Florida experts discuss plan to strengthen the safety net ahead of Medicaid redeterminations

Florida’s rising Medicaid enrollment is pushing stakeholders to collaborate and adapt in the face of two major changes. First, the Agency for Health Care Administration (AHCA) is set to release its new Statewide Medicaid Managed Care procurement contract in September. All states must also prepare for the Medicaid eligibility redetermination process once the federal public health emergency (PHE) ends.

 

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Three experts representing key perspectives in Florida Medicaid met to discuss their strategies for keeping vulnerable communities insured at the 2022 Florida State of Reform Health Policy Conference in Tampa. 

Over 5.2 million Floridians are now enrolled in Medicaid, according to the most recent data from AHCA. That represents a major increase from 3.2 million enrollees prior to the pandemic. Experts say the PHE will continue to push enrollment numbers, and ultimately the numbers of those who have the potential to lose coverage.

Jodi Ray, Program Director of Florida Covering Kids & Families, hopes that flexibilities from the PHE, such as a 6.2% increased Federal Matching Assistance Percentage and enhanced premium tax credits, can be made permanent. 

“If they’re not going to be eligible for Medicaid, we’ve got to help,” Ray said. “These are children, these are pregnant women. These are people who have chronic and acute health care issues that are in the middle of cancer treatments who are going to lose their coverage.”

From her work as an on-the-ground health coverage navigator, Ray estimated that insurance  premiums can increase as much as 53% for families once PHE flexibilities expire.

Enrolling in Medicaid and receiving health coverage for little to no cost directly translates into better health and socioeconomic outcomes, said Elodie Dorso, CEO of Evara Health, a nonprofit, federally-qualified health center in Pinellas County. 

“We’ve seen a reduction of medical debt by over $1,000 per patient that has been on Medicaid, which brings us over to economic mobility,” she said. “When you’re able to see the doctor, you’re able to get healthy, stay healthy, [and] maintain your job, which means you’re able to pay your rent and provide food for your family.”

Looking ahead, several factors play a part in the state’s ability to address redeterminations, including staff shortages and not knowing the exact number of ineligible Medicaid recipients. Patti Grogan, Director of Policy & Programs at the Office of Economic Self Sufficiency under the Florida Department of Children and Families (DCF), estimated over 550,000 people were ineligible for Medicaid at their last redetermination prior to the PHE.

She said the two groups most likely to lose their Medicaid eligibility are those who experience age-related changes, such as turning 65 and needing to move to Medicare, or those who experience a change in income.

Grogan laid out a few strategies DCF is implementing in preparation for the redetermination process: 

  1. Confirming and updating recipient addresses: A change in address can sometimes change eligibility. Call center agents are directly interacting with participants, and DCF is using technology to identify return mail. Additionally, DCF will cross reference participant addresses using data from managed care organizations, EBT vendors, and its own internal data.
  2. Ex parte review: DCF has conducted ex parte redeterminations. If DCF can confirm a member’s eligibility through their income and other required factors, they can renew their enrollment without having to make contact.
  3. Consolidating redeterminations: Grogan said some families have to review their eligibility three or four times a year for adult, children, and SNAP benefits. By reviewing all of those aspects in one visit, families would be less likely to miss a redetermination.
  4. Extensive campaigning: Grogan spoke of ways to make communication from DCF about redeterminations more distinct, such as differently-colored envelopes and establishing a special redetermination webpage.

Enrollees that do lose coverage will automatically be referred to the federal marketplace or Florida Healthy Kids. However, Ray said more can be done by the state to engage with stakeholders when it comes to strategies to maintain the coverage safety net. This includes not only working on the ground to inform participants about upcoming changes, but also analyzing the viability of Florida’s overall safety net.

On the provider side, Dorso advocated for moving more providers to a pay-per-performance structure and expanding coverage for telehealth. 

Although Medicaid expansion remains unlikely for Florida, Grogan highlighted the extension of postpartum Medicaid coverage to 12 months.

“We anticipate that federal approval of the state plan amendment will occur at very latest by the end of June, but certainly before the end of the public health emergency,” she said.