South Florida Sun-Sentinel Palm Beach (Sunday)
Florida’s Medicaid downsizing is a moral failure
The headline demanded your attention for the timing, if nothing else: “Some of Florida’s sickest kids are losing Medicaid coverage on Easter Sunday.”
Advocates around the state worried that the message didn’t reach the parents of some of those kids, or the medically fragile adults who also depend on Medicaid coverage.
Despite news stories, warnings from nonprofit groups and messages from state officials, many Florida residents whose coverage and that of their children was being dropped said they had no warning until the ax fell.
While the state claims that 93% of those families whose kids were being dropped had been contacted, that doesn’t square with statistics posted during earlier phases of the state’s downsizing of its COVID-swollen Medicaid ranks.
It also doesn’t explain the large numbers of people who were previously shoved off the Medicaid rolls despite the state’s failure to prove them ineligible.
And it casts shade on the state’s decision to move as quickly as possible to shed people from the Medicaid system, along with its status as one of only two states that refused to take advantage of assistance offered by the U.S. Department of Health and Human Services.
The great unwinding
The disenrollments stem from a reset of a COVID-era policy that allowed current Medicaid recipients to keep their coverage — even if they no longer qualified — through the end of the pandemic emergency.
Last year, federal officials told states to start moving people into other programs if they were no longer eligible for Medicaid, with guidance to “unwind” participation in the Medicaid program gradually.
Florida moved as quickly as possible. According to data compiled by the Florida Health Justice Project, 3.7 million Floridians had their Medicaid eligibility reviewed by December 2023.
Of those, more than 2 million kept their eligibility, including nearly 900,000 whom the state deemed eligible without contacting the recipient.
That sounds like a lot, but other states did a much better job of keeping people in the Medicaid program using their existing records.
The far more disturbing breakdown is the high percentage of people who had already lost coverage at that point — and may never have known it.
Of the 1.2 million kicked off Medicaid rolls through 2023, about 72% were dropped for “procedural” reasons that said nothing about their current ineligibility.
Most often, it was due to a failure to respond.
That doesn’t speak well for the state’s claim that it is reaching people and letting them know about options before they are dropped.
And that’s why advocates like the Health Justice Project, the Florida Policy Institute, the Kaiser Family Foundation and the Center for Budget and Policy Priorities have been sounding the alarm about Florida’s “unwinding” process since early last year.
They had good reason to be nervous about the last group of state disenrollments, which included the sickest and most frail among Florida’s Medicaid enrollees.
These are people who — if they lose eligibility under Medicaid — should be most qualified to move to another statebacked entitlement program such as Medikids, which offers very low-cost insurance for children ages 1-4, or Children’s Medical Services (CMS) which takes care of special needs kids.
Nowhere to turn
But those programs aren’t seeing as much of a surge in demand as they expected — and our reporting backs up health-access advocates who say the state has little information for families who need to transition to another program.
That puts parents and sick adults in a terrible bind: Many might be eligible to stay on Medicaid. Others can appeal a decision to drop them from Medicaid or move to another program. But they don’t know what to do or how to do it.
Attempts to reach out to state officials often result in long hold times or erroneous responses, the Health Justice Project and other advocates say.
There’s an easy answer to this growing desperation: Florida should expand Medicaid eligibility to cover more hard-working and low-income residents.
The state is one of only 10 that haven’t taken advantage of Medicaid expansion, which reaches people who make too little to participate in “Obamacare” marketplaces but too much to remain on Medicaid.
We have a hard time understanding why Florida didn’t expand Medicaid a long time ago — or why it has failed to take advantage of federal offers of additional time and help for those being cast off Medicaid rolls during the “unwinding” process.
State officials keep insisting they’re doing the best they can, but that assertion is proven false every time new statistics are released, or stories appear about parents of very sick children, or disabled adults who have lost the care that could be keeping them alive.
Florida can do better. It should do better. It’s a moral failure that it has not.
The Sun Sentinel Editorial Board consists of Opinion Editor Steve Bousquet, Deputy Opinion Editor Dan Sweeney, editorial writer Martin Dyckman and Editor-in-Chief Julie Anderson. Editorials are the opinion of the Board and written by one of its members or a designee. To contact us, email at letters@sunsentinel.com.