Florida Appeals Court Order

The Miami Herald reports:

Already facing sharp criticism over policies that have resulted in the rationing of care to severely disabled children, Florida healthcare regulators are challenging a federal judge’s order that the state provide a costly — but potentially life-changing — treatment to children with autism.

Last spring, U.S. District Judge Joan Lenard struck down the state’s refusal to pay for applied behavior analysis (ABA) for autistic children, calling the state’s policy “arbitrary, capricious and unreasonable.”

The court case involved three autistic youngsters — then-5-year-old K.G., 2-year-old I.G. and 4-year-old C.C. — whose efforts to obtain behavioral therapy had been denied by the state’s Medicaid insurance program for needy and disabled people. Lenard ordered that the three children be given the care they sought — and that the state provide such care to other autistic children, as well.

The state Agency for Health Care Administration has appealed the order, and, in a pleading submitted in November, argued that the ruling strips the state of its ability to weigh requests for the therapy on a case-by-case basis to ensure the treatments are “medically necessary.”

“There is no evidentiary support for the district court’s conclusion that [behavior analysis] services are medically necessary for all autistic Medicaid recipients under 21,” the brief said. “In fact, the evidence established that ABA treatment is not medically necessary, or even effective, in all cases. Some children do not respond to ABA treatment at all, and, in all other cases, the efficacy of ABA treatment diminishes rapidly after early age.”