Misunderstandings with communication materials, state staffing shortages contributing to Florida’s Medicaid redetermination problems, experts say


Shane Ersland


More than 50 organizations and House Democrats have requested a pause in the state’s Medicaid redetermination process as nearly 250,000 Floridians have lost their health coverage since the unwind began in March. 


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Florida saw a significant increase in the number of individuals and families on Medicaid during the federal public health emergency (PHE). In March 2020, there were 3.8 million enrollees. In November 2022, there were 5.5 million enrollees, according to the Department of Children and Families (DCF). 

DCF began reviewing those 5.5 million enrollees for eligibility on April 18th as the PHE’s continuous Medicaid coverage provision ended. Of the 250,000 Floridians who have seen their coverage terminated since the unwind began, 82% had their cases closed for procedural reasons, not necessarily because they were no longer eligible. 

Industry experts discussed the unwind at the 2023 Florida State of Reform Health Policy Conference. Jafet Rios, regional director of operations at True Health, said state officials informed his organization that consumers would be notified about their redetermination requirements prior to the unwind. DCF released a plan to send renewal notices to recipients through emails and letters earlier this year.

And to be quite frank, that has not been the case on a consistent basis,” Rios said. “We have seen patients come into our facility finding out they’re no longer Medicaid beneficiaries from us, when the state had promised they would get appropriate notice.”

Florida Health Justice Project Executive Director Alison Yager said the state’s outreach materials regarding redetermination requirements can be confusing for many Floridians.

“In my opinion, a big contributor might be that they don’t understand, partially, the communication,” Yager said. “The challenge for consumers is understanding what their steps are in order to make sure they do not lose coverage. And there’s a real lack of clarity that’s coming down from the communications. They don’t know what to do in order to take those steps.”

Staffing shortages at DCF are contributing to the problem as well, Yager said.

“DCF has had a huge amount of staff turnover in the past three years, which means that many of the DCF staff who are inputting codes into their system, who are at the other end of call center calls, they’re doing these things for the first time,” she said. “Which means there’s a lot of human error being put into the equation. We’re seeing that in the forms the notices are taking. DCF also still has a huge number of vacancies. As of a couple months ago, they were still hiring hundreds of call center workers. And last we heard, many of those positions were still unfilled.”

Attempting to contact DCF was also a challenging process for residents prior to the redetermination process, Yager said. 

“When you called the DCF access hotline, even pre-unwind, the hold time was hours long,” she said. “Which means we’re setting people up to have to essentially set aside a workday to get through to the call center, which is an impossibility. So people get these confusing notices, and then they’re unable to get the answers they need to figure out what their next steps are. So on the ground, this is really becoming quite a turbulent situation.”

The problems can be exacerbated for members of certain cultural groups, particularly those who are not proficient in English, Rios said.

“As an organization, about 50% of our patient populations are Hispanic/Latino, and many of them have limited English proficiency,” Rios said. “So we’re seeing a trend of many of these consumers who are receiving these letters and have no idea what they mean. And at times translation is not where it should be, to be honest. It definitely creates a barrier. Many of us in this room are subject matter experts when it comes to this. And at times the letters even confuse us while we’re reading them.”

Jodi Ray, principal investigator and project director at Florida Covering Kids and Families, said Floridians who don’t have internet access are disproportionately affected as well.

“We know that being in rural areas is considered a barrier because there are transportation issues, there’s [no] access to broadband, so if we’re expecting people to just complete (forms) online or on their phone, [it’s] not necessarily an effective  strategy,” Ray said. “Computer literacy can be a barrier. And we’re seeing that.”

True Health is taking a hands-on approach to assist patients with the redetermination process, Rios said.

“When a patient arrives (at) our facility, [and] they hear the unfortunate news that they are no longer a Medicaid beneficiary, we get them immediately connected with a member that can facilitate the unwinding process,” he said. 

What makes that process even more efficient is that we provide a follow-up to every consumer we submit an application for. We’re also conducting social media marketing campaigns. We have a flier at each of our offices a patient can pick up when they’re checking in or out. We’re also partnering with different Medicaid managed care plans to identify individuals who are more likely to lose coverage.”

Florida Health Justice Project is helping people appeal their coverage terminations if they feel they have been wrongly terminated, Yager said.

“We’re offering direct services to individuals who believe they’ve been wrongly terminated to ensure they know their appeal rights to help them through that appeals process,” she said. “The challenge for folks who are procedurally terminated is they don’t have appeals rights. They just have to reapply. That’s a big roadblock for a lot of folks, and we’re going to have to be helping those folks with new applications. 

We can call on the state to say this is not working. Far too many people are being procedurally terminated, which should be a big sign to us to say things are not going as planned. The outreach efforts have been inadequate. Too many people still are not aware of what’s happening, and are not prepared for the redetermination process.”