Arizona Marijuana: Everything to Know About Marijuana Law in AZ

(THIS ARTICLE IS COURTESY OF FACEBOOK.COM)

 

Arizona Marijuana: Everything to Know About Marijuana Law in AZ

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Brandi Atkins, an Arizona resident and former dancer, was diagnosed in late 2015 with a rare autoimmune disease that made her joints and muscles swell, causing chronic pain. She popped in and out of the hospital with a cornucopia of prescription medications handed out to alleviate her pain, ease her symptoms, and navigate around her type 1 diabetes. These medications would often clash with her disease and cause her blood sugar to soar. In desperation, she turned to medical marijuana.

Almost immediately, Adkins noticed an improvement in balance, palatable reduction in pain, and (most importantly) hope for her future. The dispensary she visited took the time to understand her specific concerns, her goals, and the particulars of her health conditions. Thanks to medical marijuana, Adkins feels like she can dance again.

This hopeful scenario plays out in dispensaries across Arizona, where more than 100,000 patients suffering everything from epilepsy to chronic pain find relief through medical marijuana.

It’s an interesting situation: legalized medical marijuana and dispensaries in one of the United States’ most conservative territories. How do these conflicting events coexist? Have you ever wondered what exactly is the state of medical marijuana affairs in Arizona? Here’s our in-depth explanation of everything you always wanted to know about Arizona’s Medical Marijuana Laws (but were too afraid to ask).

The road to marijuana legalization in Arizona

When the federal government originally passed the Marihuana Tax Act of 1937, the predecessor to the Controlled Substances Act of 1970, all American states had criminalized cannabis in one way or another. It wasn’t until the mid-1990s that Arizona state legislators began listening to decades-long calls for marijuana law reform.

In 1996, Arizona passed Proposition 200, allowing doctors to prescribe medical marijuana (specifically, controlled substances) to treat diseases or relieve pain in seriously/terminally ill patients. In order for a patient to use medical marijuana, a doctor had to provide scientific evidence to prove marijuana’s usefulness along with a second doctor’s opinion to the Arizona Department of Health Services. This caused conflict between supporters and opponents of medical marijuana, and started a lengthy battle over the law’s lack of specificity in addition to the language “prescribe.” For a doctor to prescribe medicine, the substance must first undergo FDA trials and doctors must specify the exact dosage and consumption methods to be used. Unfortunately, this rendered Prop 200 illegal on a federal scope and a medical marijuana program never materialized. It did, however, protect first-time drug offenders from prison sentences, which was a step towards decriminalization.

Arizona tried once more to legalize medical marijuana in 2002 with Proposition 203, but the initiative failed, receiving 42.7% of the vote. A viable solution was not presented and approved until nearly a decade later.

In 2010, Arizonans voted to approve a much-revised version of Proposition 203, an initiative to legalize the medicinal use of marijuana. Proposition 203 authorized doctors to recommend cannabis as a therapeutic option, as opposed to prescribing a specific dosage of cannabis with strict consumption or application methods. This law also tasked the Arizona Department of Health Services (ADHS) to regulate the “Arizona Medical Marijuana Act.”

Arizona’s current marijuana policy

The ADHS had until April 2012 to establish a registration application system for patients and nonprofit marijuana dispensaries, as well as a web-based verification platform for use by law officials and dispensaries to verify a patient’s status as such. It also specified patients’ rights, qualifying medical conditions, and allowed out-of-state medical marijuana patients to maintain their patient status (though not to purchase cannabis).

On December 6, 2012, Arizona’s first licensed medical marijuana dispensary opened in Glendale.

In 2012, Arizona legislators amended the Arizona Medical Marijuana Act to include college and university campuses in their non-consumption list, even if the cardholder was over 21 years old. However, in April 2017, this ruling was overturned by the Arizona Court of Appeals, and though colleges can privately prohibit medical marijuana on campus, lawmakers cannot make campus cannabis use illegal.

The people of Arizona took advantage of the Department of Health’s qualifying condition appeal process in 2013 when they petitioned to include PTSD, migraines, and depression among the list of qualifying medical conditions. Following due process, the Director of the ADHS denied the petition.

prop 205 arizona

While it seemed like the Arizona population was becoming more tolerant of cannabis, it proved too soon to jump to recreational legalization. In 2016, Arizonans narrowly voted no on Prop 205 by a margin of 48:52, which would have legalized the adult use of marijuana. Ballotpedia attributes this loss to heavy early campaigning by opponents of recreational marijuana years before the election process. Opponents such as Insys, the creators of Fentanyl, lobbied heavily against recreational cannabis — their CBD medicine passed the first phases of FDA trials earlier in 2016. This loss resulted in a significant surge in new medical marijuana patients, many of whom were waiting to get their card only if the recreational law failed to pass.

Despite various lawmakers’ attempts to place limitations on Arizona’s medical marijuana law, the program is growing larger each year. As of late June 2017, there were 132,487 Arizona marijuana patients, 155 dispensary licenses (up from 124 at the law’s passage), and 881 patient caregivers.

The “Arizona Medical Marijuana Act”

The “Arizona Medical Marijuana Act,” or AMMA, empowers Arizona doctors to recommend medical marijuana as a viable treatment option for Arizona patients diagnosed with at least one qualifying medical condition. With this recommendation, a patient may apply for an Arizona Medical Marijuana Card, a card that allows patients to possess, purchase, and use medical marijuana.

2.5 oz of cannabis, up to 12 plants, deliveries of marijuana, 25 miles from a dispensary

Arizona marijuana patients or caregivers may possess up to 2.5 ounces of marijuana at any given time, and obtain 2.5 ounces in a 14-day period from an Arizona medical marijuana dispensary. Patients can also be authorized to grow up to 12 marijuana plants for their own use, or otherwise, find a caregiver to grow cannabis for them if they reside more than 25 miles from the nearest medical marijuana dispensary.

Living as a medical marijuana patient

chronic pain, alzheimers, cachxia, cancer, crohn's disease, glaucoma, hepatitis c, muscle spasms, nausea, ptsd, sclerosis, seizures, two or more conditions

For Arizonans like Brandi Atkins — mentioned at the beginning of this article — who think medical marijuana might be right for them, patients must receive a recommendation to use medical marijuana from a licensed Arizona physician. The patient must have one of the below qualifying medical conditions, and their physician must determine that the patient indeed has a qualifying condition. The written certification would state the doctor believes, in their professional opinion, the patient would likely receive therapeutic benefit from medical marijuana use.

Arizona’s list of debilitating qualifying conditions

ALS, alzheimer's disease, cancer, glaucoma, hiv/aids, hepatitis c, cachexia/wasting syndrome, muscle spasms, nausea, seizures, severe and chronic pain

Once a patient has received their written certification from an Arizona doctor, they may apply to the ADHS for a Registry Identification Card, a card that grants patients and caregivers the authority to possess, purchase, and use medical marijuana legally.

To apply for a Registry Identification Card, patients must submit their written certification, the application fee, their personal information, and a statement declaring they won’t use their medical marijuana for nefarious purposes (i.e. sell it to kids). If a minor wants to be a medical marijuana patient, there are stricter rules to follow before they can qualify for their card. The ADHS website explains the application process in more detail.

The most “caring” of the bunch

Some patients in critical need of cannabis are unable to travel easily to purchase or even consume cannabis without some assistance. Arizona included regulations to cover the people who would take care of these patients, known as Caregivers, allowing them to assist patients (up to five) in the medical use of marijuana.

Whether taking care of a child or an elderly parent, this endeavor is a huge responsibility. Caregivers need to educate themselves on the different aspects of marijuana, like different strains, consumption methods, and their patients’ specific health needs. Arizona caregivers must follow all the same regulations as patients, including registering with the ADHS and carrying an ID card.

Don’t worry, the law protects you!

As federal law still classifies marijuana as a Schedule 1 drug (without medicinal value), Prop 203 and other medical cannabis laws were designed to protect citizens’ rights. Arizona medical marijuana patients are supposed to be treated like every other resident. The AMMA’s regulations protect the rights of patients and caregivers in certain circumstances:

  • A school or landlord may not refuse to enroll/lease to a qualifying patient unless failing to do so would incur ramifications under federal law.
  • Medical facilities cannot deny treatment to patients based on their status as a medical marijuana user.
  • Parental rights cannot be denied based on a parent’s status as an Arizona medical marijuana patient.

While these protections are essential, they do not provide for every eventuality. Employers may not discriminate against employees who are medical marijuana patients, and may not penalize them for a positive drug test. However, employees cannot use or possess marijuana during the hours of work. Employers may lawfully discipline and even terminate any employee who tests positive for marijuana if they used or possessed during work hours, even if the employee is a registered patient.

Despite nearly 20 years of progress toward decriminalization and regulation, Arizona is still one of the toughest states in the nation when it comes to marijuana. Even minor possession is a felony for those who aren’t medical marijuana patients, with a max sentence of 3.75 years and a $150,000 fine.

I’m a physician, what part do I play in medical marijuana?

“I have found in my study of these patients that Cannabis is really a safe, effective and non-toxic alternative to many standard medications.” -Philip Denney, MD, Testimony to the Arkansas legislature in support of House Bill 1303, “An Act to Permit the Medical Use of Marijuana,” Nov. 17, 2005.

