Official defends Florida’s process to determine Medicaid eligibility

Lawsuit claims due-process rights violated and federal law broken

TALLAHASSEE – Amid heavy scrutiny, state officials Wednesday defended a process to determine whether millions of people remain eligible for Medicaid coverage and said they are trying to help children find other health insurance if they leave the program.

“Our top priorities here are that we want to ensure that if you are eligible, you maintain your coverage and if you’re not eligible, that you are provided with alternative options for what may be available for you to choose from,” Casey Penn, a deputy secretary of the Florida Department of Children and Families, told members of the Senate Health and Human Services Appropriations Committee.

The committee received presentations from the Department of Children Families, the Agency for Health Care Administration and the Florida Healthy Kids Corp. about what is known as a “redetermination” process that started this spring.

The process was triggered by the end of a federal COVID-19 public-health emergency. During the public-health emergency, which began in 2020, Florida and other states could not drop people from the Medicaid program for reasons such as not meeting income-eligibility requirements.

Florida’s Medicaid program grew from about 3.8 million beneficiaries in January 2020 to nearly 5.8 million in April of this year. But now, the state is in the midst of a year-long effort to determine whether beneficiaries remain eligible — with Medicaid rolls dropping to about 5.25 million in August, according to data on the Agency for Health Care Administration website.

Democratic lawmakers and groups advocating for Medicaid beneficiaries have criticized the redetermination process, which also has been hit with a potential class-action lawsuit. That lawsuit, which is pending in federal court in Jacksonville, alleges the state has violated due-process rights and a federal Medicaid law because it has not provided adequate notice about reasons for terminating people’s benefits and about opportunities for hearings before termination.

Also, on Tuesday, a coalition of about 50 groups sent a letter to Gov. Ron DeSantis that, in part, called for putting the redetermination process on hold until changes can be made such as increasing staff at call centers.

“There are several issues that are causing families and individuals to erroneously lose coverage: long call-center wait times, inadequate staffing at the Department of Children and Families, inaccurate and difficult to understand language in administrative forms that families receive, and inappropriate use of household income to determine individual eligibility,” the letter said. “This loss of health insurance coverage due to procedural errors and inefficiencies is unacceptable and preventable.”

Many of the concerns focus on children losing coverage.

“It’s as if we are traveling blindly in not knowing how many children are without coverage. So, there’s no type of tracking system?” Sen. Tracie Davis, DJacksonville, asked during Wednesday’s meeting.

The Agency for Health Care Administration runs much of the Medicaid program, but the Department of Children and Families plays a key role in the redetermination process. Florida Healthy Kids Corp. operates the KidCare program, which includes offering subsidized health insurance for children whose families don’t qualify for Medicaid.

Penn touted the Department of Children and Families’ efforts in redetermination, pointing, for example, to what he called “robust” communication strategies to reach out to beneficiaries. Also, Penn and Ashley Carr, chief marketing officer of Florida Healthy Kids Corp., said the agencies are trying to help easily move children into other coverage if they leave Medicaid.

Along with KidCare, some families also could get coverage through employer-sponsored health plans or the federal insurance marketplace, officials said.

Sen. Gayle Harrell, a Stuart Republican who chairs the Health and Human Services Appropriations Committee, said she thinks the process is “on the right track.”

“I want to make sure every person who is eligible is getting either Medicaid or KidCare,” Harrell said after the meeting. “That’s what today was about.”

News Service Assignment Manager Tom Urban contributed to this report.