A recent report from the Florida Agency for Health Care Administration focuses on potentially preventable emergency room visits and hospital admissions to help answer the question, “What are we getting for our money?”
Recent news has been dominated by Congressional proposals to radically restructure Medicaid financing. Public discussion surrounding Medicaid has shed light on some stereotypes and misinformation. Medicaid is already highly cost-efficient and most Medicaid beneficiaries are satisfied with their care and have health outcomes comparable to those who are privately insured. This is particularly noteworthy since Medicaid disproportionately serves people in much poorer health with substantially fewer resources than those privately insured.
The agency’s report demonstrates the state’s valuable efforts to improve Medicaid quality of care as well as reduce costs. It focuses on “potentially preventable health care events (PPEs)” including hospital admissions, hospital readmissions and emergency department (ED) visits. The agency recognizes that, “although not all potentially PPEs can be avoided, PPE rates in populations can be used as a gauge regarding the failure to access primary care and the quality of care available.”
The report includes an analysis of managed care plan data from August 1, 2014 to July 31, 2015. Findings are broken out by age, eligibility groups, plans and regions. Here are a few highlights:
Out of the state’s $26.4 billion Medicaid budget, more than $15 billion is allocated for Medicaid managed care.Mostly private for- profit insurance companies are responsible for providing managed care to more than 3 million Florida Medicaid beneficiaries — primarily children — and thousands of beneficiaries with medically complex conditions.
The report is a terrific starting point for drilling down on the barriers beneficiaries face in trying to access needed care. But fundamental questions remain, such as:
The stage is set for critically important follow-up work, including direct engagement of beneficiaries, providers and plans. We commend the agency for taking this evidence-based, common sense approach to improving health care for the most vulnerable Floridians.
American Rescue Plan Act Changes. The American Rescue Plan Act of 2021 extended PEUC and PUA benefits through the week ending September 6, 2021. It also increased the maximum duration of PEUC benefits ($300 a week) to 53 weeks and the maximum duration of PUA to 79 weeks. Although PEUC and PUA did not end until September 6, 2021, Florida withdrew from the Federal Pandemic Unemployment Compensation Program (FPUC) effective June 26, 2021. FPUC provided persons who were out of work due to COVID-19 with an additional $300 a week in unemployment insurance.
DEO says that, after September 6, 2021, claimants will still have 30 days to submit an application for PUA benefits and that it will continue to pay eligible claimants the PUA and PEUC benefits they are owed for weeks of unemployment through the week ending September 4, 2021. New applications for PUA must be accepted through October 6, 2021, although limited exceptions to the deadline are allowed as stated here.
Reemployment Assistance weeks increased January 1, 2021. DEO determines the maximum number of weeks available to RA claimants based on a statutory formula that looks at the average unemployment rate for the most recent third calendar year quarter (i.e., July, August, and September). Based on the recent uptick in unemployment, the maximum number of weeks for RA will be increased to 19 weeks after 1/1/2021.
RA work-search and work registration requirements reinstated on May 30, 2021. Persons filing an application for RA benefits beginning March 15, 2020, are not required to complete work registration in Employ Florida through May 29, 2021. In addition, work search requirements for individuals requesting benefits for the weeks beginning March 15, 2020, were also reinstated on May 30, 2021.
Quarter change reporting instituted. DEO is requiring that Floridians receiving Pandemic Unemployment Assistance (PUA) or Pandemic Emergency Unemployment Compensation (PEUC) either reapply for assistance or complete a Quarter Change Questionnaire. DEO’s Fact Sheets and step-by-step video guides about quarter change reporting are here. According to DEO, this is because the federal government requires Florida to determine, on a quarterly basis, whether individuals who are currently receiving PUA or PEUC are eligible for Reemployment Assistance benefits.
Mobile app deployed. DEO has deployed a mobile app for RA applications.
Claimants allowed to modify application date. DEO says that, because Floridians have had a hard time applying for Reemployment Assistance due to no fault of their own, claimants can request to modify their claim filing effective date:” According to DEO, back-dating only applies to claimants who attempted to apply and were not able to file a claim between the weeks of March 9, 2020, to April 9, 2020. In those cases, the claim date can be adjusted to the date that the claimant originally tried to apply. To do so, DEO advises that claimants visit www.FloridaJobs.org and select the link “Request to Modify Claim (Application) Filing Effective Date."
