More than one million Floridians could lose Medicaid coverage this year as the state seeks to return enrollment to pre-pandemic levels.
The state can start disenrolling people who aren't eligible for the program anymore on April 1. It will be the first time the state has been able to do this since 2020, when the federal government mandated people enrolled in Medicaid get continuous coverage. Since then enrollment in Florida’s program has nearly doubled, with more than five million beneficiaries as of last month.
A provision in a spending bill passed late last year changed that, allowing states begin to remove beneficiaries who no longer qualify this spring.
States that do this will lose access to some federal matching funds. To help cover the cost of providing continuous coverage throughout the pandemic, Congress boosted Medicaid matching funds by 6.2%. That will drop down to 5% starting April 1 and will continue to gradually decline every few months this year.
Officials with the Florida Department for Children and Families say they have already identified about 900,000 cases of people who are no longer eligible for the state’s Medicaid program, due to changes in income, age or other factors. Some of those people may qualify for other health coverage, such as the Florida KidCare program.
Of biggest concern to health policy experts like Joan Alker, executive director of Georgetown University's Center for Children and Families, are the folks who remain eligible but could slip through the cracks if bureaucratic issues arise.
“They are unable to get through to the state's call center if it's overwhelmed with calls to get help with the application, they don't get the letter in the mail about this renewal process and they lose coverage,” she cited as examples. “And maybe a parent is going to show up at a pharmacy and try to get their child's asthma prescription extended and the pharmacist is going to say, ‘Oh you're uninsured,’ and that’s how they find out.”
DCF estimates there are another 850,000 Medicaid recipients who haven't responded to requests for updated information and are at risk of losing coverage. Some may have gotten other health insurance in recent years, but Alker expects many may not have received or understood the communication.
These estimates are based on data as of Dec. 2022, before the federal government published new poverty guidelines that are elevated this year to account for inflation. It's unclear how those will affect the pool of at-risk beneficiaries, but Alker says it could mean thousands more families are eligible to keep their Medicaid.
She is especially worried about children in Florida, as they account for the largest portion of Medicaid beneficiaries in the state. Most will likely still be eligible for coverage this year, so Alker says it’s imperative the state ensure they don’t experience any disruptions in care due to administrative issues.
“If the state sees those kinds of coverage losses happening, it's really time to press the pause button,” she said.
The Department of Children and Families, which handles determining Medicaid eligibility, recently published a plan for how it will move forward with renewals. Officials say they will phase out the process over the course of 12 months. The Agency for Health Care Administration actually administers the Medicaid services.
Alker says it’s important the state take their time with this and provide resources to help families navigate renewals. This includes doing outreach in multiple languages for residents with limited English proficiency and partnering with organizations that have trusted relationships in communities. It also involves having adequate staffing at call centers to handle the expected influx in calls.
DCF officials say they have boosted staff at call centers and will provide individual-focused messaging in English, Spanish and Haitian Creole.
How to get help
Enrollees should make sure their contact information on file with the state is accurate, especially those with unstable living situations, Alker stressed. People should also look out for messaging from the state in the coming months.
DCF’s Office of Economic Self Sufficiency has a customer call center residents can reach at 850-300-4323. They can also dial 711 for Florida Relay or TTY 1-800-955-8771.
Primary care physicians, health clinics and Medicaid managed care plan operators are also good resources for assistance, said Alker.
Georgetown’s Center for Children and Families published a report last year that found Florida had a large number of “red flags” in its health care system that could make disruptions in care as pandemic requirements phase out especially pronounced compared to other states. Alker said she is pleased to see some of the commitments the state has outlined in its plan for Medicaid determinations, but said this spring will be the true test.
“So there are lots of concerns here absolutely across the country, but Florida has reasons to be especially worried and that’s troubling because Florida already has one of the highest uninsured rates, and this process could make it much, much worse especially for kids,” she said.
