Systemic Issues Persist in Florida’s Medicaid Redetermination Process, Warns Group of Health Care Researchers and Advocates

A new letter from CMS to the DeSantis administration details non-compliance issues; Florida is among the five states with the most infractions ‍

FLORIDA - Four and a half months after the expiration of federal “continuous coverage” protections, which allowed for individuals enrolled in Medicaid to keep their health insurance during the pandemic, state policymakers have yet to take steps — in the form of opting into waivers and taking advantage of programmatic flexibilities — that would improve Florida’s Medicaid redetermination process for those currently and procedurally losing coverage.

During a press call this afternoon, several health care researchers and advocacy groups, including Florida Policy Institute, Georgetown University’s Center for Children and Families, Florida Covering Kids and Families, Florida Health Justice Project, and UnidosUS, shared their concerns on Florida’s Medicaid redetermination process. Florida is the only state in the nation that has not taken any of the 23 flexibilities offered by the Centers for Medicare and Medicaid Services to help mitigate the impacts of Medicaid redeterminations. Seven of these flexibilities require no waiver to implement.

The group also brought attention to a recent letter from the Centers for Medicare and Medicaid Services (CMS) to Florida’s Agency for Health Care Administration Secretary Jason Weida that outlines some possible violations by the state in its Medicaid redetermination process. Broadly, it seems that Florida is on track to receive federal corrective actions, which could include a pause in the process or financial ramifications.

Official data released in late July by CMS show that in the first month after federal continuous coverage provisions for Medicaid ended, 249,427 Floridians were disenrolled, 82% of whom had their cases closed for procedural or “red tape” reasons, not necessarily because they were no longer eligible. The data released by CMS shows Florida pushed more people off Medicaid in the first month of the redetermination process than any other state.

Additionally, CMS data backs up the stories shared by Floridians having difficulty getting through to the Department of Children and Families (DCF) on the phone to get help with their redeterminations: in April, 48 percent of the calls made to DCF were abandoned, and the average wait time for an initial contact was 40 minutes before being pushed to another helpline. Florida’s call center metrics were among the worst in the 17 states that started their redetermination process in April. Florida ranked 16th for its wait times and had the highest call abandonment rate.

During the press call, FPI pointed to steps that DCF could take to reduce barriers for eligible families during the state’s Medicaid unwinding process:

Pause redeterminations until DCF can successfully execute the goals outlined in the redetermination plans submitted to CMS;
Pause redeterminations until the call center is fully staffed and trained to handle increased call volume for all languages;
Delay procedural terminations for beneficiaries for one month (30 days) while the state conducts targeted renewal outreach;
Disaggregate data by age group to ensure that parental redeterminations are not triggering redeterminations for children and special care populations early; and
Increase the 10-day account closure notice to 30 days notice to give people time to find other coverage

Joan Alker, executive director and research professor at Georgetown University’s Center for Children and Families, said: “Florida already has one of the highest child uninsured rates in the nation and the state’s mishandling of the unwinding is likely to make a bad situation worse. It’s time for the governor to hit pause and get to the bottom of why so many Floridians are losing coverage for procedural reasons. As children head back to school, we are reminded of the important role Medicaid plays in helping them get the health care they need to show up to school ready to learn.”

Erica Monet Li, health policy analyst at Florida Policy Institute, said: “The plans outlined by the Department of Children and Families were comprehensive, and had a lot of great strategies to ensure that people did not lose their coverage unfairly; however, the execution of the plans up to now has not aligned with the intention of the plans. We are seeing coverage losses that should not be happening and at this point, advocates are calling upon the department and the governor to re-evaluate what has gone wrong.”

Lynn Hearn, senior attorney at Florida Health Justice Project, said: “We urge state officials to follow through on their promises to redetermine coverage for the most vulnerable individuals last, to make their communications with beneficiaries accurate and understandable, and to provide meaningful access to phone and in-person assistance. Pausing the process to fix these problems would not be a sign of weakness — it would demonstrate true leadership.”

Jodi Ray, senior consultant for policy, advocacy and Medicaid unwinding at Florida Covering Kids & Families, said: “We are seeing too many people requesting assistance simply because they do not know how to respond to the communication they are receiving. The language is not at a literacy level that is conducive for people who are not accustomed to navigating these programs, to be successful in completing the process.”

Jared Nordlund, Florida state advocacy director at UnidosUS, said: “Everyone can agree that a top priority for our state is to help our children grow up healthy and strong. Unfortunately, two-thirds of all Florida children are at risk of losing their health insurance because of the state’s mismanaged Medicaid unwinding plan that is dropping eligible kids from coverage. At a time when the state has a $20 billion budget surplus, it has refused to invest more money to modernize the state’s ancient Medicaid system and provide enough communication to families on how to renew their Medicaid. We need the state to step up and meet the needs of our community to avoid another fiasco like the meltdown of the state’s unemployment system at the beginning of the pandemic.”

Tasha Belton, a Broward County resident working full-time and battling long COVID, said: “If you take away the Medicaid coverage from Floridians like myself, our health care will surely decline because we are not able to afford the medical care, and without my oxygen and my medication I do feel like I would die.”

Acadia Jacob, advocacy director for Florida Voices For Health, said: “Floridians are falling through cracks in the redetermination process that DCF committed to preventing. Now families, children, disabled adults, and seniors are losing access to critically-needed care services they qualify for.”

It is important to note that official data released by CMS is delayed by four months, although the state is required to report to CMS each month by the eighth day. During these delays, data has been updated by the state. This makes it difficult to provide and interpret the Medicaid unwind data not only in the state of Florida, but nationally as well. Florida’s current and most updated trends still confirm that back in April, a majority of those who lost coverage (57%) did so because of procedural reasons.

Systemic Issues Persist in Florida’s Medicaid Redetermination Process, Warns Group of Health Care Researchers and Advocates

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

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