has not changed."
An attorney representing the Medicaid children and doctors asked Kidder if such mistakes could hurt the credibility of the agency's future budget requests.
"Aren't you worried (the legislature will think) this is coming from an AHCA, an agency saying under oath they don't know whether figures they submitted are correct?" attorney Stuart Singer asked.
Kidder said she did not want to comment on the Legislature's mindset.
Singer's New York-based law firm — Boies, Schiller & Flexner — says it has spent millions arguing the case for free.
The state has argued that the children and health providers don't have legal standing to pursue the claims because the Medicaid program promises money but not necessarily the delivery of health services, as the lawsuit contends. The state has also stressed the entire country has a serious problem with access to health care, not just Florida.
In Tallahassee, a child on Medicaid normally waits two to three months to see an ear, nose and throat doctor, compared to two-to-four weeks for children with private insurance, said Dr. Louis St. Petery, a pediatric cardiologist and executive vice president of the Florida Pediatric Society. Children with fractures in South Florida are struggling to get appointments with orthopedic surgeons, he said in an interview.
The child who recently died, 12-year-old Thomas Gorenflo, was mentally retarded, blind and required a full-time nurse because he choked on his own saliva. Medicaid forced him to wait about 16 months in 2005 for back surgery to correct scoliosis so bad it was affecting his left lung, his mother, Rita Gorenflo said. Doctors say the delay worsened the curvature in his spine, which made it difficult for him to breathe.
"I feel like the state is dragging (the trial) out and taking advantage," said Gorenflo, a former emergency room nurse and adoptive mother of seven children. "I cannot believe the state has spent all the money they've spent trying to defend this issue instead of putting it where the kids are and where it was needed."
As the lawsuit drags on, doctors say thousands of other children on Medicaid are suffering.
In April, Chavella Graham told The Associated Press she took her 9-year-old daughter Morgann to a West Palm Beach doctor because the tubes inserted in her ears as a toddler were infected and needed to be removed.
The girl's ear, nose and throat specialist could have removed the tubes in a relatively simple procedure, but was no longer seeing Medicaid patients at his office but at a free clinic in another county. When that didn't work out, Graham called the only other two ear, nose and throat specialists in the area, but they weren't taking new Medicaid patients.
"My daughter is in excruciating pain with infections and we are trying to get her seen by her ENT. I tried to explain it was an emergency situation. There was nothing they would do. No exceptions," she said.
Graham, a full-time mom, tried her pediatrician but he couldn't perform the surgery. In the meantime, the little girl was in such pain she was banging on her ears, causing sores. Graham said she felt "hopeless, helpless" staying up all night trying to soothe her daughter.
Four months later and after four trips to the emergency room, Morgann's tubes were eventually removed.
"It was really heartbreaking to see your child in pain and there's nothing you can do," Graham said. "The system is broken. It's not working."