MEDICAID'Policy' denies nutrients to 1,000 Many children were eliminated from a program that pays for food supplements for chronically ill Floridians. More than a thousand severely disabled or chronically ill children who relied on state dollars for life-sustaining nutritional supplements have been cut off from Florida's Medicaid program, resulting in hundreds of thousands of dollars in savings to the agency, state officials acknowledged Thursday. Medicaid officials said they made ''major policy changes'' that limited the number of Floridians eligible for the feeding program -- including children with HIV or AIDS who suffer from so-called ''wasting syndrome'' and children and adults with terminal illnesses such as cystic fibrosis. The disclosures, some of which were made during a conference call with doctors and nutritionists who treat Floridians who depend on the supplements, came only two weeks after the state's highest healthcare official told lawmakers no trims in spending had been made. The policy changes worked: In June, before the changes, needy Floridians -- most of them with feeding tubes attached to their stomachs -- cost the state $1.1 million for food supplements. Last month, the Medicaid billings dropped to less than half that: $462,189, according to figures the healthcare agency provided The Miami Herald. Reacting to outrage over the changes, detailed in a March 12 story in The Miami Herald, the Agency for Health Care Administration's secretary, Alan Levine, blamed the problem on doctors' confusion over new paperwork and Medicaid's system for determining who is eligible for the feedings. He said he was suspending the paperwork changes while agency officials talked to healthcare professionals whose patients were affected -- some of whom had called Medicaid's refusals to pay for feedings ''cruel'' and ``dangerous.'' News that agency officials had acknowledged changes to the food supplement program angered some state lawmakers who are in charge of the agency's budget. Two weeks ago the agency assured the state Senate's Health Appropriations Committee that The Herald story detailing the inability of critically ill children to obtain subsidized food supplements was incorrect. Now, senators say, they suspect they didn't get the full story. ''It's horrible to think that an agency of the state of Florida would cut off life-sustaining nutrients to very, very sick children. It makes absolutely no sense. There's absolutely no excuse. And we're going to make sure it doesn't happen,'' said the committee's chairman, Sen. Burt Saunders, a Naples Republican running for attorney general. ''We asked them to respond to that [article] and they said it was more of a PR screw-up than anything else,'' Saunders added. ``I'm going to ask the agency to appear before this committee at our very next meeting. And we're going to make sure that there's no restriction on access to these food supplements for these children.'' Levine said Thursday the state's spending on supplement claims is ''alarming'' and described the program as ripe for abuse because some supplements can cost thousands of dollars each month. Still, he added, he is committed to paying for all supplements that are medically necessary. Even though fewer children are being fed by Medicaid because of decisions to curtail who can get state-paid nutrition, Levine continued to insist the agency imposed no ''cutbacks'' in spending for the supplements. He defines ''cuts'' as a deliberate decision to ask lawmakers for less money. ''There was no cut to the program,'' Levine said late Thursday. ``It has the same appropriation we had before. We did not cut funding.'' He said Medicaid provided a safety net in the new policies, allowing doctors to obtain ''prior authorization'' for supplements even for Floridians who technically do not meet the new criteria. What went wrong, he said, is doctors were unable to obtain the over-rides from the agency. ''That's why I suspended the procedure,'' Levine said. ``It clearly wasn't working the way it was supposed to work.'' The Medicaid changes have resulted in 2,090 fewer adults and 1,010 fewer children getting state-paid supplements in February, compared to June. Among the changes outlined Thursday to the doctors and nutritionists by Beth Kidder, bureau chief for Medicaid services: • Medicaid ceased reimbursements for children with HIV or AIDS who suffer from ''wasting syndrome'' or failure-to-thrive, a life-threatening form of malnutrition. One result: A 16-year-old Broward County girl, who has end-stage AIDS, has been denied feedings since the new policy took effect, Lauren Bernstein, a dietitian at the Children's Diagnostic & Treatment Center in Fort Lauderdale, told The Miami Herald. The girl suffers from severe malnutrition, and the ''high-calorie milk shakes'' Medicaid officials suggested in lieu of supplements