May 30, 2018

FPI to Feds: Reject State Request to Eliminate Retroactive Medicaid Eligibility

Florida’s $98 Million Cut Would Hurt SSI Recipients, Medicare Beneficiaries and Medically Needy Floridians

LAKE MARY, FL – Florida’s plan to eliminate retroactive Medicaid eligibility (RME) through an amended 1115 Managed Medical Assistance waiver would take health care coverage away from the most vulnerable state residents when they are faced with catastrophic injury or illness. In comments submitted yesterday to the U.S. Department of Health and Human Services (HHS), the Florida Policy Institute (FPI) urged federal rejection of the state’s waiver request.

Under RME, Medicaid coverage can go back three months prior to the month of application. Congress enacted RME in 1972 to protect Medicaid-eligible persons who “do not apply for assistance until they have received care, either because they did not know about Medicaid eligibility requirements or because the sudden nature of their illness prevented their applying.”

The federal government can only waive this requirement if it determines that such a waiver promotes the overall objectives of the Medicaid Act.

“Florida should be taking steps to expand Medicaid to hundreds of thousands of Floridians struggling to make ends meet, but instead the state is trying to move in the opposite direction, taking vital health care coverage away from some of its most vulnerable residents,” said Joseph Pennisi, executive director of the Institute. “I urge the Department of Health and Human Services to reject the state’s waiver request. Eliminating retroactive Medicaid eligibility will only cause further harm and uncertainty.”

“At best, creating this uneven system turns health care into a game of chance,” said Scott Darius, executive director of Florida Voices for Health. “At worst, it will place additional stress on families in what is likely their most difficult moments.”

On April 3, during a public hearing held by the state Agency for Health Care Administration (AHCA), FPI and several health advocacy groups provided testimony strongly opposing the state’s waiver request.

In comments submitted to HHS, the Institute echoed points made during the April hearing. Notably:

  • The state’s justification for its waiver request is that it will “enhance fiscal predictability.” However, this completely fails to meet federal requirements that a waiver promote the objectives of the Medicaid Act, which is to provide coverage, not take it away.
  • Florida already has one of the most stringent income and categorical eligibility thresholds for Medicaid in the nation and it currently ranks near the bottom on national rankings of health and wellness.
  • Because Florida has failed to expand its Medicaid program, most healthy, uninsured, low-income Floridians will not qualify for Medicaid until they are seriously ill or disabled. So, the people hurt by this change are those hit with unanticipated and costly catastrophic illnesses, such as stroke, cancer or a car accident, as well as seniors needing nursing home care.
  • Cutting RME will primarily hurt the lowest income people with disabilities — Supplemental Security Income recipients — who need inpatient hospital services; Medicare beneficiaries, mainly seniors, needing nursing home care; and medically needy people, typically Floridians facing a medical catastrophe and needing inpatient hospitalizations.

“The three-month window allows a cushion for people and their families during medical crises, so they can sort out the Medicaid application process and focus on what matters the most– getting treatment and starting the road to recovery,” added Pennisi.

FPI is an independent, nonpartisan and nonprofit organization dedicated to promoting widespread prosperity through timely, thoughtful and objective analysis of state policy issues affecting economic opportunity.

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