Florida gets federal approval to trim retroactive eligibility for Medicaid

Dec. 03--TALLAHASSEE -- Floridians will now have less time to apply for Medicaid coverage if they want healthcare costs retroactively covered, after federal officials approved a state request Friday to shorten how far back the state's program can pick up the bill.

The change, which critics have charged will limit access to healthcare for the poor, elderly and those with disabilities, means those who qualify for the safety-net program now have up to 30 days of retroactive eligibility once they qualify for Medicaid, as opposed to the original 90 days. After approval from the federal Centers for Medicare & Medicaid Services, which oversees the safety net program, the 30-day policy will go into effect Feb. 1 and remain in place until June 30 unless state lawmakers vote to extend the change.

The state Agency for Health Care Administration requested the policy change in the spring, after lawmakers earlier this year voted to support shortening the retroactive eligibility period over the objections of some Democratic colleagues. State Medicaid officials had previously estimated the eligibility would affect about 39,000 people annually -- with pregnant women and children exempt -- and amount to $98 million. The agency also contended that the change would not harm applicants so long as they submitted their paperwork on time.

But during a public comment period, the federal agency received hundreds of comments, all critical of the change: that it would financially hurt providers and patients, impede continuous care or limit access to healthcare services for older patients and those with disabilities in particular.

Some also contended that limiting retroactive eligibility to the start of the month a patient applied for benefits could harm those who became eligible late in the month, shrinking the window they had to submit their paperwork.

In the letter giving the state approval, Seema Verma, Centers for Medicare & Medicaid Services administrator, acknowledged the comments but wrote the state would be required to have a "robust outreach and communication strategy" with providers and beneficiaries that would also be posted on the website.

Medicaid coverage would also date back to the first day of the month an application was filed, even if there was a delay in processing, according to the letter, "which may help mitigate these concerns."

Verma also asserted that the change, requested under an amendment process that is meant to encourage "innovative" healthcare, would enable the state to determine if shortening the retroactive eligibility period could stop people from only intermittently having coverage.

"Florida will be required to test its hypothesis that the waiver will incentivize individuals to obtain and maintain health coverage, even when healthy, or to apply for coverage as soon as possible after the finding or diagnosis that gives rise to their Medicaid eligibility," she wrote. The federal agency is also requiring the state to conduct an independent evaluation within four months of the approval.

The federal agency has approved similar changes in Iowa and Kentucky, though both states also expanded Medicaid eligibility under the Affordable Care Act to include able-bodied adults. Florida has not expanded who is eligible for the program.

The federal agency also approved several other Medicaid changes the state had proposed, from providing a new state Medicaid managed dental plan to making changes to the Low Income Pool, a Medicaid funding program.

The agency approved community behavioral health providers as participants in the funding program, which could expand their access to funding for services treating mental health and substance abuse. It also agreed to a reclassification of regional perinatal care centers, which serve women with high-risk pregnancies and newborns with special health needs, allowing them to access more funding.

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