Doctors are the gatekeepers to medical marijuana. In all medically legal states, doctors must fully evaluate their patients and determine whether cannabis is a fit for their medical needs and whether they have a qualifying condition. This places a lot of responsibility on doctors’ shoulders, which most Arizona doctors bear with professionalism and true concern for their patients. The physician must be a doctor of medicine, a doctor of osteopathic medicine, a naturopathic physician, or a homeopathic physician who holds a valid license to practice in Arizona.

medical marijuana doctors in arizona

Physicians meet patients, either in person or via telemedicine services, to determine if the patient has a qualifying condition before signing a written certification stating that, in their professional opinion, the patient has a qualifying condition and would likely receive therapeutic benefits from medical marijuana use.

However, Arizona courts have cracked down on some physicians who have turned their practices into “certification mills” due to their being no additional requirements for marijuana recommendations other than holding a valid license to practice medicine in Arizona.

Visiting from out of state?

Arizona allows non-Arizona medical marijuana patients the same rights and protections as Arizona citizens. This caveat makes sense … sort of.

The law states a Registry Identification Card, or its equivalent, issued by another state is valid in Arizona, except in that a visiting qualifying patient may not obtain marijuana from an Arizona marijuana dispensary.

This is a bit paradoxical. How is an out-of-state patient to access medical marijuana without purchasing from a dispensary or bringing it over state lines, which is federally illegal? Here’s how:

Another registered Arizona patient or designated caregiver can offer and provide medical marijuana so long as nothing of value is given in return, and the recipient doesn’t end up possessing more than 2.5 oz. of marijuana. This works, though it may be simpler to become a resident of Arizona.

Medical Marijuana Dispensary basics, keeping patients safe, obeying laws

inside a dispensary

All Arizona marijuana dispensaries are nonprofit organizations, a philosophy similar to out-of-state patients: “nothing of value may be exchanged for the transfer of medical marijuana.” While medical marijuana isn’t free, dispensaries may charge for medical marijuana as part of the expenses incurred during business operations. Patients can purchase up to 2.5 ounces of marijuana every two weeks, either as flower or an equivalent amount in concentrate, edibles, or other cannabis product forms.

As marijuana is still federally illegal (and valuable), security remains a  top priority. Dispensaries are required to use the ADHS online verification system to confirm each Arizona marijuana patient’s status as a patient and the amount of marijuana purchased over the last 60 days. This system is password protected and will not allow any access through an unencrypted internet connection. This online system does not include patients’ addresses or other personal information.

Dispensaries are also required to have a strong security system for their facility, including a single secure entrance. Medicating on the premises is forbidden. These heavy requirements go hand-in-hand with Arizona officials’ concern that marijuana products will encourage theft, violence, or negligent/illegal use.

Don’t be afraid to ask about the future

Though Arizona’s medical marijuana laws are full of sticky, complicated red tape, the program’s existence is still a huge step forward in the crusade for national legalization. Suffering patients in Arizona can find medical relief with our favorite plant and still enjoy protection from the law. Hopefully, after reading our guide, you now understand the nuts and bolts of how medical marijuana regulations work in Arizona.

Still want more information? Check out the Arizona Department of Health Services website at www.azdhs.gov.


Sources:

https://azmarijuana.com/links/legal/

https://azmarijuana.com/news/proposition-203-arizona-medical-marijuana-act/

http://norml.org/legal/item/arizona-medical-marijuana

http://www.azdhs.gov/licensing/medical-marijuana/index.php

http://medicalmarijuana.procon.org/view.resource.php?resourceID=000881#Arizona

http://www.azcentral.com/story/news/politics/arizona/2017/04/06/ruling-overturns-law-banning-medical-marijuana-arizona-college-campuses/100145648/

http://blog.norml.org/2011/05/16/alternet-the-five-worst-states-to-get-busted-with-pot/

http://www.azdhs.gov/documents/licensing/medical-marijuana/debilitating/2013-july/medical-marijuana-debilitating-medical-condition-decision-form-jan-2014.pdf

https://ballotpedia.org/Arizona_Marijuana_Legalization,_Proposition_205_(2016)

https://www.nytimes.com/elections/results/arizona-ballot-measure-205-legalize-marijuana

http://azcapitoltimes.com/news/2017/01/24/lawmakers-act-to-change-medical-marijuana-rules/

https://www.washingtonpost.com/news/wonk/wp/2016/09/09/a-maker-of-deadly-painkillers-is-bankrolling-the-opposition-to-legal-marijuana-in-arizona/?utm_term=.7428039f5547

https://www.forbes.com/sites/theemploymentbeat/2014/12/02/medical-marijuana-and-the-workplace-what-employers-need-to-know-now/#3ff5578b66b8

http://medicalmarijuana.procon.org/view.source.php?sourceID=000593

http://www.phoenixnewtimes.com/news/arizonas-week-in-weed-pot-docs-cant-lie-on-forms-az-supreme-court-says-8277359

https://www.marijuana.com/news/2014/07/arizona-court-rules-that-medical-marijuana-patients-can-sell-weed-to-other-patients/

http://www.azdhs.gov/documents/licensing/medical-marijuana/reports/2016/2016-apr-monthly-report.pdf

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Yep, Donald Trump Proves He’s An Idiot (Again), 3 Times Looking At The Eclipse Without Glasses

(THIS ARTICLE IS COURTESY OF CNN)

 

Yes, Donald Trump really did look into the sky during the solar eclipse

(CNN) There’s literally only one rule with eclipses: Don’t look at the sun during them.

Which brings me to the President of the United States:

President Donald Trump looks up toward the Solar Eclipse while joined by his wife first lady Melania Trump on the Truman Balcony at the White House on August 21, 2017.

And, again:

President Donald Trump looks up toward the Solar Eclipse on the Truman Balcony at the White House on August 21, 2017.

And, because three times is a charm:

President Donald Trump looks up toward the Solar Eclipse while standing with his wife first lady Melania Trump and their son Barron, on the Truman Balcony at the White House on August 21, 2017.

That’s Donald John Trump on the White House South Portico, seemingly looking directly into the sun. At the peak of the solar eclipse. Without any sort of protective eyewear on.
This, from the White House pool report of the moment filed by the Guardian’s Ben Jacobs is, um, amazing: “At approximately 2:39, the President initially gesticulated to the crowd below and pointed at the sky. As he did so, one of the White House aides standing beneath the Blue Room Balcony shouted ‘don’t look.'”
Trump did, eventually, put on protective eyewear — as did first lady Melania Trump.

president trump viewing eclipse_00002217.jpg

Their son Barron got in on the action too:

President Donald Trump, first lady Melania Trump and their son Barron Trump wear special glasses to view the solar eclipse from the Truman Balcony at the White House on August 21, 2017 in Washington, DC.

Heck, even “beleaguered” Attorney General Jeff Sessions got on the protective eyewear bandwagon (alongside Commerce Secretary Wilbur Ross)!

Attorney General Jeff Sessions (left) and Commerce Secretary Wilbur Ross wear special glasses to view the solar eclipse at the White House on August 21, 2017.

Just in case Trump is still President when the next solar eclipse comes in 2024 — it could happen! — here’s a story he should read. Titled “Can you really go blind staring at a solar eclipse?,” CNN’s Ashley Strickland writes:
“The retina may translate light into an electrical impulse that the brain understands, but one thing it can’t translate to your brain is pain. So even if you’re excited about the eclipse and think one brief glimpse at the sun before it completely hides behind the moon is worth it — it’s not. There’s no internal trigger that is going to let you know that you’ve looked at the sun for too long. Any amount of looking at it is too long.
Even the smallest amount of exposure can cause blurry vision or temporary blindness. The problem is, you won’t know whether it’s temporary.”
Remember, Mr. President: “Any amount of looking is too long.”
CORRECTION: This story has been updated to correctly identify where the President was standing.

Pediatricians say Florida hurt sick kids to help big GOP donors

(THIS ARTICLE IS COURTESY OF CNN)

 

Pediatricians say Florida hurt sick kids to help big GOP donors

Updated 12:03 AM ET, Sat August 19, 2017

St. Augustine, Florida (CNN) When he was 11 years old, LJ Stroud of St. Augustine, Florida, had a tooth emerge in a place where no tooth belongs: the roof of his mouth.

LJ was born with severe cleft lip and palate, which explained the strange eruption, as well as the constant ear infections that no antibiotic could remedy.
With her son in terrible pain, Meredith Stroud arranged for surgeries to fix his problems.
But just days before the procedures were to take place, the surgeons’ office called to cancel them.
Like nearly half of all children in Florida, LJ is on Medicaid, which has several types of insurance plans. The state had switched LJ to a new plan, and his surgeons didn’t take it.

