MIAMI (AP) — State child welfare officials are trying to recruit more medical foster homes and are increasing oversight to prevent disabled foster children from having to live in nursing homes.

This week’s policy change from the Department of Children and Families comes as state health officials are fighting accusations that it is warehousing disabled children in adult nursing homes with little concern for their educational and socials needs because the state routinely slashes in-home care.

DCF has about 30 disabled children who are in state custody living in nursing homes. Almost another 200 disabled children not under DCF care also reside in nursing homes unnecessarily because parents say their in-home medical services have been routinely cut. The allegations come from federal investigators and a federal lawsuit filed by families of more than a dozen children.

Federal justice officials have threatened their own lawsuit against state health officials if the state does not comply with all Medicaid laws, but the Agency for Health Care Administration has repeatedly insisted they are in full compliance.

Meanwhile, DCF sent a letter this week requiring that Secretary David Wilkin’s office or another top administrator sign off on any move to place a child in a nursing home. Children placed in institutions will be monitored monthly and a required timeline will ensure there is an attempt to move the child back home whenever possible, according to the memo.

“Let’s make it hard for anyone to be able to make a decision that would make a child go into a nursing home,” Wilkins said Thursday.

The agency will also beef up recruiting efforts for medical foster homes. There are now about two dozen.

“The biggest holdup we’ve had is if there is a child that could go home but doesn’t have a home to go to,” he said.

DCF officials stressed their policy has always been to keep children at home whenever possible.

A 16-year-old girl referred to as “T.H.” in the lawsuit came into foster care as a baby after being shaken so severely she received severe brain damage. She lived happily in a medical foster home for nearly ten years, attending physical and speech therapies at a local rehab center. But after being hospitalized in 2006 to insert a tracheotomy tube she was forced into a nursing home even though her foster parents wanted her home, according to the lawsuit. She was eventually transferred home and then back to the nursing home several months later because the state refused sufficient in-home nursing care.

Nearly six years later, her foster parents are fighting for her to return home, saying her medical condition in the facility has been stable and she is no longer requires a ventilator, according to the lawsuit.

The teen is suffering because of “current policies and practices that fail to provide medically necessary services in the community and force her to be institutionalized,” according to the lawsuit.

DCF officials said they can’t comment on minor’s cases.

Officials for the Agency for Health Care Administration have repeatedly said children should be cared for in the least restrictive setting as possible and that the parents ultimately decide to put their children in a facility.

“All medically necessary services are available to children enrolled in the Medicaid program,” Secretary Liz Dudek said in a letter sent last Friday to the Justice Department.

But parents say the continual cuts in services, especially in-home nursing care, leaves them with no other choice. Federal investigators also pointed out the state offers nursing homes financial incentives to accept children.