Medicaid enrollment in Florida continues to drop amid 'redetermination' process

Enrollment in Florida’s Medicaid program has dropped by more than 670,000 people after the end of a federal public health emergency as a potential class-action lawsuit continues about the state’s handling of the issue.

Newly posted data by the state Agency for Health Care Administration showed that 5,105,874 people were enrolled as of an October count, down from a high of 5,778,536 in April.

Decreases are expected to continue in the program, which provides health care to low-income people.

The federal government declared a public health emergency in 2020 as the COVID-19 pandemic began. Medicaid is jointly funded by the federal and state governments. As part of the emergency, Washington agreed to pick up more of the tab for the program.

In exchange for the extra money, states had to agree that they wouldn’t drop people from the Medicaid rolls during the emergency. Florida’s program grew from about 3.8 million beneficiaries in January 2020 to the nearly 5.78 million in April of this year. At least in part, the increase stemmed from the program being unable to drop people who otherwise might not qualify because of their income levels.

With the end of the public health emergency this spring, the state has used what is known as an eligibility “redetermination” process. Enrollment has steadily declined, dropping by about 56,000 people from September to October, according to the new data. The redetermination process is continuing.

A federal judge is scheduled to hear arguments Dec. 5 in a potential class-action lawsuit that alleges the state has not provided adequate information to Medicaid beneficiaries before dropping them from the program.

Jacksonville-based U.S. District Judge Marcia Morales Howard will hear arguments on a request for a preliminary injunction that would require Medicaid officials to reinstate coverage to people dropped from the program and end additional terminations until adequate information is provided. Also, the judge will hear arguments about certifying the case as a class action, according to a notice issued last month.

The plaintiffs in the lawsuit are two children and a mother whose full names are not disclosed. In a brief last month, the plaintiffs’ attorneys contended that the state had violated Medicaid beneficiaries’ rights.

“Due process guarantees an adequate notice that ‘fully informs’ the enrollee of the case against them so they can decide whether to request a pre-termination hearing,” the brief said, partially quoting a legal precedent. “The notices in this case border on incomprehensible. As a result, people incorrectly decide not to appeal, or lose the right to benefits pending appeal, and must then scramble to figure out next steps.”

But attorneys for AHCA and the Florida Department of Children & Families disputed that the state had violated beneficiaries’ rights and said the judge should reject the requests for a class action and an injunction. AHCA runs most of the Medicaid program, but DCF plays a key role in the redetermination process.

“Plaintiffs’ requested injunction upsets the apple cart with respect to millions of people: those who were found ineligible for full Medicaid whom plaintiffs demand be reinstated, and those for whom eligibility redeterminations would be halted during the pendency of this litigation,” the state’s attorneys wrote in a court document. “DCF’s administration of a multibillion-dollar program cannot simply pivot overnight to accommodate chaos of that magnitude.”

The issue also affects managed-care organizations that contract with the state to oversee care for most Medicaid beneficiaries. Centene Corp., which is a major Medicaid managed-care plan in Florida and other states, indicated last month in a federal Securities and Exchange Commission filing that it is watching the issue nationally.

“We are actively engaged to help ensure individuals take the state agency requested action to confirm eligibility in their Medicaid coverage or find other appropriate coverage that is best for themselves and their families,” Centene, which operates the Sunshine Health plan in Florida, said in a quarterly report.

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