Doctors: 'Trick question' hurt sick kids

Doctors: ‘Trick question’ hurt sick kids
LJ wasn’t alone. In the spring and summer of 2015, the state switched more than 13,000 children out of a highly respected program called Children’s Medical Services, or CMS, a part of Florida Medicaid. Children on this plan have serious health problems including birth defects, heart disease, diabetes and blindness.
The state moved the children to other Medicaid insurance plans that don’t specialize in caring for very sick children.
Stroud says that for her son, the consequences were devastating. Despite hours of phone calls, she says, she couldn’t find surgeons on his new insurance plan willing to do the highly specialized procedures he needed. Over the next seven months, her son lost 10 pounds, quit the football team and often missed school.
“He was in pain every day,” Stroud said. “I just felt so helpless. It’s such a horrible feeling where you can’t help your kid.”
LJ filed a lawsuit against the state of Florida, and he was eventually placed back on Children’s Medical Services and received the care he needed. But some Florida pediatricians worry about other children with special health care needs who, two years later, are still off the program.
The doctors aren’t just worried; they’re angry.
First, the data analysis the state used to justify switching the children is “inaccurate” and “bizarre,” according to the researcher who wrote the software used in that analysis.
Second, the screening tool the state used to select which children would be kicked off the program has been called “completely invalid” and “a perversion of science” by top experts in children with special health care needs.
Third, in fall 2015, a state administrative law judge ruled that the Department of Health should stop using the screening tool because it was unlawful. However, even after the judge issued his decision, the department didn’t automatically re-enroll the children or even reach out to the families directly to let them know that re-enrollment was a possibility.
Finally, parents and Florida pediatricians raise questions about the true reasons why Florida’s Republican administration switched the children’s health plans. They question whether it was to financially reward insurance companies that had donated millions of dollars to the Republican Party of Florida.
“This was a way for the politicians to repay the entities that had contributed to their political campaigns and their political success, and it’s the children who suffered,” said Dr. Louis St. Petery, former executive vice president of the Florida chapter of the American Academy of Pediatrics.
Experts outside Florida are also disturbed that the children were switched out of CMS, a program that’s served as a model for other states for more than 40 years.
“CMS is well-known and well-respected,” said Dr. James Perrin, professor of pediatrics at Harvard Medical School. “It’s one of the earlier programs to build in assurances that these kids get the kind of care they need.”
“These are the sickest and most vulnerable kids, and (changing their insurance) can mean life or death for them,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University. “This is really very troubling.”
Dr. Rishi Agrawal, an associate professor of pediatrics at Northwestern University’s Feinberg School of Medicine, agreed, adding that Florida should have more carefully considered how the insurance switch would affect the children’s health care.
“The process in Florida was particularly abrupt and poorly executed,” he said.
Mara Gambineri, a spokeswoman for the Florida Department of Health, said that “at no time (during the insurance switch) did children go without medically necessary services.”
State officials, including a spokesman for Governor Rick Scott’s office, initially declined to comment directly on the pediatricians’ and parents’ concerns that the children might have been switched to benefit contributors to the Republican Party of Florida. On Friday, after this story was published, the Florida Department of Health released a statement asserting that such a claim “is 100 percent false.”
“The department’s number one priority is protecting the health and well-being of all Florida residents, especially children with special health care needs,” Gambineri wrote in an earlier email. “The department remains committed to providing quality health care services to Florida’s children with special health care needs.”

A mother’s anguish

In spring 2015, LJ’s mother received a phone call from a nurse at the Florida Department of Health.
Stroud had no idea that one word she would say to that nurse — just one single word — would cause her son months of pain and suffering.

Meredith Stroud's son, LJ, was born with cleft lip and palate. He lost his Children's Medical Service coverage when he was 11.

The nurse asked Stroud a series of questions, including whether LJ was limited in his ability to do things other children could do.
Despite his birth defect, LJ goes to school and plays with friends, so she answered no.
Stroud says that because of that answer, LJ lost his insurance with CMS, the program that has cared for children with special health care needs in Florida for 40 years, and was put on a different Medicaid insurance plan.
LJ was one of 13,074 Florida children kicked off CMS — that’s about one in five children in the program — as a result of the telephone survey, according to a presentationtestimony and a letter from Florida’s top health officials.
Stroud thinks back to her answer to the nurse’s question about limitations.
“That question’s not fair,” Stroud said of the one that got her child kicked off CMS. “What [the Florida Department of Health] did was totally wrong.”
“It was a trick question,” she added.

Pediatrician: ‘A truly duplicitous question’

Experts agree with her.
“I personally find it pretty astonishing that they can take a survey question like that and use it to justify the de-enrolling of these kids,” said Dr. Jay Berry, an assistant professor of pediatrics at Harvard Medical School who studies policies for children with special health care needs.
What Florida did was “completely invalid,” added Dr. John Neff, professor emeritus of pediatrics at the University of Washington, another expert on children with special health care needs.
The pediatricians explained that many children with serious and chronic medical conditions — such as cleft lip and palate, HIV, diabetes and cystic fibrosis — are often able to do things other children can do. However, they still require extensive and highly specialized medical care.
The question the Florida Department of Health nurses asked — “Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do?” — would lead to disqualifying children who truly have special medical needs from a program designed for them, said Stephen Blumberg, associate director for science at the National Center for Health Statistics and one of the world’s leading experts on the epidemiology of children with special health care needs.
Question No. 3

“Is your child limited or prevented in any way in his or her ability to do the things most children of the same age can do?”

“You would get false negatives. Your conclusion would be that a child does not have special health care needs when, in fact, the child does,” he added.
Gambineri, the Department of Health spokeswoman, said it no longer uses the survey that resulted in 13,074 children being removed from CMS.
“It is unfortunate the negativity surrounding this issue is a continued topic of inquiry, as the department and our stakeholders have put in a significant amount of time and effort to move past this issue for the benefit of the children we serve,” she wrote.

Six pediatricians from across Florida gathered to tell CNN their concerns about children losing CMS coverage. They accuse the state of hurting sick kids to help big GOP donors.

But pediatricians in Florida point out that many children who were removed from Children’s Medical Services using the controversial questionnaire were never put back on.
“This was a truly duplicitous question,” said Dr. Philip Colaizzo, a pediatrician in Jupiter, Florida, who said that many of his patients with special health care needs were taken off CMS. “It was a trick question.”
“It’s a perversion of science,” said Dr. Jeffrey Goldhagen, professor of pediatrics at the University of Florida College of Medicine and medical director of the Bower Lyman Center for Medically Complex Children at Wolfson Children’s Hospital.
Goldhagen added that he was speaking for himself and not the institutions where he works.
“It was a scam job,” added Dr. Nancy Wright, a pediatric endocrinologist in Tallahassee who said that dozens of her patients with diabetes were removed from the program.

Dr. Nancy Wright, a pediatric endocrinologist, says dozens of her patients lost their coverage on Children's Medical Services. "For the children with diabetes that I work with, it was a disaster," she said.

“They really tried their darnedest to kick the kids out of CMS,” added Dr. Carrol Fenn, an orthodontist in West Palm Beach. “They’ve messed up kids’ lives.”
“They’re the most vulnerable of our population, and that they can be booted off the plan that was designed to help them is just amazing. How can someone in an office make a decision like that?” asked Dr. John Obi, an adjunct clinical professor in plastic surgery at the University of Florida, who operates on children with cleft lip and palate.
“I congratulate whoever came up with that question,” he added wryly. “If you want to exclude virtually anybody, that’s the way to do it.”

Johns Hopkins expert: ‘I’m speechless’

Christina Bethell’s team came up with that question — and she’s furious.
Bethell is a professor at the Johns Hopkins Bloomberg School of Public Health. She and her team spent many years and millions of dollars coming up with the right questions to accurately identify children across the United States who might have special health care needs.
The list of questions — known as the Children with Special Health Care Needs Screener — is publicly available on the Hopkins website. Many state and federal agencies use it to help decide which children might benefit from special health services.
The Florida Department of Health, however, used the questions to do something completely different: to kick children out of a program.
That’s scientifically invalid, Bethell said. Using the questions that way — especially the question about limitations — would lead to denying children with special health care needs the services they require.
“I’m speechless,” she said.
To make matters worse, Bethell said, Florida repeatedly and publicly cited research done by her group at Hopkins — the Children and Adolescent Health Measurement Initiative — to support the children’s removal from CMS.
“I feel really manipulated,” she said.
She thinks of the children who were taken off CMS and fumes that the tool used to remove them was her own work.
“I’m angry,” she said. “And I’m crestfallen for these families.”

Grave consequences for Florida children

The Shabanehs in Tallahassee are one of those families.
Aref Shabaneh, 8, is blind, and his sister, Yasmeen, 11, is severely visually impaired. Their mother, Reema Shabaneh, says they were kicked off CMS in 2015.

Aref Shabaneh lost his Children's Medical Services coverage in 2015. He is blind and reads in Braille.

Shabaneh says she told the Florida Department of Health nurse that they didn’t have limitations.
“Aref wants to do everything by himself,” she said. “He can play ball with friends. The ball has a bell, so he can hear it coming.”
After they were kicked off CMS, Shabaneh said, she couldn’t find an ophthalmologist on the new insurance plan willing to care for her children.
“I was so scared,” she said.
When Jennifer Rodriguez received the phone call from the Department of Health nurse, she said, she told the nurse she didn’t know how to answer the question about limitations. Her son, Alejandro, suffers from a congenital heart defect, asthma and kidney problems. Sometimes, his heart races and he has trouble breathing, but other times, he feels up to playing soccer with his friends.
“When I tried to explain the answer, she cut me off and said she was just doing her job and needed a yes or a no,” she said.
Rodriguez says she answered that her son, who was 10 at the time, did not have limitations. He then lost his CMS coverage.
“It makes me angry, because you would think that since he’s seeing a cardiologist, a nephrologist, a urologist and an asthma doctor, they would see he’s not your average child,” she said.
LJ, Alejandro and the Shabaneh children filed lawsuits and were put back on CMS. They were represented by the Public Interest Law Center at Florida State University.

