More than two years ago, Robert Latham and Cameron Riopelle launched a project to examine what they viewed as a troubling trend: Over many years, a significant percentage of appeals of Florida’s Medicaid iBudget Waiver decisions were denied. The federally authorized program exists to provide supports and services to eligible persons with developmental disabilities to help them live at home or in a home-like setting.
Experience representing clients and concerns raised by advocates led Latham, associate director of the School of Law’s Children and Youth Law Clinic, to conclude that the state agency was relying on nonstandard and outdated definitions of disabilities, resulting in an extremely high denial rate of administrative appeals. With Riopelle, director of Research Data and Open Scholarship and an associate professor with University Libraries, they explored the legal process and data to see if the denial rates were a systemic problem. The two University faculty members joined with Erica Musser, a clinical psychologist at Barnard College with long-standing research interests in developmental disabilities; and Jason Kahn, an attorney with Disability Rights Florida and specialist in developmental disability law.
The team was recently invited to present their findings to the National Council on Disability (NCD). The NCD provides advice to the president, Congress, and executive branch agencies to advance policies that promote the goals of the Americans with Disabilities Act. The team is currently compiling a white paper to be published within the coming weeks.
“Our hope is that this raises awareness of the number of people denied services despite having clinical diagnoses that would qualify them under modern definitions,” Latham said. “The state agency’s current standards do not accurately assess clinical need. We hope that this will lead policymakers to make changes that families have been seeking for a very long time.”
In his law clinic, Latham teaches and supervises students who handle cases involving abused, abandoned, and neglected children in a variety of forums, including dependency, administrative hearings, and appellate courts. Over the years, the clinic has handled many cases involving denials of iBudget Waiver eligibility.
He explained that the waiver, a federal Medicaid program, is used to support people with developmental disabilities to remain in their homes. Without these services, they may face institutionalization, homelessness, or serious harm.
Riopelle, a sociologist and statistician, highlighted that the Florida code is not using the current manual of diagnostic criteria that clinicians use. “The clinicians in the community who conduct the diagnoses for the appellants are using modern criteria drawn from the DSM-5, while the standards used by the state agency were developed more than 30 years ago largely from the DSM-4,” said Riopelle, who created the study design and guided the coding for the project.
Latham emphasized that their effort is aimed at supporting policy change.
“We came together to investigate this problem because we care deeply about the people impacted,” Latham said. “I've handled cases for years with children both in foster care and their family homes repeatedly denied support. This process needs to change so that more people have access to these services.”
