Feds need to oversee Florida's Medicaid wind-down

Tens of millions stand to lose coverage with the end of the COVID-19 federal health emergency. Temporarily expanding Medicaid during the pandemic was one of America's sharpest responses to COVID-19. But the wind-down has been anything but. The Biden administration needs to ensure that Florida and other states are not haphazardly removing the neediest from this vital health insurance.

Congress passed a coronavirus relief package in 2020 that offered states additional federal funding in exchange for guaranteeing that recipients of Medicaid, a joint federal-state program for low-income people, would retain their health coverage. The measure was intended to ensure that low-income families could afford medical treatment during the public health emergency. Tens of millions of Americans were spared nationwide; enrollment in Florida's Medicaid program ballooned by 1.7 million people.

But as states wind down the program, a new projection from the health consulting firm Avalere estimates that up to 30 million of the poorest Americans could be purged from the Medicaid rolls. Experts fear that many are being removed as a result of error-ridden state reviews that have taken Medicaid away even from people who still qualify. Recipients have faced a host of problems nationwide, according to a recent report by The Associated Press, including hourslong phone waits for call center staff, confusing government forms and children wrongly being dropped from coverage. And it's all happening, some experts, attorneys and organizers complain, with little pushback from the federal Centers for Medicare and Medicaid Services.

Nearly a dozen advocates around the country detailed widespread problems they've encountered while helping some of the estimated 10 million people who've already been dropped from Medicaid, the AP reported. Some fear systemic problems are being ignored. The Department of Health and Human Services said it is monitoring states including Florida, Texas and Arkansas, which account for a quarter of the country's Medicaid disenrollments. But HHS has shared little about the problems it has uncovered, beyond announcing in August that thousands of children had been wrongly removed in 29 states.

If trends continue, as many as 30 million people could end up being dropped from Medicaid once states finish reviewing their Medicaid rolls, according to Avalere's projections. That's double the Biden administration's initial estimate that 15 million people would lose coverage through the disenrollment process. Florida has removed 520, 000 people from the program since the end of the public health emergency, the Tampa Bay Times reported in October. About half of those are children.

What's more, most of those losing coverage have been removed for procedural reasons, like failing to return their renewal forms or to submit proper paperwork. As the AP reported, that reflects broader problems with how states determine Medicaid eligibility. Many patients are confused by the paperwork, or are difficult to reach. Experts fear a large number is losing coverage even though these residents still qualify.

Experts worry that federal officials are trying to play nice with the goal of helping the states improve their performance voluntarily. That spirit of cooperation is commendable, but what matters is results. The federal government needs to step in where states are falling flat. In Florida, for example, state officials are actually proud of what they have done, claiming there is no problem and asserting that they are being good stewards of taxpayer dollars.

States need to provide the resources and follow-up to ensure that residents who qualify remain on Medicaid. Adequate staffing, attention to detail and proactive, continuing outreach are essential elements of this government winddown, and states should not be allowed to shirk their obligations. - Tampa Bay Times