Monday, June 22, 2015

Bush Forgot Medicaid Fraud When He Privatized Florida Child Welfare

While this was a nice, snippet piece dealing with a preseidential candidate's background when dealing with issues of child welfare, the actual picture of the State of Florida's child welfare system is much dirtier in its levels of administration of its contracts.

The issues of Medicaid fraud in child welfare in Florida have continued to be ignored by the #DOJ and HHS health care fraud task force.

If Jeb Bush wants to take credit for launching privatization of Florida's child welfare system, then he better be man enough to talk about the Medicaid fraud that came with it...and the reasons why he did nothing to stop it.

Jeb Bush’s Florida Lost 500 Kids  
Former Florida Governor Jeb Bush

As governor, he inherited the worst foster-care system in the country and tried to change it. For some of the most vulnerable, it was too late.



Everything about Rilya Wilson’s death was horrific. She entered the Florida foster system a bright-eyed toddler, and disappeared when she was about 4 years old. And it took the state Department of Children and Families—responsible for vulnerable children like Rilya—two years to realize she was gone.

A witness in an ensuing criminal case said the girl’s caretakers locked her in a dog cage, beat her with switches, and tied her to her bed at night. Authorities never found her body. And an uncontroversial conclusion emerged: that these horrors destroyed Rilya because of the failure of the Florida Department of Children and Families.

Jeb Bush was the governor during Rilya’s disappearance and death. Now that he’s campaigning to be president, he talks often about the importance of taking care of society’s most vulnerable.

In his announcement video, he said that his core beliefs “start with the premise that the most vulnerable in our society should be in the front of the line, not the back.”

And in a June 19 speech to social conservative activists, he mentioned the state’s child welfare system and then said his administration “put the most vulnerable in society at the front of the line, guided by my faith.”

Few are more vulnerable than foster children, and as governor, Bush oversaw some sweeping policy changes that angled to get those kids better care.

And though the governor seems to relish all the wonky minutiae of immigration and education policy, he rarely if ever discusses foster care on the trail in any detail (none of the potential presidential candidates do).

Bush inherited one of—if not the—worst foster systems in the nation, and he changed it. A lot. But in the state, there’s still deep disagreement over whether or not he rectified the wrongs that let Rilya vanish and die.
“It has gotten worse over time,” Dr. George Rahaim, a psychologist who worked with the Department of Children and Families,said in May of 2002. “It is worse now, in my opinion, that it ever has been.”
When Bush became governor in 1999, Florida was a horrible place to be a foster child. Timothy Arcaro, a law professor at Nova Southeastern University, wrote a detailed and gut-churningpaper in 2001 laying out the enormity of the system’s flaws.

In his report, Arcaro cited one 1998 grand jury report that said, “[T]he problems facing the Department are extensive and so systemic that the children in the custody of or under the protection of the Department are in peril.”

Broward County’s foster care system was particularly bad.

“In addition to physical, emotional, and mental abuse, foster children in Broward County also suffered sexual victimization,” Arcaro wrote. “[A]n eight-year-old child forced to commit sex acts in foster placement; an eleven-year-old girl lured away by another foster child and then gang-raped by several men; a sexually aggressive teenager placed in a foster home with three younger children subsequently charged with sexually abusing one of the younger children, a four-year-old girl; foster parents gave a child a whistle to blow if older children in the foster home tried to sexually molest him.”

That grand jury report concluded that the children for whom the Department of Children and Families was responsible were “in peril.”

In other words, being ‘protected’ by the DCF was dangerous.

When Bush became governor, he made Kathleen Kearney the secretary of the department. And she wasn’t coy about its problems.

“We are on the Titanic,” Kearney, a former circuit-court judge, told the Sun-Sentineleditorial board. “We’ve been on it for decades.”

But the editorial board wasn’t impressed with Kearney’s plan for making things better.

“She’s showing skills better suited for re-arranging deck chairs on her favorite luxury liner,” they opined, concluding that her plans weren’t impressive and that she “may well become the next DCF secretary to go down with the ship.”

They were right.

After Rilya’s case became a national scandal—Bill O’Reilly tore into Bush over his connection to it—Kearney gave the governor her resignation. At the time, the department didn’t know the whereabouts of 500 of the children supposedly in its care. Comparing it to the Titanic might have been generous.

And during Bush’s first years in office, observers said the department’s problems metastasized.
“It has gotten worse over time,” Dr. George Rahaim, a psychologist who worked with the department, said in May of 2002. “It is worse now, in my opinion, that it ever has been.”

The department had an epidemic of caseworkers lying about checking in on the children in their charge. The Miami Herald reported that in the years before 2001, the department’s performance “in virtually every category” got worse, even though its budget had grown.

“[F]oster children continue to be abused at alarming rates,” the paper noted.

Observers couldn’t overstate the situation’s grimness.

“There is no place in the country where it is worse to be a foster child than Florida,” Richard Wexler, director of the National Coalition for Child Protection Reform, told Time in May of 2002.

Bush seems to have known it. Emails show him and staff going back and forth—in a very limited fashion—about foster kids’ deaths. At one point, he forwarded spokeswoman Katie Muniz the text of an AP story about 16 children dying while in the department’s care in 2001.

“let us discuss,” he wrote.

“sigh,” replied Muniz.

Twenty minutes later, he fired back.

