December 4, 2018

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

This post was last updated on December 8, 2021. As new policies are announced, FPI will update this page.

As Florida’s response to COVID-19 takes front and center, concern grows for low-income families who struggle to take precautions against the spread of the virus. Although Congress has passed the Families First Coronavirus Response Act to address, at least in part,  the public health crisis and economic fallout from COVID-19, many barriers continue to keep struggling families from accessing the assistance they need during the pandemic. As Florida initiates policies implementing the Act and addressing other barriers to the safety net, FPI will update this form. When available, hyperlinks are provided to agency documents or statements that provide greater detail  about the new policy.

On March 22, 2020, FPI and 44 other organizations sent a letter to Governor DeSantis, leadership in the Legislature and agency heads to urge action on 47 specific policy changes to reduce unnecessary barriers for Florida’s safety net programs in response to the COVID-19 pandemic. See the letter here.

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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