FORT LAUDERDALE, Fla. — Marne Harvich of Orange Park runs a Facebook group for Florida parents like herself who count on Medicaid as health insurance for their children. Though Harvich and her husband work, their income doesn’t cover the high cost of medical care their daughter on a ventilator requires.
For the last three years during the pandemic, Harvich’s daughter Cassidy and other children were protected by a federal law that allowed everyone to stay on Medicaid regardless of whether their households continued to be eligible. But on April 1, that changes and terminations will begin.
Florida is about to experience an unprecedented unwinding of Medicaid coverage that could leave more than a million families at risk of losing their free health insurance.
While advocates are busy preparing for the fallout, they worry that most parents aren’t aware yet of the deadline and will get caught off guard during a medical emergency.
Florida’s Department of Children and Families will begin checking eligibility for all Medicaid beneficiaries — and taking everyone off who isn’t eligible or doesn’t respond to requests to update their contact information as part of their regular annual review.
During the pandemic when people lost their jobs, the number of individuals and families seeking Medicaid assistance in Florida jumped from 3.8 million enrolled in March 2020 to 5.5 million in November 2022.
Now, DCF, the agency that’s been experiencing high turnover and vacancy rates for years, will be charged with reviewing all cases and guiding ineligible people about how to get other insurance.
In Florida there are close to 3 million children on Medicaid, the nation’s public health insurance program for people with low income. That reflects about 67% of all children in the state.
What happens, at least for children, will depend on how states handle this effort.
“This is a real big deal for kids and the systems that serve them,” said Joan Alker, executive director of the Center for Children and Families at Georgetown McCourt School of Public Policy. She noted that Florida already has one of the highest uninsured rates in the nation overall and ranks among the bottom 10 states for children.
Can parents make it through the hoops?
The concern is that 18% of the children who receive Medicaid in good times lose coverage through bureaucratic hurdles, get dropped by mistake or “fall through the cracks,” Alker said.
“We expect that number will go up because this is unprecedented, there’s so much work to be done, there’s staff shortages ... if you think of about 20% of 3 million children, that’s a lot of children,” she said. “There will be children who remain eligible but will lose their coverage inappropriately. That’s where ... how a state implements this is going to make all the difference.”
Florida’s written plan for how they will handle this effort says 92% of Medicaid applications and redeterminations are filed through the state’s online Self-Service Portal. (Participants can still file a paper application via fax, mail, or in person.)
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Someone who has become ineligible or who hasn’t provided up-to-date information will receive an email giving them a 45-day notice that their coverage is ending and they need to take action. Once they are dropped, they have a 90-day window to reapply if they believe they are still eligible.
Harvich says she is tech savvy, and still, the process of getting her daughter’s application updated via the portal was difficult.
“It is daunting,” she said. “If you are not computer savvy, you need a third party to assist you, or you could go to DCF and they will help you, but that could be a long day.”
How quickly the state will push these cases through the review-and-remove process is unclear. The federal government allows state agencies up to 12 months to initiate Medicaid reviews. But Florida Medicaid Director Tom Wallace told members of a Senate health care spending panel: “[Those who are ineligible] will probably come off relatively quickly.”
How many children are at risk?
That has community health centers, pediatrician practices and emergency rooms wary that a flood of uninsured patients could soon arrive.
Already, the state agency has identified 900,000 households it believes are no longer eligible because their income is too high. A second group of 850,000 Medicaid recipients have not responded to requests from the department for updated information and also could be at risk.
“It is important for parents to understand what is happening,” said Lynn Hearn, an attorney with the Florida Health Justice Project. “They have to participate in renewal and can’t ignore the notices.”
Hearn estimates about 222,000 children in Broward County alone are at risk.
Just because a parent’s income has gone up, they may no longer have coverage themselves, but their children are likely still eligible, she said. “The messaging needs to make that clear.”
Hearn’s concern is that parents will realize at an inopportune time that their children were terminated from the program.
“Maybe they will be in the ER or the pharmacy and thinking they will use their Medicaid card and find out they are not eligible at the time when they are getting service,” Hearn said. “That’s a real concern because they run the risk of incurring medical debt.”
Florida community health providers, legal aid programs, health navigators and insurers say they are waiting for the fallout.
“We are worried we are not getting more inquiries,” Hearn said. “People just don’t know this is coming; there are resources and a lot of fantastic advocacy groups ready to help, but until notices start arriving and the consequences are being felt, people are not taking proactive steps to reach out.”
Who may get caught in the gap?
Florida’s Medicaid program covers children ages 5 and younger in households that make $33,408 or less and older children whose parents make up to $31,795.
Those children who lose coverage automatically will be referred to Florida KidCare, a state-sponsored health insurance program with low monthly premiums. Estimates are that enrollment in Florida KidCare could more than double from the 114,000 children now enrolled.
“We have been working with DCF for several months to prepare for this,” said Ashley Carr, director of marketing for Florida KidCare. “We are prepared to accept as many as need to come over.”
Carr said DCF refers children they believe qualify for the Florida KidCare program to prevent them from losing coverage.
“We are reaching out and helping them sign up,” she said. “Families may want to shop around for other options and look at marketplace plans. Some may be in position to shift the whole family to an employer-based plan. We want families with children under 19 to understand there are other affordable insurance options, but we believe we are the best fit for a lot of these children.”
While children can enroll in KidsCare, parents cannot ― and they have fewer options for low-cost health insurance.
Medicaid covers pregnant women, families, the disabled and low-income seniors. Adults in Florida under 65 with no children are ineligible, as are parents who earn more than $7,000 a year.
A gap occurs when families have incomes that are above the state’s eligibility for Medicaid but are below the federal poverty line ($13,590 for an individual in 2022, $23,030 for a family of three). Parents won’t be eligible for Medicaid or for coverage within the Affordable Care Act marketplace.
What are health care options?
Federally qualified health centers such as FoundCare in Palm Beach County offer a sliding-fee scale based on family size and income for those who are not covered by insurance.
“We are bracing for an increase in uninsured patients,” said Christopher Irizarry, CEO of FoundCare.
During the pandemic, with Medicaid coverage, parents and children could access specialists that can be difficult to get without insurance, he said.
“We’ll have to rework the network we have for the uninsured,” Irizarry said. “It will definitely tax that system we built to have all these folks dropped off Medicaid. Not every provider accepts the uninsured.”
The net effect, he said, is that uninsured Floridians will turn to the emergency room for care or go without care altogether. Wait times in the emergency rooms and community health centers likely will spike, he said. “We don’t know if we should expect an avalanche or a gradual increase in need,” he said.
Medicaid recipients who want to ensure their information is up to date should log onto their MyAccess account at myflorida.com/accessflorida/. For frequently asked questions on Florida KidCare visit https://countonkidcare.org/. You can learn more about the Federal Marketplace at healthcare.gov.