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Florida GOP Push To Permanently Pass Medicaid Enrollment Change

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

A Senate health panel on Tuesday split along party lines as Republicans pushed through a measure to permanently eliminate a 90-day period that seniors and disabled people previously had to apply for Florida's Medicaid program. 

The legislation would put in law changes lawmakers made as a way to save money in the state’s main safety-net health care program.

Democrats on the Senate Health Policy Committee tried unsuccessfully to at least amend the proposal (SB 52) so that the change in the Medicaid enrollment process would end in July 2021.

Opponents of the measure --- which the committee approved in a 6-3 vote --- argued that the state shouldn’t make a permanent change until legislators had data about how it would impact the lives of seniors and people with disabilities.

The state Agency for Health Care Administration was supposed to provide legislators with information about the impacts of the elimination of Medicaid “retroactive” eligibility.

But the head of Florida’s Medicaid program told senators last week that the agency wasn’t able to obtain data. Lawmakers previously asked for information on the amount of medical debt that patients have racked up due to the policy; the number of non-pregnant adults who applied for Medicaid while in hospitals or nursing homes between Feb. 1, 2019 and Dec. 6, 2019; and the number of Medicaid applications that were approved and denied.

Oliva Babis, public policy analyst for Disability Rights Florida, said the agency “did not follow through” with the study and said lawmakers shouldn’t make the change permanent until they have the information.

Babis reminded lawmakers that Florida didn’t expand Medicaid coverage to childless adults as allowed under the federal health care law. As such, adults in Florida cannot proactively apply for Medicaid. They must wait until they experience an accident or a health event that qualifies them for the program.

“The people that we are potentially saving money for the state are people that are experiencing traumatic events that may have had a heart attack or a stroke or experienced a car accident that did not apply by the deadline,” said Babis, who was born with a physical disability.

Federal law directs state Medicaid programs to provide 90 days of retroactive coverage to give people time to apply for Medicaid following traumatic incidents or diagnosis of illnesses. That way, people can gather needed information, such as proof of age, citizenship, sources of income and assets.

But at the urging of former Gov. Rick Scott, state lawmakers in 2018 agreed to change Florida’s policy. Instead of the three-month time span, the new policy requires people to apply for the Medicaid program in the same month they seek health care. Lawmakers excluded pregnant women and people under age 21, which means the policy change impacts elderly and disabled Medicaid beneficiaries.

The time-frame change, which required approval from the federal Centers for Medicare & Medicaid Services, took effect last February. Florida has one of the largest Medicaid programs in the nation, with the state expected to spend about $29 billion in the program during the 2020-2021 fiscal year providing care and services for an estimated 3.8 million people.

Trish Neely, with the League of Women Voters of Florida, told lawmakers she understands the policy benefits of encouraging people to proactively enroll in health care and understands the savings associated with the policy.

“Even though it saves the state money to do what is currently being proposed, and as a taxpayer it saves me money, I don’t want to be saved at the expense of the elderly and the disabled,” she said.

Sen. Lori Berman, a Lantana Democrat who wanted to put a July 2021 expiration date on the proposal, said that the state should wait for the data before moving ahead.

But bill sponsor Aaron Bean, R-Fernandina Beach, said the amendment to set the expiration date would essentially kill his bill. The amendment died on a 6-3 party-line vote.

Bean told committee members that eliminating the 90-day retroactive period saves $103 million in Medicaid spending, about $40 million of which is state revenue.

Bean, chairman of the Senate Health and Human Services Appropriations Subcommittee, said the state could ill afford to let those savings expire.

“My one job is to deliver a balanced budget that is responsible in the health care silo,” he said.

Meanwhile, Sen. Dennis Baxley, R-Ocala, said retroactive eligibility is illogical and that it’s imperative Florida has good management practices.

“There has to be some reasonableness to what we agree to pay for,” Baxley said. “And retroactivity has a very poor management ring to it to me because you are agreeing to pay things that already happened.”