“I would like an explanation of this,” he wrote.

In another email, he told Muniz to have Kearney call him. That phone conversation obviously wasn’t public record—as his emails are—but one could speculate it was tense.

Foster children weren’t without advocates, but their efforts often came up short. In the summer of 2000, children’s rights advocates sued Bush, Kearney, and the Department of Children and Families in federal court. The case, Foster Children Bonnie L. v. Bush, charged that the state showed “deliberate indifference” to the children’s rights. The plaintiffs also charged that the department treated black foster children worse than their white counterparts, and put less effort into trying to find them adoptive homes.

“One toddler from Flagler County is now partially paralyzed after being beaten by a foster parent,” reported the Sun-Sentinel, describing more details of the suit. “Two sisters from Manatee County were tied by their wrists and ankles to their beds by their adoptive parents and made to sleep on concrete surrounded by a brick cage. A 14-year-old Hillsborough County girl lived for a nearly a year in an overcrowded foster home where children were punished with hot sauce on their tongues and head dunkings in toilets.”

The suit also said that one plaintiff, 14-year-old Tanya M., shared a bedroom and a single dresser with seven other children and suffered “harmful weight loss” because she didn’t get enough to eat. Tanya eventually ended up back with her biological parents, and her father assaulted her and broke her arm. She then went back to an overcrowded shelter, and her caretakers planned to put her in a wilderness program designed as a “moderate risk delinquency commitment program”—in other words, a program for troublemakers —“even though she is not delinquent and has not committed any violations of law.”

Tanya ran away. She was one missing kid out of hundreds.

Ultimately, the United States Florida District Court dismissed most of the plaintiffs’ claims on the grounds of states’ rights, wrote John Pardeck (who was professor emeritus in Missouri State University’s school of social work) inChildren’s Rights: Policy and Practice.

The lawsuit’s small win was a promise from the Department of Children and Families “to reinforce a nondiscriminatory policy toward African Americans and older children,” Pardeck wrote. The attorneys appealed the dismissal of the other charges, but the Supreme Court refused to take the case.
So Bush won in court. But he knew things still needed to change.

His predecessor, Democratic Governor Lawton Chiles, had overseen the beginning of a movement toward privatizing the Department of Children and Families, which oversaw foster care.

On this front, Bush went all in. In a 2001 speech to the Dependency Court Improvement Program Summit,  Bush proclaimed that his state was “leading the nation in the quiet revolution of child welfare reform.”

That revolution doubled the funding for the state’s child welfare services, privatized the state’s entire child welfare service system and subcontracted out the work of caring for foster kids, Robert E. Crew Jr., an associate dean of Florida State University’s College of Social Sciences, wrote in Jeb Bush: Aggressive Conservatism in Florida.

These actions essentially moved all the responsibility for the provision of child welfare services to the private, nonprofit sector, said Michael Dale, a law professor at Nova Southeastern University in Florida and an expert on juvenile and children’s law.

Each area of the state got a community-based corporation, or lead agency, to provide services, conduct evaluations, provide social workers, and subcontract further with other private providers.  
The state agency’s role shrunk dramatically, limited to contracting with private agencies, conducting oversight of them, providing lawyers for the department to litigate cases involving abuse or neglect, and handling the initial investigations in new cases.

Dale said he wasn’t impressed with the outcomes of Bush’s changes and he doesn’t think privatization was the right move.

“I don’t think it was a good idea, because it promised things that didn’t happen,” he said. “There is no evidence that it has succeeded in doing what it was supposed to do.”

Others defend Bush’s changes. Buddy MacKay, a Democrat who ran against (and lost to) Bush in 1998 and later spent a few months helming the department, praised the governor’s move.

“I think it's one of the finest things that has happened,” he told the Sun-Sentinel in 2011.
And that paper reported that Bush’s move to privatization brought good outcomes.

“By many existing yardsticks, the private agencies are doing better than the state did,” the paper reported in 2011. “Adoptions are up 200 percent, kids are being returned from foster care to their families faster and fewer children are harmed again once they go home, statistics show.”

Dale said he’s skeptical of any analysis like that.

“There have been public changes in policy after every major visible public event,” he said, referring to situations like Rilya’s disappearance and death. “I can tell you that to my knowledge, there has never been an objective evaluation of the impact of any of these things that have been done.”

And Rilya’s death was far from the last. In March of 2011, the Palm Beach Postreported that more children’s deaths had spurred debate about the wisdom of a privatized system.

In February of 2011, 10-year-old Nubia Barahona was found dead in her adopted father’s truck. Her adoptive parents have been indicted but not yet convicted. And the Department of Children and Families has drawn scorching criticism for failing another child.

Two weeks after Nubia’s death, the bodies of two more kids—Jermaine McNeil and Ju'Tyra Allen—were found. A community-based corporation was responsible for making sure they were safe in their home, but the Palm Beach Post noted that it never ascertained that the children were living with a convicted felon who could have been putting them in danger. The Sun-Sentinel reported that man’s case is underway.

The reality is that Florida has failed a lot of kids. Though Bush’s oversight and innovative policy-making might have helped protect children, the data isn’t clear. And more vulnerable Sunshine State kids are likely to face the same fates as Rilya, Jermaine, Ju’Tyra, and Nubia.

But that’s not good campaign trail material.

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