Sawyer Stuart is 11 years old, has autism and significant developmental disabilities, and sleeps in a trampoline his family converted into a makeshift bed. His mother, Kelli Stuart, says it is no longer safe as he gets bigger, and she has spent more than 18 months trying to get Florida Medicaid to cover an enclosed Cubby safety bed that his own doctors say he needs.
A Case Dismissed Over a Missing Accessory
Stuart, who lives in the Tampa Bay area, has appealed Medicaid’s denials of the specialized bed for a year and a half, according to Tampa Bay 28. She recently attended a fair hearing, described as the final step in the appeal process, where officials dismissed her case after determining that a different bed had been requested and that they no longer had jurisdiction. Stuart says the bed itself had not changed — only additional accessories had been removed to bring the cost down, making it cheaper but still, in her view, the same request.
Hearing officials gave her one week to prove the requested bed was the same one under review, the station reports. Stuart says the most recent denial claimed she had not proven that lower-level options could not meet Sawyer’s needs, and those listed options included reverse locks on bedroom doors. She says she will not lock her son in his bedroom, calling that approach unethical and unsafe, and she fears he could suffocate without an enclosed, monitored bed designed for children like him.
Five Providers, Three Denials
According to the station’s report, the Children’s Medical Services Health Plan, operated by Sunshine Health, has denied Stuart’s Cubby Bed request three times. She presented letters from five types of providers backing the bed as medically necessary — a developmental pediatrician, primary care physician, neurologist, occupational therapist, and behavioral therapist, per the same account. Stuart says Sawyer wakes during the night in distress and has banged his head on the floor, a detail she has raised as she has fought for her son for eight years.
Attorney MaryGrace Longoria of Southern Legal Counsel took Stuart’s case pro bono. Longoria said the difficulty Stuart is experiencing is very typical of what other families go through, and that the providers’ letters have not been sufficient to satisfy Medicaid, though the reason remains unclear because the denial notices did not explain why the medical opinions failed to meet policy. She said no parent she has represented in similar cases has abandoned the fight, and Stuart says she believes Medicaid should simply approve a bed her son’s own doctors call medically necessary — especially since she suspects Medicaid may have spent close to half the bed’s cost simply contesting the request.
What Sunshine Health Says
Sunshine Health has said that its members’ health and well-being are its top priority, per its statement to the station, and that authorization requests are reviewed by board-certified physicians licensed in Florida, including board-certified pediatricians for Children’s Medical Services cases. The company says peer-to-peer reviews are available to ordering physicians and clinical practitioners, and that appeals or other review options may still be available to families like Stuart’s.
How Other States Have Handled Similar Requests
Cubby Beds, the manufacturer, says its products have helped more than 17,000 families nationwide, according to company CEO Caleb Polley, who said approvals for enclosed safety beds in Florida remain limited today, which he attributed to older coverage policies. The company’s own guidance notes that insurance appeals can prolong the approval process, according to Cubby Beds.
Outcomes elsewhere have varied. In Wisconsin, an administrative law judge approved a $13,490 Cubby Plus Safety Bed on April 3, 2023, for a young child with autism, elopement risk, and head-banging behavior, according to Elder Law Wisconsin. That decision found the bed covered under the Medical Assistance program because it was prescribed by a physician and deemed cost-effective, after the family’s care team tried less expensive alternatives without success. By contrast, a Massachusetts appeal involving a Cubby Bed was denied on Aug. 20, 2024, though the full record of that case has not been reviewed in detail.
Federal Medicaid rules require the Early and Periodic Screening, Diagnostic and Treatment benefit to provide comprehensive and preventive health care services for children under 21, according to the Centers for Medicare and Medicaid Services. For now, Stuart says she does not feel heard after a year and a half of seeking coverage, and Sawyer continues to sleep in the trampoline his family converted to keep him from getting hurt.