DEO to allow RA applicants to file using paper applications. On April 2, 2020, the Governor issued an executive order allowing RA applicants to use paper applications to apply, reassigning state agency staff to assist with RA efforts, authorizing DEO to procure additional resources to accommodate the increased volume of applications, and directing DEO to identify a third-party company to collect and deliver hard copy applications to DEO. The paper application can be downloaded here. Paper applications can also be obtained at CareerSource offices, where assistance in submitting applications will be available. Some libraries are also offering application forms. Check with your local CareerSource office or library first. New applicants who wish to apply online should apply at FloridaJobs.org.
DEO to begin answering claim-specific questions. Effective 4/20/2020, DEO says that it began answering the claim-specific questions of those who call 1-833-353-6799. In addition, DEO also has an online contact form for claims-specific questions here. For general questions that are not claim-specific, DEO asks that callers call 1-833 FL APPLY (1-833-352-7759) 8:00 a.m. - 5:00 p.m. on Satur
Updates from DEO on PUA CARES Act assistance. DEO issued guidance governing Pandemic Unemployment Assistance (PUA) for Floridians who have exhausted their RA benefits as well as self-employed, contract employees and gig workers who do not qualify for RA. To receive PUA, a claimant’s job must have been directly impacted by COVID-19.
DEO announces extended benefits. DEO announced implementation of Extended Benefits (EB), a federal UI program, in December 2020. Extended Benefits provides up to an additional 6 weeks of benefits to eligible individuals who have exhausted their RA and PEUC benefits during periods of high unemployment.
Resources and guidance. For a list of resources and guidance from the United States Department of Labor on unemployment insurance and COVID-19, go here.
For DEO’s “Reemployment Assistance Frequently Asked Questions and Additional Resources,” updated 4/23/2020, go here.
For DEO’s latest claims data, go here.
DCF closes offices. DCF announced on March 18, 2020, that it was closing brick-and-mortar storefronts due to coronavirus. Because 10 percent of persons apply for safety net benefits in person, DCF recommends that those Floridians use drop-boxes at the Department’s storefront locations to turn in their applications.
DCF adds call center numbers. DCF has added a call center number for Monday through Friday, from 7 a.m. to 6 p.m. Call center numbers now include 850-300-4323, 866-762-2237, or TTY 1-800-955-8771.
Certification periods extended by 6 months only through August 2020. Certification periods for cash, food and medical assistance were extended by 6 months for individuals and families scheduled to recertify in April through August 2020. FNS’ approval of the SNAP extension for August is here. However, effective September 1, 2020, SNAP, TANF and Medicaid recertifications have been reinstated, although DCF says that no one will lose Medicaid due to recertification.
DCF allows phone interviews. Phone interviews are now being used for TANF cash and SNAP food assistance.
Mandatory work requirements suspended only through May 2021. Under a directive from Governor DeSantis to waive work requirements for safety net programs, DCF waived work requirements for individuals participating in the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) through May 2021. To do this, DCF explains that it partnered with the Department of Economic Opportunity to apply “good cause” statewide for TANF and SNAP recipients who would otherwise be subject to participation in mandatory work requirements as a condition of receiving those benefits. Through May 2021, persons who were sanctioned in the past due to work requirements will be able to reapply and participate in SNAP or TANF again.
Work requirements were reinstated effective June 1, 2021.
Emergency allotments (EA) ended. DCF automatically supplemented SNAP allotments of current recipients up to the maximum for a household’s size for July 2021. However, EA was discontinued beginning August 1, 2021.
SNAP benefits increased by 15 percent through September 2021. Floridians who participate in SNAP to put food on the table will receive a temporary 15 percent supplement to SNAP under COVID relief passed by Congress and extended by the American Rescue Plan Act through September 2021.
FNS permanently increases SNAP through revamp of the Thrifty Food Plan. Effective October 2021, FNS has mandated a permanent increase to SNAP through a revamp of the Thrifty Food Plan. DCF says that the increase amounts to about 6% for Floridians.
Florida to roll out the Summer Pandemic Electronic Benefit Transfer program (Summer P-EBT). USDA has approved Florida’s plan for Summer P-EBT. Qualified children include those who were eligible for free or reduced price meals last school year or who became eligible over the summer, as well as children under 6 who participate in SNAP. The program will provide $375 in food assistance per child to make up for meals kids lost over the summer when school was not in session. DCF says that it hopes to begin issuance on November 24, 2021. However, DCF cautions that eligible households should anticipate a staggered disbursement through the beginning of 2022.
