Florida is asking a federal appeals court to overturn a district judge’s ruling in a decade-long battle about children with complex medical needs receiving care in nursing homes, describing a key part of the ruling as an “arbitrary and unachievable” goal.
A panel of the 11th U.S. Circuit Court of Appeals is scheduled Jan. 24 to hear arguments in the state’s appeal of a ruling by U.S. District Judge Donald Middlebrooks that the Florida Medicaid program violated the Americans with Disabilities Act.
Siding with arguments raised by the federal government, Middlebrooks said the state is required to provide services in the most “integrated setting appropriate” to meet the needs of people with disabilities. He issued an injunction that, in part, requires the state to provide more private-duty nursing to help children live with their families or in their communities, rather than in nursing facilities.
But in a 39-page brief filed last week, the state’s attorneys wrote that “the number of children shown to have been admitted to nursing homes because of insufficient in-home nursing over the last 10 years is vanishingly small.”
The brief said the injunction “is overbroad and offends federalism.” It particularly focused on part of the ruling that requires the Medicaid program to provide 90 percent of private-duty nursing hours that are authorized for children to help them live in family homes or communities.
“The district court was presented with no evidence that, in the midst of a national nursing shortage, utilization rates of in-home nursing in Florida differ from those in other states,” the brief said. “Yet the district court subordinated Florida to federal micromanagement and entailed on a state sovereign the immense, daily costs and burdens of answering to federal managers.”
The case involves children in the Medicaid program with conditions that often require round-the-clock care, including such things as ventilators, feeding tubes and breathing tubes. About 140 children are in nursing homes, while the case also involves a broader number of children considered at risk of going into nursing homes, according to court documents.
In addition to ruling based on the Americans with Disabilities Act, Middlebrooks cited a major 1999 U.S. Supreme Court ruling, in a case known as Olmstead v. L.C., that said “undue institutionalization” of people with disabilities is a form of discrimination.
U.S. Department of Justice attorneys wrote in a brief last month that the appeals court should uphold Middlebrooks’ ruling and argued the state had not provided evidence showing a nursing shortage would prevent it from expanding access to private-duty nursing.
“The district court properly concluded that Florida is operating its Medicaid system in a manner that leads to the unnecessary institutionalization of children with medical complexity and a serious risk that other such children will be unnecessarily institutionalized,” the Justice Department brief said. “The court acted well within its discretion in issuing a limited injunction to remedy that Title II (of the Americans with Disabilities Act) violation. Florida implausibly contends that the court erred in myriad ways, but the state ignores the court’s factual findings and supporting evidence; fails to grapple with the court’s discretion to fashion relief; and misunderstands governing law.”
Federal officials filed the lawsuit in 2013, after conducting an investigation that concluded the state 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.
In his July decision, Middlebrooks said Florida had violated the Americans with Disabilities Act and the rights of children “who rely upon the provision of vital Medicaid services and are trying, in vain, to avoid growing up in nursing homes.”
“Unjustified institutionalization of individuals with disabilities is unacceptable, especially given the advances in technology and in the provision of home-based care,” Middlebrooks wrote. “Any family who wants to care for their child at home should be able to do so.”
But in the brief last week, the state’s attorneys argued that the federal government “has not identified any child who lives in a nursing home today and whose parents — though ready and willing — cannot transfer their child home because of Florida.”
“The United States treated the trial like a legislative proceeding and presented no evidence that its proposals to modify Florida’s policies will prevent the institutionalization of a single child,” the state’s attorneys wrote. “Its brief also fails to name any child who will go home because of the injunction. Its claim that the injunction will be effective and produce widespread redress of a cognizable harm — unlawful institutionalization — fails for several reasons.”
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