Health worker Verónica Ortiz is having a conversation in Spanish with her client Gloria Martinez inside the Hispanic Services Council's Riverview office. She tells her to be on alert for letters from the government. If Martinez receives a letter with a yellow stripe on the envelope, it’s about her Medicaid coverage.
This weekend, a requirement passed by Congress early on in the coronavirus pandemic to keep people continuously enrolled on Medicaid expires. For the first time in three years, states like Florida can start removing participants who don't qualify or who don’t reapply properly. Advocates like Ortiz are trying to help people through the process.
Ortiz is what's known in Spanish as a promotora de salud. Promotoras offer health education to members of their community and help them apply for benefits. Most of the clients Ortiz serves live in Hillsborough County and either can’t speak English, or just feel more comfortable speaking Spanish, like Martinez.
Martinez, 57, has multiple sclerosis and said she qualifies for Medicaid because she is on disability.
“It's difficult to apply because it's very confusing,” she said in Spanish.
The Florida Department of Children and Families said in its plan for Medicaid redetermination that it will try to use existing information to automatically renew as many people as possible. But Florida performs worse than some other states when it comes to that process, with fewer than half of its renewals done automatically.
Staff will have to reach out to most enrollees for more information, such as documents verifying income or disability status.
Martinez says her status hasn’t changed since the pandemic, so she should be able to maintain coverage. But she said it still helps to have Ortiz walk her through reapplying.
“I’m very grateful for this service, and I don’t know what I would do without this service and Ms. Veronica,” she said in Spanish. “May God always take care of her.”
Ortiz beamed.
Across the state, health advocates like Ortiz are gearing up to help the record 5.7 million Floridians currently enrolled in Medicaid navigate the renewal process. Of those, the state estimates roughly 1.75 million could lose their coverage.
Some will find or already have other health care options, such as employer-sponsored insurance, but experts fear thousands of families could slip through the cracks. Research shows children, who make up the bulk of Florida’s Medicaid population, are most at risk.
Enrolling in health care isn’t easy, said Jodi Ray, executive director of Florida Covering Kids and Families at the University of South Florida, part of the statewide nonprofit initiative Covering Florida.
“The way our health care coverage system is set up in Florida, it actually reflects, probably, the most complicated health coverage program in the country in terms of navigating it,” Ray said.
One reason is that unlike some states, Florida administers its Medicaid program separately from CHIP, short for the Children’s Health Insurance Program, also known in this state as Florida Healthy Kids. The latter serves children with slightly higher incomes, and could be an option for some kids who no longer qualify for Medicaid. But transitioning between the two programs requires added steps for Florida families that some in other parts of the country won’t have to deal with.
Florida is also one just ten states that have not expanded Medicaid to cover more working-age adults. Because of this, these enrollees may find themselves in a coverage gap, meaning they earn too much for Medicaid but not enough to qualify for subsidized health plans on the Affordable Care Act marketplace.
Covering Florida has navigators in all 67 Florida counties trained to help people explore their options.
“We know the policies and the processes really, really well,” said Ray, who has been helping people find insurance for the last 20 years. “That helps us identify where there might be problems, maybe something in the process didn't go right, or where the family missed something and they just don't understand what their next step is.”
For example, a family with unstable housing could miss that letter with the yellow stripe if the state sends it to an old address. Or providing proof of income could be challenging.
Some of the people Verónica Ortiz with the Hispanic Services Council works with have employers who pay them in cash and don’t leave much of a paper trail.
“We try to help them as much as we can to tell them how to tell their bosses that they need a letter,” she said. “Sometimes they feel afraid. They don't want to lose their job, they say, ‘I don't want my boss to get mad.’ I say, ‘Just tell them, you know, it's medical insurance for my kids.’”
The Department of Children and Families says it has ramped up call center staff to assist enrollees and is sharing educational materials about the unwinding in multiple languages.
But advocates say it's important to have people who have built relationships in the communities they serve involved in the process.
Resources
You can make an appointment in-person or virtually with a Covering Florida navigator on its website or by calling 877-813-9115.
Residents in the Tampa Bay area can get help from the Hispanic Services Council's promotoras de salud by calling 813-936-7700 or learn more on its website.
The Family Healthcare Foundation has navigators in Hillsborough, Pasco, Pinellas, and Polk Counties. Residents can schedule in-person or virtual appointments on its website or call 813-995-7005.
The Department of Children and Families' 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.
DCF also has how-to instructional videos about the process on its Medicaid redetermination webpage.