DCF estimates that almost 3 million children will qualify for Summer P-EBT.
DCF has an online form for families to fill out if they dispute what is happening with their child's P-EBT benefits. DCF also says that families can call 1-833-311-0321 if they have questions about a student's P-EBT benefit.
Time limits suspended. SNAP time limits are suspended during the COVID-19 public health emergency. No one in Florida should be barred from SNAP due to time limits, even if they exhausted their time limit in the past.
Florida granted waiver to allow families to purchase groceries online. DCF has been granted a federal waiver to permit the State of Florida to launch a pilot project statewide effective April 21, 2020, that allows families to purchase groceries online with their Electronic Benefit Transfer (EBT) card instead of going into stores.
What about Disaster SNAP (D-SNAP)? Although a COVID-19 disaster declaration has been declared at the federal level, no D-SNAP program has been approved by the President or initiated as of now. Disaster Supplemental Nutrition Assistance Program (D-SNAP) is linked to a federal declaration of disaster approving the program.
For a list of current SNAP waivers for Florida from USDA, go here.
No Medicaid terminations from March 2020 through the end of the federal public health emergency. The national public health emergency has existed since January 27, 2020 and has been renewed by the Secretary of the U.S. Department of Health & Human Services in 90-day increments since that time. The most recent renewal is effective July 20, 2021.
Redetermination/recertification times are reinstated. As of October 1, 2020 AHCA's website is alerting recipients that the Department of Children and Families is now mailing letters for case reviews to check if a household is still eligible for Medicaid and/or Medically Needy. AHCA is urging people receiving these letters to take steps now to re-apply. But note, Medicaid coverage will not end during the COVID-19 Public Health Emergency. In January 2021 DCF conducted one-year “automated renewals” for people whose sole income is social security and SSI and are enrolled in an SSI-related Medicaid program (e.g., MEDS/AD, Medically Needy and Medicare Savings Programs). People getting VA income were not included in the automated renewal.
Extended application time. Effective with applications filed in February 2020, the time for submitting documentation required to process an application is extended for 120 days from the date of the application and eligibility will still be effective the first day of the month the application was received. Effective July 1, 2021, this policy has been rescinded. Medicaid applications submitted on or after July 1, 2021 may be denied on the 30th day after application or the day after verification information is due. Applications filed prior to July 1, will be allowed 120 days to provide requested verification to establish Medicaid eligibility.
Exclusion of additional unemployment payments in determining eligibility. The $600/week of additional unemployment insurance payments under the CARES Act will not be counted as income in determining Medicaid eligibility. (However, these payments will be counted as income in determining marketplace subsidy calculations.)
Coverage of Medicaid services during the state of emergency
COVID-19 Vaccines for Medicaid Enrollees. In an executive order published March 16, 2021 Governor DeSantis revised the vaccine distribution plan, which applies to the general public including Medicaid enrollees, to lower the age requirement to 40 effective March 29, 2021 and then effective April 5, 2021 all Floridians are eligible to receive any COVID-19 vaccination approved by the Food and Drug Administration.
Medicaid enrollees eligible to receive the vaccine may visit myvaccine.fl.gov to find a location distributing the vaccine and to schedule an appointment.
On March 12, 2021, AHCA published instructions for Medicaid enrollees on how to obtain Medicaid transportation once they have scheduled an appointment for a vaccine. AHCA states: "Florida Medicaid will take you to get the COVID-19 vaccine at no cost. All you need to do is set up a time to get your vaccine. Next, let your Medicaid plan know you need a ride and they will take care of the rest. If you are not enrolled in a plan, call the Medicaid Helpline at 1-877-254-1055 to find out the name and phone number for a transportation service."
The state has also recently launched a new email system to help bring COVID-19 vaccines to homebound seniors. Seniors will be able to sign up to have the vaccine come to them by emailing a request to HomeboundVaccine@em.myflorida.com.
AHCA has posted Medicaid Alerts and FAQs providing more detail on Medicaid service changes in response to COVID-19. They address a wide range of topics including, but not limited to: telemedicine guidance for medical, behavioral health, and early intervention services providers; long-term care provider network flexibilities allowing more types of providers to deliver specified long term care services; and continuity of care for adult day care center enrollees during the time these centers are closed.
