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Law May Rescue Patients from Paperwork

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
Bruce R. Bennett/The Palm Beach Post
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

The disease Greg Eisenstein endures is described as more painful than childbirth or even amputation in the medical literature. The state of Florida, Eisenstein says, is making him worse. (Editor's note: This story has been reprinted with permission from the Palm Beach Post.)

Eisenstein suffers from a disease called RSD, or reflex sympathetic dystrophy. It’s a syndrome that softens his bones, swells his limbs and distorts nerve perceptions. A touch can feel like a burn, heat can feel cold, a minor injury can feel agonizing. One by one his joints are failing and being replaced with titanium.

His doctor says there’s no cure. His disability, and his pain, are permanent.

But the state of Florida is not convinced. To continue receiving his Medicaid safety-net health benefits, Eisenstein must file paperwork every year proving that he’s still disabled. He must also re-prove that he’s still poor, and still a U.S. citizen.

But big changes are coming next year. New Affordable Care Act rules require a streamlining of states’ Medicaid eligibility process. States must connect their Medicaid application systems to a federal data hub linked to the health insurance exchanges opening on Oct. 1.

This, the Obama Administration says, should result in a “no wrong door” application system for people poor enough to qualify for Medicaid. Whether the new connectivity will change Florida’s eligibility verification bureaucracy is another question.

That bureaucracy employs 4,000 people in offices statewide, at a cost of $273.5 million a year, all to verify that people qualify for the state benefits they’re attempting to claim — including Medicaid, welfare and food stamps.

The Florida Department of Children and Families oversees the eligibility system. Spokesman Whitney Ray says DCF spends an average of $77.31 per beneficiary per year.

For Eisenstein, that would have been the equivalent of three months’ worth of food stamps, if he was getting them. He gave up trying because of how difficult it was to assemble the paperwork.

In his Boynton Beach kitchen, stacks of threatening letters warn Eisenstein that his Medicaid is ending, and an investigation of him beginning, all because he started and then abandoned his food stamp application.

He didn’t stop because he wasn’t eligible. He stopped after learning they’d send him just $21 a month.

Hours on hold

Once an apartment property manager, Eisenstein, 51, now lives in the mobile home of his 89-year-old mother. He takes comfort in a pair of disabled cats, Hope and Faith, as he sits with a phone to his ear, on hold for hours at a time, hoping for the chance to discuss his status with a state worker.

He has only a few days to fix the misunderstanding, and he’s white-knuckled with stress. Did they receive his fax and his certified mail? He doesn’t know. He can’t afford a computer and so he calls again and again to find out, only to be told he may want to drive in person to a DCF office to deliver his paperwork and get help. That’s difficult for him to do, as one of his legs won’t bend.

“My medications cost between $1,200 and $3,000 a month,” he says. “If I don’t get my medications, I’m dead.”

Among bureaucrats, Eisenstein is what’s known as a “dual eligible;” someone on both Medicare and Medicaid. Such “dual eligible” patients are the sickest – and most expensive – in the federal entitlement system. They accounted for only 14 percent of Medicaid enrollment nationwide in 2010, but consumed 36 percent of all Medicaid spending, according to the Kaiser Family Foundation.

According to some health care experts, one of the ways states have controlled their Medicaid costs historically has been to make life more difficult for patients like Eisenstein.

Adding complex new paperwork requirements and forcing clients to re-apply guarantees some won’t make the cut, and costs will be controlled, said health industry analyst Allan Baumgarten, author of the Florida Health Market Review.

Florida appears to be especially effective at removing people from their Medicaid benefits.

The Florida Medicaid program has one of the highest “churn” rates in the nation, according to a new report by the Association of Community Affiliated Plans in Washington, a group that represents Medicaid HMOs.

The report found Florida’s average Medicaid coverage lasts 8.9 months, compared to a national average of 9.7 months. The group is pushing for Congress to pass a bill requiring that Medicaid benefits, once approved, are valid for an entire year, like private health plans.

DCF itself doesn’t know how many people lose coverage during a year due to paperwork failures or fraud, and doesn’t track its “churn” rate, DCF spokesman Ray said.

$22 billion for Medicaid

What is clear is that Florida’s Medicaid expenses have skyrocketed amid the economic downturn. The state’s Medicaid budget, paid for with state and local dollars, will be over $22 billion this year, up from $18 billion in 2010. Medicaid covers the poorest children, pregnant women, and aged and disabled people.

The state’s costs are expected to rise still more next year, after the Affordable Care Act’s mandatory insurance rule goes into effect, because people who have been eligible for Medicaid, but not enrolled, are expected to come out of the “woodwork” when they create new accounts on the federal health exchanges.

Only about 63 percent of adults who technically qualify for Medicaid now are actually enrolled, according to the Kaiser foundation. The remaining 37 percent could be if they create an account at

Still, Florida isn’t making any extra preparations to absorb newly eligible people in its Medicaid program, said Jeri Flora, director of DCF’s “economic self-sufficiency” programs. The state projects only about 35,000 new Medicaid enrollees.

“We don’t anticipate a tsunami of applicants,” she said.

After 2014, people like Eisenstein won’t have to unearth documents that prove their U.S. citizenship once a year, because the state will have an electronic connection to the Social Security Administration’s database, Flora said.

“I think it’s going to be an easier process,” said Flora. “There will be no wrong-door processes.”

The information held by the IRS and the Social Security Administration will be shared with eligibility reviewers in Florida.

“We are connecting electronically with the federal data hub,” Flora said. “We will be exchanging information with the feds through that portal.”

The online application isn’t much help for people as poor as Eisenstein, though. He cannot afford an Internet service account, he said. The state referred him to a charity that helps people apply for aid online. The charity didn’t take appointments — it was first-come, first served. He waited four hours outside before he was able to sit down and create an online account.

“I didn’t want to be sick. I used to love working,” he lamented. “What did I do wrong? They treat prisoners better.”


  • Florida spent an average of $11,931 per dual-eligible Medicare/Medicaid beneficiary (disabled or aged). The national average was $16,460. Only Georgia, Alabama, Louisana, Mississippi, Nevada and Tennessee spent less per person.
  • Florida had 675,000 dual-eligibles as of 2010, about 235,000 of them were under age 65.
  • Millions of uninsured U.S. residents are eligible for Medicaid, but they haven’t enrolled, according to the Kaiser Family Foundation.
  • About 85% of children who are eligible for Medicaid or children’s health insurance participate. But only 63% of adults who are eligible actually have Medicaid.