Providers, Advocates Blast Proposed $98 Million Medicaid Cut

A push by the Florida Legislature and Gov. Rick Scott to trim nearly $100 million from the state’s main safety-net health care program for the poor is coming under fire by health-care providers and advocates for low-income families.

The state wants to reduce from three months to 30 days the grace period for retroactively paying Medicaid claims.

The state estimates that the policy change will impact about 39,000 people, but representatives from the Safety Net Hospital Association of Florida and two left-leaning policy institutes testified Tuesday that the state’s estimate is too low. The groups have made public record requests for the data. 

The latest round of criticism came at a public meeting in Tallahassee Tuesday, the second meeting in two weeks the state has held on the proposed the changes to Florida’s sweeping Medicaid 1115 waiver.

Agency for Health Care Administration spokesperson Mallory McManus said the state would provide the data to the groups within the next two days. In a prepared statement to The News Service of Florida, McManus stressed that “no Medicaid services are being reduced as a result of this amendment.”

Federal law directs state Medicaid programs to provide a 90-day retroactive coverage to give people time to apply for Medicaid coverage following a traumatic incident or diagnosis of an illness. That way people have time to gather what they need for the application that includes, among other things, proof of age and citizenship, as well as proof of all sources of income and assets.

But at Scott’s urging, state legislators agreed to authorize the Agency for Health Care Administration to amend its Medicaid 1115 waiver to limit coverage to 30 days. If approved, Florida will join a handful of states that have eliminated so-called “retroactive eligibility.”

While proponents say the move is meant to encourage people to quickly apply for the program and begin receiving benefits, opponents say the shortened time frame hurts those who need the help the most.

“This proposal in fact zeroes in on people with disabilities, including seniors coping with end-of-life-care. They are going to be disproportionately hurt,” said Anne Swerlick, an attorney with Florida Policy Institute.

She asked the state to give people an additional 30 days --- after the data is made public --- to comment on the changes.

Under the proposed change, Medicaid will cover health-care bills retroactively to the beginning of the month that the care was provided. That means if a patient was admitted to a hospital on April 10, the hospital --- working with the patient --- would have 20 days to gather the information needed to properly fill out the application.

However, if a patient was admitted to the hospital on April 30, they would have just one day to gather what they need to submit the application.

Tallahassee economist Jim Zingale said the policy was random and arbitrary and called the disparate time frames for patients to submit applications for the health-care program is unfair.

Zingale, the executive director of research for the Safety Net Hospital Alliance of Florida, predicted that the number of Medicaid applications sent to the Department of Children and Families by hospitals that will scrambling to meet the deadline will balloon.

Florida’s Medicaid program provides health care coverage to about 3.9 million Floridians, most of whom are enrolled in a Medicaid HMO, either for long-term care or for traditional and acute-care services.

Longtime social services advocate Karen Woodall pressed for information about how state officials came up with an estimate that 39,000 patients would be affected.

“Who are they?” asked Woodall, the executive director of the Florida Center for Fiscal and Economic policy.

Florida did not expand Medicaid to able-bodied childless adults, as allowable under the federal health care law, often referred to as Obamacare.

As a result, Medicaid is limited to the poor, elderly and the disabled. Nevertheless, Woodall said there are some people in the legislative arena “that have this misconception or perception that we have able-bodied adults.”

Woodall said the public should know who the Medicaid recipients really are.

“When you throw out a statement that says 39,000 non-pregnant adults, it’s not clear that these are people with disabilities, seniors who are low income and very poor adults. It doesn’t give a whole picture,” she said.

According to a Medicaid presentation, the 39,000 figure comes from an analysis of 2015-16 Medicaid data that shows one percent of the enrollees were made retroactively eligible during that fiscal year.

Swerlick said she’s concerned that the estimate doesn’t take into consideration people who are eligible for both the Medicare and Medicaid programs.

Every month, there are thousands of Medicare beneficiaries in Florida who don’t understand that they qualify for Medicaid and that they have to apply separately for the program, according to Swerlick.

The state can pay for Medicare Part B premiums, which are about $134 a month, with Medicaid dollars, Swerlick said. The proposed policy change would limit the state’s ability to make those payments, which would be problematic for low-income seniors whose monthly incomes are less than $1,400, she said.

“So we have to ask, are Florida policy makers really making a decision that Florida seniors --- compared to seniors in Georgia, Alabama and Texas --- are less deserving of this benefit?” Swerlick asked. “It’s unclear if that’s the intent of this proposal.”

Zingale also questioned the estimate, noting that a November 2017 Kaiser Health News report showed that Iowa  --- a state with 3.1 million people --- is projected to reduce its Medicaid spending by as much as $36.8 million annually with the same changes.

Zingale predicted that, if approved, there would be “somewhat of a crisis” as Florida hospitals scramble to submit applications to the Department of Children and Families, which processes Medicaid applications in the state. Many of the applications will be rejected because they will be incomplete, he said.

Legislators included the state’s portions of the savings from the proposed changes --- $34 million --- in the budget that is slated to take effect July 1.

In addition to limiting the state’s retroactive coverage, Medicaid officials also are proposing to make two changes to what health care services can be covered with supplemental Medicaid funding, known as “Low Income Pool,” and which hospitals can participate.

One of the changes would add community mental-health providers to the list of those able to participate in a supplemental Medicaid funding program.

If approved, the change could result in a projected $15.7 million increase in funding for community receiving facilities that treat patients for mental health and substance-abuse disorders, including opioid addictions, according to Melanie Brown-Woofter, interim president and CEO of the Florida Council for Community Mental Health.

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