AHCA is loosening coverage restrictions for behavioral health services. Effective May 5, 2020, all prior authorization requirements for mental health or substance use disorder treatment are waived and service limitations (frequency and duration) are lifted. For behavioral analysis services, current authorizations will be extended through an "administrative approval process" which does not require providers to reassess beneficiaries currently getting services. Effective July 1, 2021 service limits will be reinstated for behavioral health services and effective July 15, 2021 Medicaid prior authorization requirements will be reinstated for behavioral health services.
Per a May 29, 2020 provider alert, during the state of emergency AHCA will be reimbursing providers for telemedicine well-child visits provided to children older than 24 months through age 20. Providers are directed to actively work to schedule follow-up in-person visits to administer immunizations and other physical components of the exam which cannot be accomplished through telemedicine.
Coverage of home and community-based waiver services (HCBS) - In response to the public emergency, Florida obtained approval from the federal government to make changes in HCBS waiver programs, including the Long Term Care and Developmental Disabilities programs. The changes are effective retroactively from January 27, 2020 to January 26, 2021. Details can be found here. They include, but are not limited to:
Note on COVID-19 testing, treatment, and vaccines for the uninsured. Florida has not opted to receive 100 percent federal Medicaid funding for COVID-19 testing of people without health insurance. Under the 2021 American Rescue Plan Act this option has been expanded to cover COVID-19 treatment and vaccines for the uninsured as well. Since the state has not taken up this option Floridians must look to an uneven patchwork of free testing, treatment, and vaccine resources scattered around the state. AHCA advises that uninsured people may receive free testing from their county health department or a federally qualified health center and that “many communities provide testing for free for individuals who do not have insurance. Please [click here] to find a test site in your area. Uninsured individuals should ask before the test whether testing is free of charge." There are no state agency instructions on where uninsured people can receive free treatment. However, more information on possible sources for free treatment is available here.
Residency proof no longer required at some vaccine sites, “paving the way for migrants.” - On April 29, 2021 Surgeon General Rivkees issued a new public health advisory specifying that COVID-19 vaccines are available to “a Florida resident” or someone “who is present in Florida for the purpose of providing goods or services for the benefits of residents and visitors of the State of Florida.” This new policy applies to all state-run and federally supported vaccination sites. It rescinds an advisory issued in January that had restricted vaccinations to people who could show proof of Florida residency
2021 unemployment compensation claimants can access free or reduced cost health insurance through the ACA marketplace. The Affordable Care Act (ACA) Marketplace was re-opened in February 2021 to give people who need health insurance a new “special enrollment" opportunity to get covered. The 2021 American Rescue Plan eliminated or vastly reduced premiums for many people with low or moderate incomes.
Starting July 1, 2021, people who received or have been approved for unemployment compensation for any week beginning in 2021 can access free or reduced cost comprehensive health insurance plans through the ACA marketplace. This benefit is available regardless of someone's current income. To get this benefit, people must enroll in the marketplace no later than August 15, 2021. For help with enrollment, contact Covering Florida at 877-813-9115.
School children in distance learning still eligible for free or reduced cost meals. Students in distance learning for 2020-21 can still receive school meals through the National School Lunch Program if they are eligible. The student or parent/guardian may pick up meals at the school but should contact their school for more information.
For a list of current child nutrition program waivers for Florida from USDA, go here.
Congress allows increased fruit and vegetable benefits. At present, WIC provides $9 for children and $11 for women monthly for fruits and vegetables. The American Rescue Plan Act makes funding available for a four-month increase in the benefit of up to $35 monthly, if a state chooses to do so.
DOH attains waiver allowing remote issuance: Department of Health (DOH) obtained a waiver of the requirement that participants pick up their EBT cards in person at recertification or during nutritional education appointments.
WIC participants allowed to substitute certain food. Under a waiver from USDA, WIC participants in Florida are allowed to substitute milk of any available fat content and whole wheat or whole grain bread in package sizes up to 24 oz. when 16 oz. packages are unavailable.
USDA waived physical presence requirements: Although the scope and logistics are unclear at this time, USDA has given DOH permission to waive the requirement that persons be physically present at each certification or recertification determination in order to determine eligibility under the program through May 31, 2020.
USDA extends certification periods through May 31, 2020, for some participants.
For a list of current WIC waivers for Florida from USDA, go here.
HHS provides guidance. HHS has issued guidance on the flexibilities in TANF to respond to COVID-19.