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State Considers Changes To Medicaid Eligibility

Agency For Health Care Administration
Agency For Health Care Administration

Proposed changes to Florida’s Medicaid eligibility requirements would make it harder for people to get coverage after they become sick.

The state is considering doing away with a three-month “retroactive eligibility period,” which allows patients to enroll in Medicaid up to 90 days after they see a provider. The change would apply to anyone who is not pregnant and 21 or older.

“I can only think the goal here is to save money,” said Joan Alker, director of Georgetown University’s Center for Children and Families. “I can’t really think of any policy reason to pursue this kind of change.”

Retroactive eligibility is especially important for elderly people who require long-term care, Alker said. 

That’s because seniors are covered by Medicare, but their nursing home care is covered by Medicaid. Many patients are brought to a nursing home after an unforeseen health episode and may not be able to immediately apply for Medicaid coverage.

Retroactive eligibility allows them time to go through the application process, which can take several weeks, depending on the person.

“So this is a way to protect both the beneficiary as well as the hospital or nursing home from uninsured debt that would result both to the person and the provider,” Alker said.

Hospitals that care for a lot of low-income patients have been critical of past proposals to remove retroactive eligibility.

“Both hospitals and long-term care facilities are going to be on the hook and ultimately the patients are going to be on the hook,” Alker said. “So this is double trouble really because when you make a policy change like this people’s health care needs don’t change. It’s just the way they are getting paid or not getting paid for in this case.”

The state is also considering making more hospitals eligible for Medicaid funds that reimburse care provided to people who cannot afford to pay.

Under the proposal, regional intensive care centers would become eligible for the Low Income Pool or LIP funds.

The proposals will be discussed at two public meetings:

  • March 28, 3:30-5 p.m. at the Agency for Health Care Administration, 6800 N. Dale Mabry Highway, Suite 220 in Tampa. Those who cannot attend in person can call in at 888-419-5570. The participation code is 571-178-31.
  • April 3, 10-11 a.m. at the Agency for Health Care Administration, 2727 Mahan Drive, Building 3 in Tallahassee. Those who cannot attend in person can call in at 888-339-2688. The participant code is  616-259-66.
Julio Ochoa is editor of Health News Florida.