A federal court decision to block a change to Kentucky’s Medicaid program could affect a similar request from Florida.
Both states asked to eliminate retroactive eligibility, which allows recipients to get coverage up to three months after they see a provider.
Florida officials requested a waiver from the federal government to change the eligibility requirement in March and are awaiting a decision from the Centers for Medicare and Medicaid.
The change would mean that patients who are eligible for Medicaid would have to apply for it within the same calendar month that they received services from a provider. They currently have 90 days from the date of their service to apply.
The change would apply to anyone who is not pregnant and 21 or older.
In Kentucky, officials also asked for a Medicaid waiver that would put in place work requirements for Medicaid recipients along with lock-outs for not paying premiums and increased cost-sharing.
The Centers for Medicare and Medicaid Services approved Kentucky’s waiver request but a federal judge blocked it.
The judge ruled that the Medicaid waiver process dictates that proposals are only supposed to be approved if they promote the objective of the Medicaid Act, which is to provide health care coverage, not take it away, said Anne Swerlick, with the Florida Policy Institute.
The reason Florida provided for its waiver request -- fiscal predictability -- could put it in hot water, Swerlick said.
“It’s really another way of saying we’re going to save money – we’re making a cut,” she said.
Removing retroactive Medicaid eligibility makes it harder for people to get care, she said.
“If you’re going to ask the federal government for permission to change your Medicaid program, it’s supposed to be to do something innovative that’s going to promote the objective of the Medicaid act, which is to provide people coverage,” Swerlick said.
If the Centers for Medicare and Medicaid Services decides to approve Florida’s waiver request, it could open the state up to a legal challenge, Swerlick said.
“The legal reasoning in the Kentucky case would apply and would be persuasive to judges in the Florida judiciary,” she said.
Retroactive eligibility is especially important for elderly people who require long-term care, advocates say.
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.
Hospitals that care for a lot of low-income patients have been critical of past proposals to remove retroactive eligibility.
