The state quickly launched an appeal after a federal judge ruled Friday that Florida has violated the Americans with Disabilities Act and needs to make changes to keep children with “complex” medical conditions out of nursing homes.
Attorneys for the state filed a notice Monday that is a first step in challenging U.S. District Judge Donald Middlebrooks’ ruling at the 11th U.S. Circuit Court of Appeals.
As is common, the notice does not detail arguments the state will make at the Atlanta-based appeals court. But the state Agency for Health Care Administration issued a statement Monday that criticized Middlebrooks’ ruling and said Florida would seek a stay and appeal.
“The judge’s failure to understand the law is demonstrable in his order,” said the statement from the agency, which runs most of the Medicaid program. “The court’s conclusion that the state’s actions or omissions force children to live in nursing homes against their parent’s wishes is unsupported and refuted by the evidence presented at trial.”
Middlebrooks’ ruling and an accompanying injunction came in a decade-long legal battle in which the U.S. Department of Justice alleged the state unnecessarily institutionalized children in nursing homes. The South Florida-based judge ordered the state to make changes aimed at providing care to children in their family homes and communities.
“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.”
The case focuses 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. The 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.
But the statement Monday from the Agency for Health Care Administration disputed Middlebrooks’ conclusions.
“During the trial, witnesses testified that their medically complex children were in nursing homes for various reasons unrelated to the state or its policies,” the statement said. “Not one parent testified that they are ready and willing to take a child home but cannot do so because of the state’s actions or omissions. The court’s conclusion that the state’s actions or omissions force children to live in nursing homes against their parents’ wishes is a generalization unsupported and even refuted by the evidence presented at trial.”
The Justice Department filed the lawsuit in 2013, after conducting an investigation that concluded the state Medicaid program was unnecessarily placing 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.
A key part of Middlebrooks’ ruling was that the Medicaid program and contracted managed-care organizations were not providing adequate private-duty nursing that could enable children to receive care in their family homes or communities.
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.
