Florida Medicaid officials may have overstepped their authority when they asked the federal government to waive for the next four years a requirement that frail and elderly Medicaid beneficiaries have 90 days to enroll in the program.
Gov. Ron DeSantis’ administration made the request Monday as it sought broader approval to keep intact the state’s use of private health plans as part of a mandatory Medicaid managed-care program.
The issue stems from a federal law that directs state Medicaid programs to provide 90 days of retroactive coverage to give people time to apply for Medicaid following traumatic incidents or diagnoses of illnesses. That way, people can gather needed information, such as proof of age, citizenship, sources of income and assets.
But state lawmakers in 2018 decided to move away from the 90-day retroactive eligibility period. Instead of giving patients up to three months, the state policy requires people to apply for the Medicaid program in the same month they seek health care
The state policy, however, has been temporary and is scheduled to expire June 30. Lawmakers decided to extend the policy, estimated to save about $100 million annually, through June 30, 2021 as part of this year’s budget negotiations, though DeSantis has not acted on the budget.
But Medicaid officials are now asking --- without legislative direction --- for the federal government to approve extending the change through 2024.
“The Legislature has just authorized it for next June,” said Florida Policy Institute senior analyst and attorney Anne Swerlick, who has long worked on Medicaid issues. “And in the meantime, there is supposed to be an evaluation done to figure out how this is really impacting beneficiaries and providers. So I think it does raise questions about whether they have authority to ask the federal government for an extension through 2024.”
The state Agency for Health Care Administration did not immediately answer questions about the issue.
It’s not the first time that state officials have asked the federal government to approve the controversial policy change without legislative authority. Florida Medicaid director Beth Kidder in March 2018 asked that the federal government eliminate the three-month retroactive eligibility period through June 30, 2022. She made the request even though the Legislature had approved it only through June 30, 2019.
“The state must submit a letter to CMS … if it receives state legislative authority to continue the waiver past June 30, 2019. In the event the state does not receive legislative authority to continue this waiver through June 30, 2019 and timely submit a letter to CMS to this effect, this waiver authority ends June 30, 2019,” said a Nov. 30, 2018 letter from the federal Centers for Medicare and Medicaid Services to the Agency for Health Care Administration.
The broader request Monday involves seeking a two-year extension to 2024 of what is known as a “Medicaid 1115 waiver.” Such waivers are approved by the federal government for “experimental, pilot, or demonstration projects” that are found likely to assist in “promoting the objectives of the Medicaid program.”
Florida’s waiver is now 15 years old, first secured from the federal government by former Gov. Jeb Bush in 2005. The initial waiver allowed the state to establish a "Medicaid Reform" demonstration project between July 1, 2006 and 2010. The federal government then agreed to extend the pilot project, which was in five Florida counties, through June 30, 2014.
After garnering legislative approval, the state in June 2013 asked to expand statewide the program that requires most Medicaid beneficiaries to enroll in managed-care plans. Just five months later, the state asked the federal government to extend the waiver through June 30, 2017. Florida has since then sent a bevy of amendments to the federal government.
In 2017, the Centers for Medicare and Medicaid Services agreed to another five-year extension, pushing the expiration date to June 30, 2022. As in the past, the state submitted changes that have been approved, including the 2018 amendment on retroactive eligibility.
“It is supposed to still be a demonstration project?” Swerlick said, noting that Florida no longer needs a Medicaid 1115 waiver for a mandatory managed-care program. “A lot of this could be done through regular state plan amendment stuff and not through a waiver.”
The waiver also authorizes the state to operate a $1.5 billion supplemental Medicaid financing program called the Low Income Pool. But the federal government in recent years has restricted how the so-called LIP funding can be used, and the $1.5 billion in available funding isn’t being fully utilized.
In an interview with the News Service of Florida this week, Agency for Health Care Administration Secretary Mary Mayhew acknowledged that the state did not need the Medicaid 1115 waiver to run the mandatory managed-care program but said, “I think the 1115 gives us the greatest amount of flexibility.”
Meanwhile AHCA posted a copy of the waiver extension request to its website and has scheduled public meetings on the request for June 8 and June 17. The state also is soliciting comments from the public.
Swerlick, a longtime social-services advocate, hopes to attend at least one of the meetings.
“I’ll be very interested in what the agency has to say,” Swerlick said.
