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Senators Move Toward Keeping Medicaid Change

Patient in discussion with doctor at a desk.
Daylina Miller/WUSF
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Despite opposition from disparate special interests, a Senate panel on Monday approved a bill that would make permanent a policy requiring poor, elderly and disabled people to apply for Medicaid the same month they become ill or suffer catastrophic injuries. 

AARP Florida, the Florida Health Care Association and the Florida Catholic Conference, among others, opposed the measure (SB 192). Despite that, the bill cleared the Senate Health Policy Committee in a party-line 6-4 vote, with Republicans supporting the measure and Democrats opposed.

Under federal rules, people in the past had 90 days to qualify for Medicaid coverage in Florida.

But the Legislature last year approved requesting a waiver from the federal government to limit to 30 days the maximum amount of time people have to apply for the program after becoming ill or suffering injuries. The state exempted pregnant women and children, which means the policy applies to elderly and disabled people.

Doreen Barker, associate state director of AARP Florida, said some of those people could have difficulties filling out applications because of cognitive or physical impairments. Moreover, she told senators that not all senior citizens have family members nearby and that filling out applications could be difficult.

“Perpetuating the change in Medicaid eligibility proposed by this bill could be considered in football vernacular … piling on or unnecessary roughness,” Barker testified Monday. “Florida could and should do better.”

Florida Medicaid director Beth Kidder tried to assuage concerns about the policy. She told senators that people only have to begin the application process, not complete it, within the same month.

“As long as they put an application in, it’s good from the first day of that month they put it in. Even if it takes a while to get the rest of the eligibility information into the system,” Kidder said, adding that people should be able to submit applications with basic information including a name, address and social security number.

“If they get the basics in, they have preserved their application date,” she said.

In his proposed $93.1 billion spending plan for the coming year, Gov. Ron DeSantis recommended keeping the Medicaid change. Also, state economists included the continuation of the cut in a Medicaid spending estimate for the upcoming year.

Nevertheless, Florida Health Care Association chief lobbyist Bob Asztalos said he hopes to work with the Legislature on the issue.

Asztalos said that while he doesn’t expect the state to return to the long-standing policy that gave people 90 days to apply for benefits, he said what the Legislature approved last year doesn’t apply equally across the board. People injured early in a month will have longer to apply for the program than people who are injured or diagnosed with a disease in the latter part of the month.

Asztalos, whose association represents nursing homes across the state, said there probably is a “hard number” that gives people time to apply for the application but didn’t provide further details.

“If you kinda look at the political tea leaves, I think that there’s probably no chance they go back to a 90-day period,” he said. “But I think there is a reasonable period that we all need to get to working through the process.”

An initial analysis by the Agency for Health Care Administration indicated that the change could affect as many as 39,000 non-pregnant adults. But the state has revised those figures downward. A review of the Medicaid program in state fiscal year 2017-2018 showed that 11,466 elderly and disabled individuals were granted retroactive eligibility under the 90-day window.

Kidder told members of the Senate Health Policy Committee that the people who took advantage of the Medicaid retroactive eligibility process generally were patients in hospitals or residents of nursing homes. She said health-care providers can help their clients and that generally providers are “adept” at helping them fill out applications.

Florida needed approval from the federal government to implement the policy, which went into effect Feb 1. Because the policy change was included in the state budget --- and not in law --- it will expire June 30 unless lawmakers agree to extend it or make it permanent during the legislative session that starts Tuesday.

The Trump administration approved Florida’s waiver request last year.

But Anne Swerlick, a health-care policy analyst at the Florida Policy Institute, said AHCA’s argument doesn’t make sense given the fact that the state didn’t expand Medicaid to working uninsured adults under the federal law known as Obamacare.

“It ignores the reality of Florida’s Medicaid program, which is that most healthy adults can’t qualify for Medicaid when they are healthy,” Swerlick said. “So this isn’t a failing of personal responsibility. If somebody shows up at the (state) and tries to apply when they are healthy, they are going to be denied eligibility.”