Doctors and advocates suing the state used Florida officials' own words against them during opening arguments of a trial Monday by playing video clips of top health officials lamenting health care delays for Medicaid patients.
"The biggest problem our agency faces is access to specialty care for Medicaid recipients," former Florida health secretary Dr. Andrew Agwunobi said at a Medicaid conference in 2007.
He gave examples of children going to emergency rooms with broken bones unable to find orthopedic surgeons accepting Medicaid calling them "unacceptable delays." But a year later, during a deposition for a class-action lawsuit claiming about 1.2 million children on Medicaid are not getting access to critical medical care, Agwunobi repeatedly said he couldn't recall making those statements.
The suit, filed four years ago against the Department of Children and Family Services, the state Health Department and the Agency for Health Care Administration, claims 390,000 children did not get a medical checkup in 2007 and more than 750,000 received no dental care as reimbursement rates are among the lowest in the country.
Twenty of Florida's 67 counties have fewer than two dental providers for medicaid patients, according to AHCA's 2007-2008 budget request to increase reimbursement rates.
In 2005 e-mail former AHCA Secretary Alan Levine said "We have a system that is growing by-double digits, where providers are paid less and less each year. Access is limited, outcomes are not measured. ... I'd say that's a bad system."
The state's attorney, Marcos Jimenez, said Agwunobi's speech was referring to the entire state's Medicaid program, not just children's Medicaid. He said the entire country has a serious problem with access to health care, not just Florida.
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.
If the plaintiffs succeed, it could cost Florida taxpayers tens of millions of dollars, but their attorneys argue it will save the state money in the long run by avoiding costs for children who didn't get adequate care early on. A mediation attempt earlier this year failed.
Rita Gorenflo, a former emergency room nurse and adoptive mother of seven children, said she joined the lawsuit after heartbreaking nights of comforting children who were in pain, but couldn't get in to see a doctor.
Her 10-year-old son Thomas is mentally retarded, blind and requires a full-time nurse because he chokes on his own saliva. Medicaid red tape forced him to wait about 16 months in 2005 for a back surgery to correct scoliosis so bad it was affecting his left lung, Gorenflo said. Doctors say the delay worsened the curvature in his spine.
Thomas is a named plaintiff in the suit, along with his 11-year-old brother, Nathaniel, who has HIV.
Gorenflo has similar stories of her other children, five of whom have HIV. At times, she's forced to take them to the emergency room for minor issues because they can't get a doctor's appointment.
Doctors and patients for years have also complained about administrative problems plaguing the system and difficulty getting information from the state. Children frequently have their coverage dropped or are switched to another provider without their parents' knowledge, said plaintiffs' attorney Stuart Singer.
Singer represents the Florida Pediatric Society, the Florida Academy of Pediatric Dentistry and all Floridians under age 21 who now or in the future would be eligible for Medicaid.
Singer noted an earlier deposition in which DCF Secretary George Sheldon said more than 25,000 Medicaid-eligible children had their benefits terminated less than one year after they became eligible.