Saying that time is "of the essence," the U.S. Department of Justice on Tuesday offered to quickly meet with Florida officials about a federal investigation that found disabled children were unnecessarily being placed in nursing homes.
"Children in Florida are unnecessarily living in nursing homes,'' U.S. Assistant Attorney General Thomas Perez said in a letter to lawyers for three state agencies. "Other children are at serious risk of the same fate. Families are being separated, and parents are being forced to confront the cruel choice of struggling daily to find a way to care for their child at home without necessary supports or placing their child in a nursing facility."
The state has vehemently denied the findings of the investigation, which the Department of Justice released Sept. 4. Agency for Health Care Administration Secretary Liz Dudek released a statement late Tuesday that said the agency is open to meeting with Department of Justice officials to "clarify their misunderstanding."
"Florida cares about kids,'' Dudek said in the statement. "All medically necessary services are available to children enrolled in the state plan Medicaid program. Medicaid has a comprehensive medical service package that can accommodate any family who chooses to have their child at home and encourages children to be in the least restrictive setting that can best serve their needs."
Federal officials alleged in the investigative findings that the state is violating the Americans with Disabilities Act. In Tuesday's letter, Perez reiterated that the federal government could take the issue to court, saying that if "mutually agreeable resolution is not possible, we will not hesitate to take swift and appropriate legal action."
Also, Perez's letter said state officials refused to provide requested information during the investigation.
"You claim our findings are wrong; yet, you refused to provide information that could have informed the findings,'' Perez wrote. "As a result, we were forced to obtain our information from other sources."
Attorneys for the Agency for Health Care Administration, Department of Health and Department of Children and Families sent a terse letter to the Department of Justice on Sept. 14 in response to the investigative findings. That response said, in part, that the state "fundamentally disagrees with the (Department of Justice) letter's factual assertions and legal conclusions."
Dudek said Tuesday that state officials have visited all of the nursing homes that care for children and contacted the children's parents. She also said the state will request information that the Department of Justice used in the investigation.
It was not immediately clear when state and federal officials could meet, though Perez suggested a meeting within two weeks.
The investigation, which has received widespread attention, centers on 221 children with costly, complex medical conditions who have been placed in nursing homes. As examples of the severity of their conditions, 58 percent of those children have what are known as tracheostomy tubes to help them breathe, while 33 percent are on ventilators, according to the state.
The Department of Justice, which informed the state in December 2011 that it had opened the investigation, focused on part of the American with Disabilities Act that requires public agencies to ensure that disabled people "receive services in the most integrated setting appropriate to their needs." It said many of the children could live at home with their families or in community settings if adequate services were provided.
In the letter Tuesday, Perez said department attorneys and a consultant visited nursing homes, met with children and families and interviewed nursing-home staff, other service providers and advocates. The letter said department attorneys have continued to receive calls from families and advocates since the findings were released.
"The issues raised in our findings letter are not simply our concerns; they reflect the concerns of families across Florida struggling to keep their families together and to have their children grow up at home, with all the benefits that flow from home and community living,'' the letter said.