Alejandro Rodriguez wears a nebulizer mask to help him breathe. After he filed a lawsuit, the state put him back on Children's Medical Services.

Many Florida pediatricians say their patients also suffered when they were taken off CMS and put on other Medicaid plans. The doctors say those other plans typically have fewer pediatric specialists than CMS, which specializes in caring for very sick children.
Dr. Lisa Cosgrove, a pediatrician in Merritt Island, Florida, said she had a difficult time finding an orthopedist to treat a 6-year-old with a broken elbow who had been taken off CMS. The girl ended up having surgery later than she should have and now can’t extend her elbow all the way.
She said a baby born with a clubfoot also suffered because she couldn’t find an orthopedist willing to take the baby’s plan. The baby couldn’t have the necessary casts to twist the foot back into place and may need surgery, Cosgrove said.
Dr. Elizabeth Curry, a pediatrician in Port St. Joe, Florida, said that last year, she took care of a baby whose eye wiggled back and forth involuntarily, which can be a sign of a brain tumor.
Curry said it took her more than a month to find an ophthalmologist willing to take the baby’s Medicaid plan — and the doctor she finally found was three hours away, in Pensacola.
Fortunately, the baby turned out to be fine.
“This child could have had cancer. That’s a kid who should have seen a doctor right away,” Curry said. “I feel terrible for these children. It makes me so angry.”

Dr. Elizabeth Curry, a Florida pediatrician, says some of her patients didn't get the treatment they needed because the state had removed them from Children's Medical Services.

Because of problems like these, switching the children’s insurance “was a complete dereliction of Florida’s responsibility to children,” said Goldhagen, the professor of pediatrics at the University of Florida College of Medicine.
Gambineri, the spokeswoman for the Florida Department of Health, said the children didn’t suffer as a result of the switch, because the insurance plans they were moved to were “more than capable” of caring for them. She added that even before the 13,074 children were switched, those plans cared for tens of thousands of children with special health needs.
Other pediatricians agree that plans besides CMS have done a good job of caring for these very sick children.
The other plans “do a pretty good job with our families,” said Dr. Karalee Kulek-Luzey, medical director of the Pediatric Health Care Alliance, a group practice with multiple locations in the Tampa area. “They’re working really hard.”
“For the most part, they do a good job,” said Dr. Michael Freimark, a pediatrician in Plantation, Florida.
“We have a good relationship with the plans,” said Dr. Michael Gervasi, president and chief executive officer of the Florida Community Health Centers, a large medical practice with offices in several counties. Most of the time, he said, the plans take care of the children’s needs, but if there’s ever a problem, his practice contacts the plan, and they fix it.

Aref's older sister, Yasmeen Shabaneh, was also was removed from Children's Medical Services. She has a vision condition so serious that even a minor bump could cause her retinas to detach.

Florida’s ‘outreach’ to experts

In January 2016, about eight months after the Florida Department of Health started to move the 13,074 children out of CMS, Jennifer Tschetter, then the department’s chief operating officer, testified before the state legislature. She said that the decision to use the Hopkins screening tool was made “in consultation with … national experts.”
But it remains unclear who those experts were.
Tschetter, who has since left state government, did not respond to phone calls and emails seeking comment.
Gambineri, the Florida health department spokeswoman, said the department did “research” into what Louisiana, California, Texas and New York “were doing and experiences they had in regard to clinical eligibility for children with special health care needs.”
When asked for the names of individuals Florida consulted in those states, Gambineri didn’t respond.
Gambineri added that “outreach” was made to the federal Health Resources and Services Administration.
An official at that agency said she spoke with a Florida health official.
Dr. Marie Mann, senior medical adviser in the Division of Services for Children with Special Health Needs at the federal agency’s Maternal and Child Health Bureau, said she spoke with Stannard, who works for the Florida Department of Health.
Mann says she told Stannard she couldn’t give her any guidance.
“I told her I was not in a position to provide advice,” Mann said.
Mann said she suggested that Florida health officials reach out to Daniel Armstrong and Dr. Jeffrey Brosco, director and associate director respectively of the Mailman Center for Child Development at the University of Miami Miller School of Medicine.
“We will make sure they’re both involved in this review process,” Stannard wrote back to Mann in an email obtained by CNN under the Freedom of Information Act.
CNN asked Gambineri, the department spokeswoman, whether the department ever reached out to Armstrong to review and make recommendations on using the telephone survey to screen children out of CMS.
“Not to our knowledge,” Gambineri answered.
“I played no role in the decision-making process related to the use of the tool for the Children’s Medical Services program,” Armstrong wrote in an email to CNN.
Brosco said he told the Department of Health that in his opinion, a child should not be kicked off CMS based on a parent’s answer to the question about the child’s limitations.
“I gave them my feedback, and they said, ‘thank you for your work,’ ” Brosco said.
In July, Brosco was named the Florida Department of Health’s deputy secretary for CMS.

Christmas shopping at the Florida Mall

Despite the lack of support from the very experts they’d consulted, Florida health officials forged ahead with using the phone survey to disqualify children from CMS.
They had a schedule to stick to.
In November 2014, state officials set out to “go live” with the phone survey in six months, according to a timeline developed by the state and obtained by CNN under the Freedom of Information Act.
Before implementing the surveys, the officials gave themselves 21 days to “solicit feedback from the field” about the questions they would ask the parents.
One of the first things they did was to ask one of the state’s most experienced pediatricians to leave a meeting.
It was St. Petery, who at the time was the executive vice president of the Florida chapter of the American Academy of Pediatrics and who has an encyclopedic knowledge of Medicaid rules and regulations. He’d served as interim director of CMS for six months during the mid-1970s.
He’d also been a thorn in the side of the state Department of Health for years. He’d been instrumental in a lawsuit that accused the state of failing to reimburse doctors properly in the Medicaid program and to ensure that children receive adequate care.
His side eventually won that lawsuit, and the American Academy of Pediatrics gave him a prestigious award for being “a tireless advocate for children’s health and well-being.”

Dr. Louis St. Petery, a pediatric cardiologist and frequent critic of Florida's health policy, was asked to leave a state meeting where Children's Medical Services screening was discussed.

On December 13, 2014, St. Petery showed up at the Department of Health meeting. It was for the regional medical directors of CMS, the group of pediatricians who help run the program. St. Petery wasn’t one of the directors, but he’d been attending their meetings for many years in his role with the Florida chapter of the American Academy of Pediatrics.
St. Petery said that just before the meeting started, Tschetter, then the department’s chief operating officer, approached him.
“She said, didn’t I want to go Christmas shopping at the Florida Mall?” St. Petery remembered. The mall was adjacent to the conference center in Orlando where the meeting was taking place.
St. Petery said he told Tschetter that he hates shopping, especially around the holidays, and wanted to stay at the meeting.
“I protested. I asked her, is this meeting not in the sunshine?” he said, referring to Florida’s Sunshine Law, which gives the public the right to access most government meetings.
“After she told me for the third time to leave, I decided not to create a scene,” he said.
St. Petery got up and left.
Other doctors watched the action, stunned.
“We were all kind of shaking,” said Dr. Barbara Rumberger, one of the CMS regional medical directors who attended the meeting.
After St. Petery departed, health officials explained that they would start screening children off of CMS. Their justification: a new analysis showing that half the children on CMS might not belong there.
There are no minutes for this meeting, according to Department of Health officials, but a year later, Tschetter presented similar data to the Florida Legislature.

A ‘totally inaccurate’ analysis

By Florida law, a child can be in CMS only if he or she has a “chronic and serious” condition requiring health care “of a type or amount beyond that which is generally required by children.”
The analysis Tschetter presented showed that about half of the children on CMS had lower than average risk scores, an assessment of how much a patient uses health care services.
Tschetter called these results “surprising.” By legislative mandate, children on CMS are supposed to have health needs greater those of other children.
“The analysis made clear, certainly to the department, that we were not meeting legislative direction: (that) the children in the plan have both chronic and serious health care conditions,” Tschetter told legislators. “It was clear to the department that something had to be done, because complying with legislative direction is certainly not optional.”
But an expert who developed the software Florida used to make that data analysis said the state did its calculations incorrectly.
“It’s totally inaccurate,” said Todd Gilmer, co-developer of the Chronic Illness and Disability Payment System and chief of the division of health policy at the University of California, San Diego.
Gilmer’s software, which is used by dozens of state Medicaid programs, tracks patients’ diagnoses and their prescription drug use to calculate risk scores for each individual.
After viewing Florida officials’ analysis of the data, he said they made two errors when they calculated that half the children on CMS had below-average risk scores.
First, he explained that his software relies on doctors’ diagnoses, and Florida failed to account for the fact that doctors frequently don’t document a child’s full diagnosis in the medical record. For example, if a quadriplegic child goes to the doctor because of bedsores, doctors often write down the reason the child came in — the bedsores — instead of the more serious diagnosis of quadriplegia.
Second, he said, Florida did the wrong calculation for disabled children, who represent 40% of the patients on CMS, according to Mallory McManus, a spokeswoman for Florida’s Agency for Health Care Administration.
He said his software compares disabled children with each other. Even the ones who fall in the lower half of the risk-score spectrum still have serious and chronic illnesses, he said, such as HIV or heart failure.
He said that what Florida did was akin to assembling a group of people who are over 7 feet tall and calling the bottom half of that group short.
Gilmer called Florida’s analysis “kind of bizarre” and said he was disappointed to see his software “misapplied” by the Florida Department of Health.
Spokeswomen for the Florida Department of Health and the Agency for Health Care Administration did not respond directly to Gilmer’s criticism.
Gambineri, the health department spokeswoman, said that the department no longer uses the screening method that it used in 2015 and that parents can ask to have their children re-screened at any time.
“Our mission is now and has always been to provide the best health care possible to the populations that we serve,” McManus wrote in an email.

