TALLAHASSEE — After a decade-long legal battle, a Florida federal judge has ordered an end to placing children with “difficult” illnesses in nursing homes and helping them receive care in their family homes or communities.
U.S. District Judge Donald Middlebrooks, on the side of the U.S. Justice Department, ruled that Florida violated the Americans with Disabilities Act and the rights of children “who rely on the provision of life-saving Medicaid services and try in vain to avoid growing up.” in nursing homes.”
“The unjustified institutionalization of people with disabilities is unacceptable, especially given advances in technology and home care,” Middlebrooks wrote in a ruling released Friday. “Any family that wants to take care of their child at home should be able to do so.”
Middlebrooks criticized the state for not doing more to provide services such as private care that could allow children to live outside nursing homes and help children who are at risk of institutionalization. The case focuses on Medicaid children with medical conditions that often require around-the-clock care, including needs such as ventilators, feeding tubes, and breathing tubes.
“Those who are institutionalized spend months, and sometimes years, of their youth isolated from family and the outside world,” writes Middlebrooks. “They don’t need to be there. I became convinced of this after listening to the testimonies, listening to the opinion of experts and personally visiting one of these sites. With the right services, most of these children could develop in their own homes, being raised by their own families. Or, if not at home, then in some other public place that will support their psychological and emotional health, as well as satisfy their physical needs.
The Justice Department filed the lawsuit in 2013 after an investigation concluded that the state Medicaid program unnecessarily placed children in nursing homes. The state has fought the allegations and the lawsuit furiously, and the U.S. Supreme Court last year refused to hear the state’s appeal aimed at preventing the case from moving forward.
Friday’s ruling said about 140 Medicaid children are in three nursing homes in Broward and Pinellas counties. It also states that more than 1,800 children are at risk of institutionalization.
Middlebrooks wrote that the Americans with Disabilities Act requires the state to provide services in the most “comprehensive setting appropriate” to meet the needs of people with disabilities. He also cited a landmark 1999 U.S. Supreme Court ruling that stated that “inappropriate institutionalization” of people with disabilities is a form of discrimination.
Most Florida Medicaid beneficiaries receive services through managed care organizations. A key part of Middlebrooks’ ruling was that Medicaid and managed care organizations did not provide adequate private care that could allow children to receive care in their family homes or communities.
As part of the ruling and accompanying injunction, Middlebrooks ordered that the Medicaid program provide 90% of the hours of private childcare allowed for children.
In an April 28 court filing, state attorneys disputed that the Medicaid program did not properly serve children.
“The United States alleges that parents are demanding the return of their children but cannot take them home because Florida does not provide Medicaid services,” state attorneys wrote. “This assertion is not supported by the evidence. Every child’s circumstances are different and individual, and everyone lives in a nursing home for reasons that their parents found compelling. The ADA (Americans with Disabilities Act) does not give the court the power to review these decisions, even if the United States does not agree with them.”