December 4, 2018

Statement on Federal Approval of Florida's Request to Eliminate Retroactive Medicaid Eligibility

Under current law, if someone is approved for Medicaid, coverage can go back not only to the date of application, but also three months prior to application. This coverage is only available in those months when the person would otherwise have met all Medicaid eligibility requirements, such as income and asset limits.

Congress adopted the 90-day requirement in 1972 to protect people who are eligible for Medicaid but do not apply for help until after they have received care.

The Florida Policy Institute staunchly opposed Florida’s request to eliminate retroactive Medicaid eligibility, or RME, but the federal government last week approved the state’s waiver request.

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.

Sorting out the Medicaid application process takes time. That’s why RME is so crucial. The three-month window allows people and their families in the midst of medical crises to focus on what’s most important at that moment: getting the proper treatment and recovering.

The approval letter from the Centers for Medicare & Medicaid Services states that Florida will be testing whether elimination of the RME benefit ‘encourages beneficiaries to obtain and maintain health coverage, even when healthy.’ However, it’s Florida’s current Medicaid program structure that prevents most low-income adults from accessing coverage when they are healthy, or even when they suffer from serious chronic conditions, like diabetes or asthma.

And while the state Agency for Health Care Administration purports it will test ‘the efficacy of measures designed to encourage eligible individuals to enroll as soon as possible,’ this ignores the reality of Florida’s stringent Medicaid program. Typically, people can only qualify at a moment of medical crisis.

Ironically, Florida’s justification for cutting RME — getting people to sign up for coverage when they are healthy — is the best argument for expanding Medicaid, something that has not yet happened in the Sunshine State.

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