Pediatrician: ‘We were just irrelevant’

Pediatricians say that by the time the Department of Health meeting was held at the Orlando conference center at the end of 2014, they felt like Florida was dead-set on screening a large number of children off CMS.
They said state officials didn’t listen to their concerns, even though they were stated repeatedly, both in person and in writing.
At the meeting, health officials asked the pediatricians to tell them what was on their minds, according to Rumberger, one of the doctors who was there.
She said she and her colleagues brought up concerns that children might be taken off CMS inappropriately.
The Department of Health official wrote down what the doctors said on pieces of paper taped to the wall, Rumberger said. The official then told the doctors that these were issues to discuss at another time.
“She said, ‘We’re going to park these. We’re putting these ideas in the parking lot for some time, and we’re not talking about these things today,’ ” Rumberger remembered, adding that she was speaking on behalf of herself and not in her role as a CMS regional medical director.
“We were all amazed at what they did,” she added.
A few months later, the state held a series of telephone conference calls with the same CMS regional medical directors.
“They didn’t ask us ‘What do you think?’ or ‘Do you have any suggestions?’ ” Rumberger said. “It was just ‘This is how we’re going to do it.’ It was clear they didn’t want to have a free discussion.”
“It appears to be a very conscious decision to not get input and not receive any dissension,” said Goldhagen, the professor of pediatrics at the University of Florida. “We were just irrelevant.”
Dr. Rex Northup, another CMS regional medical director and associate professor of pediatrics at the University of Florida College of Medicine, agrees.
“It was like, ‘When we want your opinion on a given topic, we’ll let you know, and we’ll provide that opinion to you,’ ” Northup said, adding that he speaks for himself and not the university or any other institution.
Several doctors present on those conference calls said they voiced their concerns anyway.
There’s no record of these concerns. According to the Florida Department of Health, no minutes were taken of these phone conferences.
CNN asked the Florida Department of Health about the meeting where St. Petery was asked to leave and about doctors’ complaints that the state steamrolled through a screening tool that would harm sick children.
“When CMS began the process of implementing a new screening tool in 2014, the department may have underestimated the need for stakeholder input and the time required to obtain feedback and ensure our community was comfortable with the mechanisms for determining clinical eligibility,” responded Gambineri, the Department of Health spokeswoman.
She added that the department has “engaged our stakeholders using several methods” including public meetings to solicit input from patients, parents and providers and “remains open to feedback and input in order to best serve children with serious and chronic medical conditions.”
True to its schedule, the state started screening children off CMS in May 2015.
Florida pediatricians repeatedly told the state that it was hurting sick, vulnerable children.
In August 2015, Goldhagen, Rumberger, Northup and 11 other doctors with positions at CMS wrote a letter to a Department of Health official saying the screening process was “flawed” and was removing too many children.
The doctors did not receive a response, Goldhagen said.
Two months later, St. Petery wrote to Department of Health officials, sharply criticizing the use of the screening tool.
He said he never received a response, either.

Dr. Elizabeth Curry, examining Micah Creamer, says she wrote to the Florida Agency for Health Care Administration, expressing her concerns about patients being kicked off Children's Medical Services, but the agency didn't respond.

Curry, the Port Saint Joe pediatrician who practices in a rural area of the Florida Panhandle, said she also complained to the state’s Agency for Health Care Administration about children being kicked off CMS, along with other issues affecting children on Medicaid.
She said the agency worked with her on some of the other issues but didn’t respond to her complaints about the children being taken off CMS.
“Our Agency has been in contact with the provider and is working with the health plan to resolve what issues might be resolved,” wrote McManus, the agency spokeswoman.
Curry said she took her complaints even higher.
“I even called the governor’s office once and left a message,” she said. “I admit that I finally gave up. I’m just trying to take care of my patients.”
Pediatricians interviewed for this story said they felt pressure from the state not to speak to the media about the removal of the children from CMS.
On November 15, 2016, Dr. John Curran, then the Florida Department of Health’s deputy secretary for CMS, said on a conference call that a CNN reporter was working on this story, according to several doctors on the call.
That evening, a department official wrote an email to the doctors who’d been on the call. It advised these pediatricians that prior to responding to media inquiries, they should contact the department’s communications director.
“I’m going to be so fired for saying all these things,” Rumberger said.
But she and other pediatricians say they’re speaking up because they feel that the Department of Health hurt children because they didn’t listen to their concerns.
They say it could be because pediatricians don’t tend to have millions of dollars to donate to political campaigns.
But insurance companies do.

‘Like a plot in a Carl Hiaasen novel’

All of this — the telephone survey, the question about limitations, the analysis that’s been called flawed — leaves many Florida parents and pediatricians suspicious about why the state wanted to take 13,074 children off CMS and why it worked so hard and so quickly to do it.
Switching the children from CMS to the other Medicaid plans didn’t save taxpayers money, according to McManus, the agency spokeswoman.
The doctors wonder, then, whether the inspiration for the change was political: to send taxpayers’ dollars to generous donors to the Florida Republican Party.
CMS is a public program; it’s not owned by a private insurance company.
When the children were taken off CMS, they were switched to 11 insurance plans that are owned by private companies. The parent companies of nine of those 11 plans donated a total of more than $8 million to Florida Republican Party committees in the five years before the children were switched.
“I knew it had to be about money,” said Wright, the pediatric endocrinologist in Tallahassee who said that dozens of her patients had their insurance switched. “This sounds very believable for Florida, and I’m from Florida.”
“When this was all unfolding, I told my office manager, ‘I feel like we’re in a plot in a Carl Hiaasen novel,’ ” she added, referring to the Miami Herald columnist who writes about politics and corruption in Florida.

Dr. Nancy Wright, a pediatric endocrinologist, says she thinks the state's motivation for taking patients off Children's Medical Services "appears to be about money. ... It's clearly not medical."

The companies that own the nine insurance plans contributed $8.6 million to Florida Republican Party committees from 2010 to 2014, according to an analysis done for CNN by the National Institute on Money in State Politics, a nonpartisan nonprofit group.
Here’s a breakdown of how much money each insurance company with a Medicaid contract contributed to Florida Republican Party committees from 2010 to 2014:
  • $5.9 million from Blue Cross and Blue Shield of Florida. Florida True Health is an affiliate of Blue Cross and Blue Shield of Florida. At the time the money was contributed, Florida True Health owned 40% of Prestige Health Choice, which has a Medicaid contract with the state of Florida. In 2015, Florida True Health purchased Prestige outright.
  • $90,000 from Simply Health, which owns a Medicaid plan called Better Health.
  • $849,433 from Miguel Fernandez, the former chairman of Simply Health. In addition, Fernandez donated about $1.3 million to Scott’s Let’s Get to Work political action committee from 2010 to 2014.

Insurance companies’ outsize contributions to Florida Republicans

Nearly all states pay insurance companies to insure some of their Medicaid patients; this is not unique to Florida.
And insurance companies often contribute money to state political parties. That’s not unique to Florida, either.
What is unusual is the size of the contributions, even for a large state.
Take UnitedHealthcare, an insurance giant with business in all 50 states. From 2010 to 2014, United contributed $442,500 to Florida Republican Party committees, according to the National Institute on Money in State Politics.
The company’s next largest contribution to any other state political party was $145,000 to California Democrats — less than half the Florida amount.
Humana, another insurance company with a national reach, gave substantially more money to Florida Republican Party committees than to any other state political party committees.
From 2010 to 2014, Humana donated $482,815 to Florida Republican Party committees. Its next largest contribution was $213,823 to Florida Democrats. The next largest contribution after that was $22,000 to the Illinois GOP, less than one-20th the size of the contribution to Florida Republicans.
Blue Cross and Blue Shield of Florida gave Florida Republican Party committees $5.9 million from 2010 to 2014 and gave Florida Democrats $1.8 million. The next largest contribution after that from any other Blue Cross and Blue Shield company in the United States was $730,696 from Blue Shield of California to Democrats in that state — about one-eighth the size of the contribution to Florida Republicans.

Florida’s payments to the insurance companies

Nearly all states pay private insurance companies monthly premiums to insure Medicaid patients. It’s become big business.
The Florida Department of Health declined to say how much it paid the private insurance companies to insure the 13,074 children when they were switched out of CMS.
“If they got 13,000 new kids, (it’s) that times however many dollars per member per month,” St. Petery said. “I think that’s a lot of money when you start talking about that many kids.”

LJ Stroud sued the state of Florida to be put back on Children's Medical Services. He has now had the procedures that he needs.