won't provide adequate nutrition, Bernstein said. • Medicaid stopped reimbursements for adults who are able to receive even small amounts of food by mouth, such as people with cystic fibrosis who gain much of their nutrition through feeding tubes but can also eat some solid food. • Medicaid stopped paying for supplements for children who receive at least half their food by mouth. • Medicaid will not pay for supplements for children who are capable of eating and digesting solid food. But even though children with kidney failure can eat solid food, the disease leaves them with no appetite, Pat Hare of All Children's Hospital in St. Petersburg told Medicaid officials, according to agency records. They can suffer from malnutrition and failure to thrive -- which are not covered diagnoses. During the conference call, a handful of healthcare workers complained the state has made it extremely difficult to get approval for nutritional formula even for people who qualified under the new policies. Nutritionists said they were never told about new billing ''codes'' that were necessary to gain approval. Clara St. Thomas, a pediatric nutritionist at the University of Miami, said later Thursday: ``They changed the rule book and they didn't tell us the rules.'' Even after state officials halted the new restrictions, some healthcare workers say they still can't get the state to pay for needed supplements. Bernstein said a 6-year-old boy with a rare genetic disorder, Opitz-Frias Syndrome, who gets all his nutrition through a tube connected to his small intestine, had been repeatedly denied supplements since February. When Levine announced he had suspended the new policies, she resubmitted the claim. On Monday, she said, the child's claim was denied again. ''That's absolutely unacceptable,'' Levine said after being told of Bernstein's frustrations. ``I will not go along with that.'' Sen. Ken Pruitt, a Port St. Lucie Republican who will become the next Senate president, said lawmakers will ensure that children get the supplements they need. ''We're going to fix it,'' Pruitt said. ``You always have concern if an agency comes forward and says one thing and is doing the opposite.'' BY CAROL MARBIN Herald staff writer Marc Caputo contributed to this report. MILLERcmarbin@MiamiHerald.com 2007 National Nutrition Month Article FAD DIETS The 1-Day Diet, the 48-Hour Diet, the 365 Days of the Year Diet… Seems like every day is a diet! It’s like searching for the Holy Grail. That miraculous diet that helps shed those unwanted pounds. Like fashion and music, what comes around goes around – and comes back around – like those unwanted pounds and diets. Ironically, many of the diets that have surfaced in the 2000’s date back to the 70s. Reminds me of those old clothes (i.e. flared pants, embellished jeans) we swore we’d never wear again! Think about it, how many diets that you know that have come and gone? The list can go on and on. The bigger question is, do they work to keep the weight off and can you do them for a long time? Fads come and go, but it seems that the terms dieting and weight loss have been around for awhile – and are here to stay. Everyday, the American Dietetic Association (ADA) serves the public, getting the word out by promoting optimal nutrition, health and well-being. But every year, in the month of March, they kick it up a notch. With about 65,000 members, the ADA is the nation’s largest organization of food and nutrition professionals. Ask anyone what March means and they will probably mention St. Patrick’s Day or the beginning of March Madness, but ask a registered dietitian or registered diet technician what March is – well, that is a whole other story. They won’t mention clovers or basketball! Sure those events happen, but ADA professionals know March is National Nutrition Month®! It’s the time of year to spread the world nationally about health and nutrition – the importance of making informed food choices and developing eating and physical activity habits. This year the campaign is promoting 100% FAD FREE! So what is the 411 on Fad Diets? Type in fad diet on the computer, search and you can only imagine the hits you get – credible or not. The ADA defines "food fads" as "unreasonable or exaggerated beliefs that eating (or not eating) specific foods, nutrient supplements or combinations of certain foods may cure disease, convey special health benefits or offer quick weigh loss." Simply stated, a fad diet is a weight-loss plan or aid that promises dramatic results – not focused on long-term success. Whether it is the latest "candy bar plan" (fictitious) or a science-based approach plan; the bottom line is if you follow a diet that promotes a calorie deficit, you will most likely shed some pounds. The question is which plan is healthier for you in the long run – a plan that is there for the moment (fad diet) or