Judge Rules Against Florida in Fight Over Putting Children in Nursing Homes
On July 14, U.S. District Judge Donald Middlebrooks ruled that Florida’s Medicaid program violated the Americans with Disabilities Act (ADA) by institutionalizing children with “complex” medical conditions, requiring them to receive care in nursing homes rather than their family homes or another community-based setting. The lawsuit was filed in 2013 by the U.S. Department of Justice, following an investigation that determined the state’s Medicaid program unnecessarily institutionalized children in the program with conditions requiring around-the-clock care, like those on ventilators or with feeding or breathing tubes. Judge Middlebrooks said, “Unjustified institutionalization of individuals with disabilities is unacceptable, especially given the advances in technology and in the provision of home-based care. Any family who wants to care for their child at home should be able to do so.” Around 140 children in the Medicaid program are in three nursing homes in Broward and Pinellas counties, with over 1,800 children at risk of being institutionalized, according to the ruling. Judge Middlebrooks noted that states are required by the ADA to provide services to people with disabilities in the most “integrated setting appropriate,” and he cited a U.S. Supreme Court ruling from 1999 that deemed “undue institutionalization” of people with disabilities to be a form of discrimination. He determined that “the deficit of PDN (private-duty nursing) in Florida is causing systemic institutionalization” and ordered the Medicaid program to provide 90% of PDN hours authorized for the children and the state to improve both “care coordination” services and the transition of children from nursing homes.
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