These children came from CMS, a Medicaid program for sick children, and the state pays insurance companies more money to care for such children.
This is how it works, according to McManus, the spokeswoman for the Florida Agency for Health Care Administration.
Florida takes a look at all the people who’ve signed up with an insurance company and calculates a risk score for that group based on factors such as the age of the enrollees in the plan and their health conditions.
A plan with the lowest risk score has a “typical population” and might be paid a rate of, for example, $320 per person per month, McManus said. A plan with sicker enrollees might have a risk score that’s twice as high and so would be paid $640 per person per month, she added.
The numbers can get even higher from there.
“The state will pay a pretty good rate for these children,” said Agrawal, the pediatrician at Northwestern who studies health care systems for children with special medical needs.
“They could get paid thousands more per month for a child with serious medical needs,” said Steve Schramm, founder and managing director of Optumas, a health care consulting group.
“The enhanced reimbursement may be 10 times what the insurance companies get for a well child,” said Goldhagen, former director of Florida’s Duval County Health Department.

Yasmeen Shabaneh sued Florida and was placed back on Children's Medical Services.

Sick children are, of course, also costlier for insurance companies because they need more care. But insurance plans monitor that care to manage costs.
“Plans have gotten very sophisticated in their ability to manage very sick kids, so their willingness to take very sick kids is great,” said Jeff Myers, president and CEO of Medicaid Health Plans of America, an industry group representing insurance companies.
Pediatricians questioned whether such outsize political donations were an attempt to gain influence and favor with Florida’s Republican administration, which orchestrated the transfer of the children out of CMS and to the private companies.
“It certainly raises a lot of suspicion and concern,” said Northup, the associate professor at the University of Florida College of Medicine.
“Why would they make contributions in the hundreds of thousands and the millions to Florida Republicans? Why would they be so uniquely committed to Republicans in Florida? It gives one pause,” he added. “If you follow the money, at the very least, it’s worrisome.”
“It’s the left-hand-washing-the-right-hand kind of business,” said Dr. Joseph Chiaro, who was Florida’s deputy secretary of health from 2005 to 2011. “It breaks my heart.”
Six Florida pediatricians gathered in Orlando to tell CNN their concerns. They practice in rural, suburban and urban areas. Some of them are Republicans, and others are Democrats.
They said they feared that big donors had influence on the state’s decision-making process and that in many cases, the children suffered as a result.
“I don’t see this in writing anywhere, but my impression is, this was a way for political payback at the expense of the sickest of the Medicaid children,” St. Petery said.
“It just comes back to money or power. It’s not about health care for the children,” said Wright, the pediatric endocrinologist in Tallahassee.
“Just follow the money,” said Colaizzo, who runs a rural health care clinic in Pahokee, Florida.
State leaders “don’t give a damn about the kids. They don’t give a damn about the families,” said Dr. Marcy Howard, a pediatrician in Crystal River, Florida.

State officials and insurance companies respond

State health officials did not respond directly to the pediatricians’ concerns that campaign contributors had influence over Republican leadership’s decision to take the children off CMS.
“The Statewide Medicaid Managed Care program was designed to provide comprehensive care to recipients through high quality health plans with a payment structure designed to ensure that plans paid an appropriate rate based on the health conditions of those enrolled in their plan,” McManus, a spokeswoman for the Florida Agency for Health Care Administration, wrote in an email.
“The program currently covers more than 2 million of Florida’s children, offers the strongest provider network and access standards in program history, and provides families with a choice of high quality, nationally accredited plans so that they can choose the plan that best suits their needs, including specialty plans for those who qualify.”

Alejandro Rodriguez also sued the state of Florida and was placed back on Children's Medical Services.

CNN reached out to officials at all nine insurance companies. Two responded.
“WellCare contributes to a variety of organizations that shape health care policy, including the Florida Republican Party committees, the Democratic Party committees and those without political affiliation,” wrote Alissa Lawver, a spokeswoman for WellCare. “The company also discloses and publicly reports all political contributions on its website above and beyond the requirements of state and federal law. As a provider of managed care, WellCare is committed to partnering with the state of Florida to provide access to quality, affordable health care solutions for the state’s most vulnerable populations. We maintain a robust provider network and offer comprehensive care management services to create personalized, coordinated care plans to help improve and maintain the health of families and children across the state.”
She added that WellCare has accountability to Florida’s Agency for Health Care Administration, “which provides careful oversight of the state’s Medicaid program to ensure all members, including children that transitioned from Children’s Medical Services, receive access to the right care, at the right time and in the most appropriate setting.”
Ethan Slavin, a spokesman for Aetna, said the company makes “donations to campaigns for both major political parties to support and address issues that impact our customers and members.”
He added that “we are required to meet state rules and regulations regarding our network of health care providers and are consistently compliant with those requirements” and that “we regularly work with our members, health care providers and the state of Florida to move children with special health care needs into the Children’s Medical Services program, when appropriate and in the best interest of our members. Our integrated care management program regularly identifies these children and assists in this process.”
Miguel “Mike” Fernandez, founder and former chairman of Better Health, said he had contributed several million dollars to both Republicans and Democrats. He added that states move Medicaid patients into the care of private companies so they can “move the risk off their financial books.”

A victory for Florida families

Many pediatricians use strong language to describe their anger and frustration with the Florida Department of Health and what it did in 2015 to the 13,074 children.
“This has just been a nightmare, and we’re still experiencing the fallout,” said Dr. Toni Richards-Rowley, treasurer of the Florida chapter of the American Academy of Pediatrics.
“It’s disgusting,” said Cosgrove, the pediatrician in Merritt Island. “It’s all about money and not looking out for the children.”
“Honestly, it makes me want to puke,” said Lida Sarnecky, nurse manager of the team at the University of Florida that takes care of children with cleft lip and palate.
“In my heart, what I want to do is go down to Governor Scott’s office and ask him, ‘What if this were your child or grandchild who couldn’t receive the care they needed? How would you feel then?’ ” she said.
By June 2015, some Florida parents had had enough.
Five children, including Alejandro Rodriguez, and Yasmeen and Aref Shabaneh, sued the state Department of Health to get it to stop using the telephone questionnaire to take patients off CMS, claiming that the state Department of Health hadn’t gone through formal rulemaking procedures.
The children won.
The state didn’t fight the ruling. Instead, it came up with a new way to screen children for the program — one that doesn’t rely on a telephone survey and takes into consideration a child’s diagnosis.

Aref Shabaneh lost his Children's Medical Services coverage when his mother told the state he didn't have limitations. "Aref wants to do everything by himself," she said.

Many parents and pediatricians assumed the state would soon reach out directly to parents to let them know they could reapply to have their children put back on CMS.
They were very wrong.
Five months after the judge’s decision, St. Petery, the Tallahassee pediatric cardiologist, implored the secretary of the Department of Health to reach out to parents.
To St. Petery, the reasoning was obvious: A judge had said that the state had violated the law. Reaching out to the parents was a way of correcting wrongdoing.
The state had a notice on its website about the ability to be rescreened for CMS, and at a meeting with state legislators, a department official had given out a phone number parents could call. But St. Petery knew that busy parents of very sick children might not attend official state meetings or notice pages on government websites.
“I would hope that you would consider notifying each of the parents of those 13,074 children that the tool by which their child was screened out of CMS has been declared invalid, and that they have the right to appeal that decision,” St. Petery wrote to Dr. John Armstrong, then secretary of the Department of Health and the state surgeon general.
Armstrong wrote back that doing so would violate federal regulations, since the children had been switched to other Medicaid insurance plans.
“Federal regulations prohibit direct marketing to children currently being served by another managed care plan,” he wrote back to St. Petery.
CNN was unable to reach Armstrong for comment. Gambineri, the Florida Department of Health spokeswoman, said he “is no longer employed by DOH.”
Not satisfied with Armstrong’s response, St. Petery sought help from US Rep. Kathy Castor, a Democrat from Tampa. Castor took his concerns to the federal Centers for Medicare and Medicaid Services.
On March 23, 2016, an official at that agency sent an email to Justin Senior, then the Medicaid director at Florida’s Agency for Health Care Administration. CNN obtained the email under the Freedom of Information Act.
In that email, the federal official explained to Senior that federal regulations do not prohibit Florida from reaching out directly to families.
“To clarify, 42 CFR 438.104 does not prohibit marketing,” wrote Jackie Glaze, associate regional administrator for the Division of Medicaid and Children’s Health at the Centers for Medicare and Medicaid Services, citing a federal regulation.
More than a year later, on July 24, 2017, the Florida Department of Health sent a letter to parents letting them know that their children could be screened to get back on CMS. The letter was sent to 6,081 parents whose children were removed from CMS and put on another Medicaid plan and were still on that plan and financially eligible for Medicaid, according to Gambineri, the Florida health department spokeswoman.
That letter was sent nearly two years after the judge’s decision. Pediatricians say they’re angry it took that long to directly let parents know about the possibility of getting back on CMS.
Gambineri said there was concern that parents might get confused.
“It was originally thought to be, and still is considered a risk, in terms of confusion and disruption to families, to send a letter because they have had rescreening available since 2015,” Gambineri said a few months before the letter was sent out.

Nelson Mandela and Mr. Rogers

Now that LJ Stroud is back on CMS, he’s a happy, strapping 13-year-old who loves to play football and horse around with his brother and sisters in the family’s backyard in St. Augustine.
But his mother looks back on the dark days in 2015, after her son was switched off CMS, when she says he would lie on the couch in pain, unable to get the surgeries he needed.
It’s not just her son’s physical pain that makes Stroud angry; it’s his emotional pain.

