Sun Sentinel Palm Beach Edition
Florida must handle Medicaid shakeout with care
Florida could soon strip up to 1.75 million people off its Medicaid rolls as the federal government slowly reduces COVID-era support for expanded benefits. Legislative committees in the Florida House and Senate are getting their first look at how it might play out. We hope it left lawmakers with a lot to think about — including a desire to ensure that Floridians who truly need coverage can retain their safety net. They should also seize this chance to permanently expand coverage to the hardworking people who keep the state’s habitually low-wage economy afloat.
This is a pocketbook issue as much as a compassionate one. Floridians who have decent health coverage are more likely to be active participants in the economy, filling jobs in the construction, health care and hospitality industries where they are badly needed. Communities and hospital systems aren’t asked to absorb the exorbitantly high cost of providing care through emergency rooms. The most vulnerable — young children, pregnant women, frail seniors and those with disabilities — retain a safety net, protected against the desperation of needing care they can’t afford.
The great ‘unwinding’
These are the groups most likely to be caught in Florida’s “unwinding” of its Medicaid rolls, which grew from 3.8 million in March 2020 to 5.5 million in November 2022. In the coming year, federal authorities will slowly wind down the extra money they were sending to states to get people covered in the face of a pandemic.
To get that funding, states were required to keep people enrolled in the program throughout the duration of the public health emergency, even if they no longer qualified due to increased income or other factors. After extending funding a few times, federal authorities plan to gradually reduce it to pre-COVID levels over the next 12 months — leaving states with some tough decisions.
Florida health officials have been working on a plan, and parts of it look fairly painless: The first to be dropped aren’t using the coverage anyway, officials said. Others took advantage of increased demands for workers and are currently employed in jobs that offer decent health coverage, either directly from employers or through Florida’s affordable care marketplace. And many of the children on Medicaid rolls will be offered an easy transition to eligibility through one of the insurance programs offered through Florida KidCare.
We want to be confident that these transitions will be handled as quickly and seamlessly as representatives from the state Department of Children and Families and Agency for Health Care Administration promised. But it’s hard not to worry, given the meltdown in the state unemployment system that had hundreds of thousands of Floridians waiting on hold for hours — and waiting on checks for months.
It’s one thing to talk a good game, but we won’t know how prepared Florida really is until the process is underway. State officials say they have multiple safeguards in place to protect people who are dropped by mistake or get sent to the wrong place for replacement coverage. Many have moved and might not be aware they are at risk of losing coverage. Others won’t know where to turn — or have no viable alternatives that they can afford, especially those in areas where the cost of living is still ticking up faster than many families’ incomes.
The toughest decisions
The state has said it plans to handle the most difficult cases last. But even that might not be enough. Because at the end of this process — even if it’s managed as well as lawmakers were promised — there will be some Floridians for whom this transition will be truly devastating. Some of the people the state might be dropping suffer from chronic conditions such as diabetes or even cancer.
Will they lose insurance that’s literally keeping them alive? Others are in nursing homes and might not be capable of responding to requests that will keep them enrolled. Will they be unceremoniously evicted? Some are children. Others have serious disabilities. Stripping them of coverage could lead to much higher longterm costs.
Some are hardworking Floridians who earn too much to be eligible for Medicaid but not enough to afford coverage. Lawmakers should — at long last — add Florida to the vast majority of states that allow working adults to retain eligibility for Medicaid under the Affordable Care Act.
It is true, these COVID-era benefits were never meant to be permanent. But Florida’s transition doesn’t have to spark widespread misery, and lawmakers should do everything in their power to ensure that it doesn’t.
The Sun Sentinel Editorial Board consists of Editorial Page Editor Steve Bousquet, Deputy Editorial Page Editor Dan Sweeney, 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 letters@sun-sentinel.com.