a way of eating that you can live with (scientific-based approached weight-loss plan)? With any kind of weight loss, maintenance or weight gain plan (I like to use the term plan, which I feel is a more positive term than diet), it is important to develop the habits you can stick to permanently. In this day and age, we often seek that quick fix. Who can blame us? Our days seem like they are in overdrive and we need to get things done as quickly as we can. We expect these fad diets to work faster and get us quickly to the finish line – whether it’s healthy or not. Unfortunately this isn’t always the case. Can you lose weight that quickly (and healthy) when it took you time to get there? Can you undo those habits you learned over the years and shed them as quick as weight? Think back if you have gained weight (unintentionally) over the past year or period of time: How can diet claims or fad diets that state you can permanently lose that weight within days be realistic? Unfortunately, you didn’t gain weight that quickly (It takes an extra 3,500 calories to gain a pound – that’s a lot of extra food in one day!), so you aren’t going to lose it that fast. Because most fad diets don’t teach healthy eating habits, you can fall right back in the same routine. If you follow a plan that encourages you to give up some of your favorite foods or eat only specific items (whether you like them or not), that really isn’t teaching you much. I often see people following plans that they aren’t even enjoying. If a fad diet consists of only eating cabbage and I don’t even like it – how can I incorporate that into my lifestyle? Recognize what is promoting optimal health and nutrition. The American Dietetic Association guides you to remember these key points: Develop an eating plan for lifelong health. Look at the big picture and chose foods sensibly. Moderation, moderation – we have heard those words many times, but moderation is the key. Eating one piece of cake or going to a fast food restaurant isn’t going to sabotage your eating pattern in the long run, but consuming excess sweets or additional calories overall just may. Portion size does matter. It would be great if we could eat as much as we wanted, but the reality is that won’t work. I am a big proponent of all foods can fit but the caveat is moderation. Tired of that word? We can call it something else -- self-control or restraint -- but I don’t think those words are any better – they sound more stringent. Choose foods sensibly by looking at the big picture. Like we mentioned, a drive through the fast food lane won’t break your healthy plan. Keep in mind portion sizes. Limit the food items that add those extra calories daily without providing any positive nutritional value. Learn how to spot a food fad. What is that old cliché? If it sounds too good to be true, it probably is. Pay attention to what you read. Don’t fall victim to unrealistic claims or a food that is quoted to cure this or shed that weight quickly. Find your balance between food and physical activity. This one can be a challenge to most. Finding enough time in the day to do everything is hard enough, then make room for physical activity? Balance is the key. My advice is to keep moving. It’s not all about food; it’s also becoming physically active. The Dietary Guidelines for Americans recommends to reduce the risk of chronic disease in adulthood be physically active for at least 30 minutes most days of the week; children and teenagers should be physically active for 60 minutes daily or most of the days. You don’t have to run a marathon. Walk a little more, clean a little more, dance, and go to an exercise class a few times a week. Getting that heart pumping and that blood flowing will improve your health in the long run. Food and nutrition misinformation can have harmful effects on your health and well-being, as well as your wallet. Be careful what you hear and read! Make sure the facts are true and the information you receive is credible and accurate. Registered dietitians can help provide science-based nutrition information and play an active role in developing a meal plan that fits your individual needs. Most people want to get to the weight that makes them happy. As professionals, we do understand that and want to make sure that as a consumer you know the facts. Knowledge is power. The key is to take charge of your behaviors and know that every step counts. Be proud of each positive change you make – baby steps is the key! Pamela Ofstein is a registered and licensed dietitian. In addition to being the Director of Nutrition Services for eDiets.com in Fort Lauderdale, Florida, Pamela provides her expertise and services to clinical consulting services to local physicians, clients and public health venues, local/state dietetic associations as well as publishes articles for local media publications.