Since LJ Stroud was placed back on Children's Medical Services, he's been able to play football again.

When LJ was on CMS, Stroud says, he received excellent care and was a contented, well-adjusted child, never thinking of himself as different despite his birth defect.
But she says that when he was in pain because he couldn’t have surgery, he started to feel sorry for himself.
” ‘Why did God make me this way?’ ” she says he asked. ” ‘Why can’t I be like my brothers and sisters?’ “
When she hears about how top Florida officials have spoken with pride of what they did to her son and to more than 13,000 other children, she becomes livid.
Last year, Armstrong, then Florida’s surgeon general and secretary of health, made a presentation to the Florida Children and Youth Cabinet, a panel created by the state Legislature to promote children’s welfare.
Declaring that the Department of Health “cares about every child in Florida,” Armstrong explained how the state removed the 13,074 children from CMS.
Armstrong’s presentation quoted two great advocates for children, Nelson Mandela and Fred Rogers.
First, he quoted Mandela: “There can be no keener revelation of a society’s soul than the way in which it treats its children.”
And he quoted Fred Rogers, the star of the children’s television show “Mister Rogers’ Neighborhood”: “Anyone who does anything to help a child in life is a hero to me.”
Stroud struggles for words to describe what she thinks of Armstrong quoting these two champions for child welfare.
“It’s just — it’s just disgusting,” she said. “I feel my blood boiling just thinking about it.”

New York Health Dept. Proposes Medical Marijuana Improvements

(THIS ARTICLE IS COURTESY OF THE MPP WEBSITE)

 

New York Health Dept. Proposes Medical Marijuana Improvements

 Aug 10, 2017  


The New York Department of Health proposed additional changes to the state’s medical marijuana program today. While the official proposed regulations will not be released until August 23, the changes appear to be very positive. Once the rules are released, the public will have 30 days to comment.
New forms of medicine would be allowed, including topicals and chewable lozenges, as well as “[c]ertain non-smokable forms of ground plant material,” which will hopefully be clarified in the full text of the regulations. Having whole plant cannabis available for vaporization could dramatically reduce prices for patients, and we will seek to make sure it’s permitted.
Other changes would reduce burdens on medical professionals, hopefully encouraging more of them to participate. For more information and the complete list of proposed changes, you can read the Department of Health’s full announcement.

Marijuana: New Hampshire Adds Chronic Pain to Qualifying Conditions

(THIS ARTICLE IS COURTESY OF THE MPP WEBSITE)

 

New Hampshire Adds Chronic Pain to Qualifying Conditions

 Aug 17, 2017  


New Hampshire’s therapeutic cannabis law is finally expanding to include patients who suffer from chronic pain. HB 157 went into effect on Tuesday, adding “moderate to severe chronic pain” as a qualifying condition. This new law will allow many more Granite Staters to use cannabis as an alternative to prescribed opioids — a critically important reform for a state that is struggling to turn the tide against opiate addiction.

Until this week, patients could only qualify with a pain diagnosis if their pain was deemed to be “severe” and related to one of the specific medical conditions provided for in the law. As a result, it was much easier for medical providers to prescribe opioids than to certify patients for therapeutic cannabis. Patients who would like to apply now that the law has changed can access the updated application forms here.

For those who are waiting for the addition of post-traumatic stress disorder (PTSD), that is scheduled to take effect on August 27.

IDF Soldiers Work Within Program That Helps Autistic Children

(THIS ARTICLE IS COURTESY OF THE TIMES OF ISRAEL)

 

Soldiers, parents of autistic children, high school students and random volunteers joined forces in Tel Aviv to make life easier for people with autism and their caregivers.

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Some 85 people took part in a 24-hour hackathon last month organized by OFEK, the computing unit of the IAF. Held jointly with ALUT, the Israel Society for Autistic Children, people worked in groups to put innovation in the service of disability by creating an app or computer program for the benefit of the children.

“Until recently, the only treatment available for autistic children and adults in Israel was admission into psychiatric hospital,” said Arkady Gurevich, chairman of OFEK Alumni Association. “Even the necessary equipment or tools required to diagnose a patient as autistic are minimal or of poor quality due to costly-budget issues.”

The project also helped OFEK soldiers meet the three goals they abide by: “networking, working better together and contributing to society,” said Gurevich, who was in charge of ensuring the smooth running of the collaboration. “This is important for our soldiers as it allows us to put our knowledge into practice, all while continuing to learn at the same time, creating a lasting legacy of productive work.”

Gurevich explained that the hackathon’s 24-hour time frame “provides an indication of how quickly we can respond to a need through technology.”

Participating groups prepare for the start of the hackathon. (Dror Sitahkol)

Participating groups prepare for the start of the hackathon. (Dror Sitahkol)

Prior to the hackathon, ALUT organized several meetings in which therapists, specialists and psychologists educated the soldiers and volunteers about autism and the challenges of both the children and their parents. They introduced some 100 different challenges in total, out of which ALUT chose 13.

OFEK then divided all the participants into 13 different groups with each group tackling one task.

The challenges

The blank facial expression is a typical issue for autistic people who do not know how to show facial expressions when they are happy, mad or sad. The condition makes communication between autistic individuals and their caregivers extremely difficult as the facial expressions are impossible to read.

Participants try out some technology developed at the hackathon. (Dror Sitahkol)

Participants try out some technology developed at the hackathon. (Dror Sitahkol)

One group tackled this challenge by creating an app that aims to teach the autistic person how to express their feelings.

The app that was developed displays the an image of a smiling face and asks the person to imitate it. Then the app does the same for other feelings. The app monitors the expressions of the users to give them feedback if they are doing it correctly or not.

Navigation is another issue that burdens both people with autism and their caregivers. It is common for autistic persons going out in a group to want to wander off on their own. The navigation tools and apps currently available are complex to use due to an overload of information, and maps that are complicated to read.

One group aimed at simplifying the current tools by creating a GPS built-in wearable device for the autistic person. The device would then be linked to an app so that if one leaves the group’s perimeters, the instructor would get an immediate update on where the person is.

Another group tackled the inability of autistic individuals to maintain eye-contact. Autistic people have difficulty looking at one specific thing at the time. Quantifying the lack of eye contact would help doctors measure the severity of the autism, so the soldiers came up with a way to help doctors measure eye contact in an objective way — they created a camera-like device to monitor the patients’ eye contact.

This project with ALUT “is the first of many to come, as OFEK intends on using its soldiers’ powerful skills and knowledge to help one non-profit organization a year,” Gurevich said. “While the project took place in the form of a competition, the real prize was to bring attention to the autistic community of Israel and eventually develop what could be life changing technology for many.”

‘Our beautiful little boy has gone’: Parents of Charlie Gard say he has died

(THIS ARTICLE IS COURTESY OF THE WASHINGTON POST)

 

‘Our beautiful little boy has gone’: Parents of Charlie Gard say he has died

 July 28 at 6:20 PM
The lengthy legal battle over Charlie Gard
Charlie Gard’s parents ended their legal fight over the terminally ill infant’s treatment July 24. Here’s what you need to know about the legal battle over his life. (Monica Akhtar, Elyse Samuels/The Washington Post)

After months of fighting for Charlie Gard’s life — then pleading for time to bid him goodbye — the terminally ill British infant’s parents said Friday that he had died.

The 11-month-old boy’s case had elicited sympathy and support from Pope Francis and President Trump and inflamed an international debate over end-of-life rights.

His parents, Chris Gard and Connie Yates, announced his death a day after a British court ruled that the infant should be moved to hospice care and removed from a ventilator — as the pair pleaded for a few more days with their son, a spokesman for the family told BBC Newsthe Guardian and the Associated Press.

“Our beautiful little boy has gone,” Yates said Friday in a statement, according to British news reports. “We are so proud of you Charlie.”

The somber news of Charlie’s death reverberated across the world Friday evening.

Francis wrote in a message on social media, “I entrust little Charlie to the Father and pray for his parents and all those who loved him.”

Prime Minister Theresa May said she was “deeply saddened” and extended her “thoughts and prayers” to Charlie’s parents, according to BBC News. Vice President Pence‏ said on Twitter that he was “saddened to hear of the passing of Charlie Gard.”

I entrust little Charlie to the Father and pray for his parents and all those who loved him.

For several months, Charlie’s parents had been fighting in court to keep him alive. His case became the embodiment of a passionate debate over his right to live or die, his parents’ right to choose for their child and whether his doctors had an obligation to intervene in his care.

The bitter legal battle came to an exhausting and emotional end Thursday when High Court Judge Nicholas Francis made the decision to move Charlie to hospice care and let him die after Charlie’s parents and doctors could not agree on how much time the child should have to live. The judge said Charlie should be removed from the ventilator, which “will inevitably result in Charlie’s death within a short period of time thereafter.”

His parents had also lost a fight to let him die at home.

London’s Great Ormond Street Hospital, which had been treating Charlie, said it had been “a uniquely painful and distressing process” for everyone.

Charlie, who was born with a rare genetic condition called mitochondrial DNA depletion syndrome, sustained brain damage that had taken away his ability to see, hear and breathe on his own.

