Feds say Florida is failing to help many at risk of losing Medicaid

A letter sent by the Centers for Medicare & Medicaid Services says Florida may be out of compliance with federal rules as it conducts first purge of Medicaid rolls since the end of the pandemic.
Almost 40% of callers to Florida call centers set up for Medicaid recipients concerned about losing coverage gave up waiting for an answer. The federal government has written to the state warning that it needs to do better.
Almost 40% of callers to Florida call centers set up for Medicaid recipients concerned about losing coverage gave up waiting for an answer. The federal government has written to the state warning that it needs to do better.
Published Aug. 17, 2023|Updated Aug. 17, 2023

As more than 120,000 Florida children have lost Medicaid coverage since April, Florida families looking for help have struggled to get through to state help lines.

Average call center wait times in May was 32 minutes while 38% of callers gave up waiting for an answer, according to state data reported to the Centers for Medicare & Medicaid Services. Florida also failed to process 10% of new Medicaid applications within a 45-day window.

Florida’s performance led the federal government to send a letter to the Florida Agency for Health Care Administration last week warning that the state may not be in compliance with federal guidelines that require states to provide prompt assistance to those renewing or applying for the health insurance program that covers the nation’s poorest families.

The letter states that call center failures will have a disproportionate impact on minorities, who are less likely to have broadband or internet access, transportation or jobs that grant them time away to meet with Medicaid enrollment staff in person.

Centers for Medicare & Medicaid officials also expressed concern that 14% of those who lost Medicaid coverage in May were red-tape terminations, where families lose coverage because they failed to respond to requests for information on their income.

“Eligible individuals, including children, may be losing coverage,” the letter states.

The warning for Florida comes as states across the nation earlier this year resumed normal Medicaid operations after the end of the public health emergency and must reassess the eligibility of millions of recipients. Florida is one of only five states that have failed to meet call center response times and other benchmarks set by the federal government to manage that transition as smoothly as possible, according to Joan Alker, executive director and research professor at the Georgetown Center for Children and Families.

The letter sent to Florida is a first step toward enforcement, said Alker. If Florida fails to correct the concerns raised, the federal government could take action, including ordering the state to pause the Medicaid redetermination process or the withholding of Medicaid funding, she said.

The Florida Department of Children and Families is responsible for reviewing the eligibility of the vast majority of almost 5 million Medicaid recipients. Department officials did not address call center response times but said the letter is based on old data and that only 7% of those removed from Medicaid are for procedural reasons.

“While CMS continues to attempt to smear red-state Medicaid programs, Florida is focused on ensuring care is available to those who need it the most,” said spokesperson Mallory McManus in an email. “Florida’s top priority is serving the health and safety needs of our vulnerable populations, and will not sacrifice this or change its process because of a form letter sent to all 50 states.”

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Access to state help may be even harder to get for Spanish-speaking residents.

Latino civil rights group UnidosUS in July and August conducted a test of Florida’s call center with 40 calls at different times and days of the week. On half, the caller chose the Spanish language option.

Spanish language calls averaged a wait time of more than two hours to reach a call taker, more than four times as long as those in English. Roughly 30% of Spanish language calls were disconnected before the caller reached a human being compared to 10% for calls in English, the test found.

“It’s shocking,” said Stan Dorn, UnidosUS senior health policy director. “Two-thirds of all children in Florida rely on Medicaid. You would think a top priority would be to make sure parents can reach someone and renew their children’s coverage.”

Florida has removed about 400,000 people from Medicaid since it began reviewing eligibility in April. But it has faced criticism from several health advocacy groups concerned that the state has not lived up to the plan it published earlier this year.

That stated that most children removed from Medicaid would be transferred to child health insurance programs run through Florida KidCare. Officials also said that the eligibility of children with complex medical needs would not be reviewed until closer to the end of the review process expected in February 2024.

But enrollment in the state’s child health insurance program has only risen by about 6,000, and Florida nonprofits have heard from families of disabled children who have lost coverage, said Erica Monet Li, an analyst at the Florida Policy Institute.

The performance of Florida’s call center is a major concern as the state is requiring the vast majority of recipients to update their income information, Li said. Of 606,700 people reviewed in April, only 13% were renewed based on income data the state already possessed.

That same month, the average wait time for an answer at Florida’s call center was 40 minutes and 48% of callers gave up waiting for an answer, the worst performance out of the 17 states that began Medicaid renewals that month, she said.

“A majority of the families who are going through this process are being burdened with administrative paperwork,” Li said. “Those who have attempted to respond to notices are still having trouble reaching the department, leading to delays that can cause them to lose coverage.”

Florida is one of only 10 states that have not taken advantage of additional federal funding available to states through the Affordable Care Act if they make more residents eligible for Medicaid. That means many parents may be ineligible for the program even when their children are not.

That has led to a concern that the state is taking coverage away from children based on their parent’s eligibility, said Jodi Ray, a senior consultant and program director at Florida Covering Kids & Families, a nonprofit that works to find coverage for uninsured residents.

“We’re seeing coverage losses that should not be happening,” she said.

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Editor’s note: This story has been updated to reflect the correct percentage of new Medicaid applications that have been processed.