His parents had raised money to take him to the United States for an experimental treatment they had not yet tried, but doctors at Great Ormond Street asserted that the child had no chance of survival. The case trickled through the British court system and ended up in the European Court of Human Rights, which declined to hear it, upholding previous court rulings that it was in Charlie’s best interest to let him die.

It was that decision that thrust Charlie’s case into the international spotlight.

In June, the Vatican’s children’s hospital said it would admit the boy, with the pope saying on social media that “to defend human life, above all when it is wounded by illness, is a duty of love that God entrusts to all.”

To defend human life, above all when it is wounded by illness, is a duty of love that God entrusts to us all.

Charlie’s parents said the support had given them renewed hope. Hospitals in Rome and New York opened their doors, and the High Court gave his parents the opportunity to present evidence in the case.

Michio Hirano, a neurology expert at Columbia Medical Center in New York, and the Vatican’s Bambino Gesù Children’s Hospital initially said the experimental medical treatment might help Charlie, according to the Associated Press. But Great Ormond Street said that idea had done nothing more than give Charlie’s parents false hope that their son could recover.

Given the American invitations to assist Charlie, the court case also raised significant differences between British and American ethical approaches to experimental treatments.

In the United States, patients can be given certain drugs even if it is known that the drugs in question will not improve their condition, insofar as knowledge of their effects may improve the conditions of others in the future.

The same it is not the case in the United Kingdom, where, by contrast, doctors cannot administer treatments that know will not improve the patient’s condition in a specific case.

It was decided earlier this week that Charlie’s parents should let him go, when it became clear that the experimental treatment they wanted for their son was no longer possible.

After further medical tests, Chris Gard told reporters, “we’ve decided it is no longer in Charlie’s best interest to pursue treatment, and we will let our son go and be with the angels.”

“Had Charlie been given the treatment sooner, he would have had the potential to be a normal, healthy little boy,” Gard added. “We will have to live with the what-ifs that will haunt us for the rest of our lives.”

After Charlie’s death, Great Ormond Street said in a statement that it sent “heartfelt condolences to Charlie’s parents and loved-ones at this very sad time.”

This story has been updated. James McAuley contributed to this report from Paris.

Read more:

After losing battle to keep Charlie Gard alive, his parents are fighting to let him die at home

Charlie Gard not allowed to receive Vatican’s care, hospital spokesman says

Charlie Gard may have new hope: Hospital asks court to rehear case of terminally ill infant

Charlie Gard’s parents to present new evidence in case surrounding terminally ill son

London: Charlie Gard’s Parents Have Decided To Let Him Go

(THIS ARTICLE IS COURTESY OF THE CHRISTIAN POST)

 

http://www.christianpost.com/news/charlie-gards-parents-we-have-decided-to-let-him-go-193069/?utm_source=newsletter

How Cows Are Helping the Fight Against HIV

(THIS ARTICLE IS COURTESY OF TIME.COM NEWS)

 

How Cows Are Helping the Fight Against HIV

Jul 20, 2017
TIME Health
For more, visit TIME Health.

In an unexpected turn of events, cows are helping scientists better understand how to prevent HIV infections.

One of the biggest questions facing researchers developing a vaccine against HIV is why people who are infected do not efficiently make antibodies against the virus. Scientists estimate that only about 20% of people who are infected with HIV produce what are called broadly neutralizing antibodies (bNAbs): naturally occurring antibodies that can defend a cell against the virus. Even among people who do produce them, that production typically starts around two years after infection.

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“We are faced with a dilemma,” says Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID) , whose agency is supporting the new research. “People infected do not seem to make really good antibodies in terms of potency and breadth.”

So far, scientists have been unable to successfully induce the creation of bNAbs in humans through an HIV vaccine. This is where the cows come in.

In a new study published Thursday in the journal Nature, researchers at the Scripps Research Institute, the International AIDS Vaccine Initiative (IAVI) and Texas A&M University showed that they were able to induce potent antibodies against HIV in cows. Though cows do not get HIV, their immune systems produce unique antibodies against infections.

MORE: Why You Still Can’t Get a Vaccine for HIV

The researchers injected four calves with HIV immunogens, which are proteins designed to elicit an immune response to the virus. They discovered that the cows very rapidly developed bNAbs to HIV in their blood.

“I was shocked,” says study author Devin Sok, the director of antibody discovery and development at IAVI . “It was really crazy and very exciting. The responses developed very quickly — between one to two months — which is well beyond what we anticipated.”

The researchers were able to isolate antibodies from the calves and took a closer look. An antibody called NC-Cow 1 was revealed to be especially powerful when it came to attacking HIV.

“The kind of insight we get from studying this is an understanding of the mechanisms whereby the cows’ immune system is capable of creat ing these antibodies,” says Fauci.

Understanding how an immune system effectively develops antibodies against HIV, even if it belongs to a cow, is valuable information for scientists hoping to develop an HIV vaccine, especially if they can find a way to get the human body to mimic the creation of these antibodies. The new research also provides insight into how to develop new therapies or treatments for viruses that evade the human immune system.

“As a scientist, this is really exciting,” says Sok. “To put it into perspective, the first broadly neutralizing antibodies were discovered in the 1990s. Since then, we’ve been trying to elicit these antibodies through immunization, and we’ve never been able to do it until now. Until we have immunized a cow. This has given some information for how to do it so that hopefully we can apply that to humans.”

Senator John McCain Has Aggressive From Of Brain Cancer

(THIS ARTICLE IS COURTESY OF CNN)

 

Sen. John McCain, 80, has been diagnosed with a primary glioblastoma, a type of brain tumor, Mayo Clinic doctors directly involved in the senator’s care told CNN exclusively. The doctors spoke directly to CNN Chief Medical Correspondent, Dr. Sanjay Gupta.

The senator underwent surgery to remove a blood clot on Friday at Mayo Clinic Hospital in Phoenix. Lab results from that surgery confirmed the presence of brain cancer associated with the blood clot.
Glioblastoma is a particularly aggressive tumor that forms in the tissue of the brain and spinal cord, according to the American Brain Tumor Association.
A pathologist was in the operating room during the procedure, a minimally invasive craniotomy with an eyebrow incision, said his doctor, who added that the surgery lasted about three to four hours. Post-surgical brain scans show the tissue causing concern has been completely removed.
McCain is recovering “amazingly well,” according to a statement from his office.
The senator showed no neurological problems before or after the operation, said his doctors. Though not identified by name, at McCain’s request, his doctors were given permission to speak with Gupta, who is also a practicing neurosurgeon.
McCain is now recovering at his Arizona home. He and his family are considering treatment options, which will likely include radiation and chemotherapy, his doctors said.
“The news of my father’s illness has affected every one of us in the McCain Family,” tweeted Meghan McCain on Wednesday. “It won’t surprise you to learn that in all this, the one of us who is most confident and calm is my father.”

Routine exam

Doctors discovered the clot during a routine physical exam last week. They said he is very diligent about coming in for scheduled exams and is seen every four months for skin checks due to his history of skin cancer.
He arrived at his early morning appointment, Friday before 8 a.m. and as per usual, looked good, according to a doctor who has been involved in his care for nearly a decade. McCain, described as not being a complainer, did report feeling fatigued, which he attributed to a rigorous travel schedule.
He also told his doctor he had, at times, felt foggy and not as sharp as he typically is. In addition, he reported having intermittent double vision. These symptoms and doctor intuition prompted a CT scan.
When the results came back, McCain, who had already left the clinic, was asked to return for an MRI. Before the operation, his neurological exam was normal, according to his doctor.
The operation began in the late afternoon and the senator was recovering in the ICU by evening. His doctors told Gupta they were amazed at how sharp McCain was when he awoke. He knew what year it was and started cracking jokes. He also made it clear that he wanted to leave the hospital and get back to work, his doctors said.
Showing no signs of cognitive delays, McCain was discharged Saturday and has been recovering at his home since then.
His doctors would not reveal details but said his post operative care is standard.

‘Aggressive tumor’

His doctor said McCain was oriented, with good balance and no headaches or seizures.
The clot was over the senator’s left eye, not far from the left temple where he was diagnosed with melanoma in 2000. Previously, McCain had three other malignant melanomas removed in 1993, 2000 and 2002. None of these melanomas were invasive. All were declared Stage 0.
However, McCain has been regularly screened by his doctors since 2000.
Gupta was one of a select group of reporters who reviewed McCain’s medical records in 2008 when he was campaigning for president.
The surgical procedure McCain underwent is “a significant operation,” said Gupta, explaining that a bone underneath the eyebrow had to be removed to do the procedure and then later put back.
“It’s a very aggressive tumor,” said Gupta. He explained that average survival for malignant glioblastoma tends to be around 14 months with treatment. In McCain’s case, additional therapy, including radiation, could not begin until the incision heals, which would be in the next three or four weeks.
Still, one 2009 study reported that almost 10% of patients with glioblastoma may live five years or longer, according to the American Brain Tumor Association.
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“This is the same tumor that Ted Kennedy had,” said Gupta.
McCain’s diagnosis is the latest chapter in a storied life. Tortured as a Vietnam prisoner-of-war, the maverick politician fell short of the pinnacle of politics with two failed presidential runs. His absence from Washington in recent days has come at a politically inopportune time for a bill repealing and replacing Obamacare. This week, McCain broke ranks and called for discussions with Democrats and a full committee process to finally provide “Americans with access to quality and affordable health care.”

 

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