Medicaid COVID expansion nears end

Nearly 1 million people across Florida may start to lose health coverage next month as the COVID-era expansion of Medicaid runs out and state officials choose not to replace it, according to the state Agency for Health Care Administration.

That's because Florida provided continuous Medicaid coverage to people with lower incomes during the public health emergency declared because of the coronavirus pandemic. During the emergency, the state did not unenroll anyone who no longer qualified for the program.

As a result, 1.7 million more residents used Medicaid to get dental care, X-rays and pay for doctor's visits as COVID-19 affected their ability to work and stay healthy. A total of 5.5 million Floridians depend on Medicaid for health insurance.

But with the March 31 end of the public health emergency comes the end of those benefits: Florida is one of 11 states that has failed to expand Medicaid, contributing to its status as the state with the second-highest uninsured rate in the country, behind Texas.

Starting April 1, the state will begin the yearlong process of determining which residents are no longer eligible and unenrolling them. State officials expect about 900,000 people to be affected.

The process is likely to create confusion and frustration, according to Erica Monet Li, a public health professional with the nonpartisan Florida Policy Institute.

"As of October 2022, there were over 5.5 million people enrolled in Medicaid in Florida. None of these newly enrolled individuals have had to go through the process of re-enrolling: This is concerning, as they might not know to submit renewals once the (public health emergency) ends," she wrote in February in an online article for the institute.

"Additionally, people who have been enrolled in Medicaid since before the pandemic may have moved or not updated their contact or financial information, which could cause them to lose coverage — even though they remain eligible. This 'churn' has the potential to affect the millions of Floridians who rely on Medicaid for their health care," Li added.

Who qualifies for Medicaid?

Florida has some of the strictest criteria in the country for Medicaid eligibility.

The state program covers children up to 5 years old if they're living in households that make up to $33,408 per year. Older children are covered if their parents make up to $31,795 annually.

But adults under 65 with no children are ineligible regardless of their income, as are parents who earn more than $7,000 per year.

This creates a problem because people living below the federal poverty line — making less than $13,590 each — are not eligible for insurance plans offered through the Affordable Care Act on the federal marketplace.

And that leaves Florida with a notable coverage gap for its lowest-income residents.

Florida leaders, 10 other states, chose not to expand Medicaid

A 2012 Supreme Court ruling scrapped the national Medicaid expansion mandate and left it up to states to decide.

The optional expansion extended coverage to nearly all adults with incomes up to 138% of the federal poverty level and provided states with federal dollars for local expansion, according to the Kaiser Family Foundation.

To date, 39 states and the District of Columbia have adopted the Medicaid expansion. Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Wisconsin and Wyoming chose not to.

State GOP leaders, including Gov. Ron DeSantis and U.S. Sen. Rick Scott, who served as governor when Medicaid expansion first became available, have argued that recurring costs in the program would make expanding Medicaid to more people unaffordable in the longer term.

But when Florida decided not to expand Medicaid under the Affordable Care Act, an estimated 52,000 Palm Beach County residents were left without coverage, according to the Health Care District of Palm Beach County.

As Floridians brace for changes to health care coverage, other parts of the social safety net expanded in response to COVID-19 have been rolled back.

In August 2021, Florida stopped issuing emergency allotments of Supplemental Nutrition Assistance Program (SNAP) benefits. Those allotments were required to provide a minimum of $95 to families each month.

Just one month later, a temporary 15% increase to SNAP benefits authorized by Congress to help families during COVID also expired.

That left families with much less support when buying groceries just as food prices skyrocketed. After Florida ended its emergency SNAP allotments in 2021, food prices rose 9.9% in 2022, according to the U.S. Department of Agriculture.

This month, the 32 states still paying emergency allotments also ended the program, leaving families across the U.S. with their normal pre-COVID payments for groceries.

Every SNAP household saw at least $95 a month less, but some saw reductions of $250 a month or more, USA TODAY reported.

What will happen if you lose health care coverage

If you are no longer eligible for Medicaid coverage, you will be notified by message to your online account, and sent a letter and/or an email, according to the Florida Department of Children and Families.

People eligible for different health care coverage programs may automatically be referred to Florida KidCare, a low-cost health coverage program for children based on family income, or the Medically Needy Program, which allows Medicaid coverage after the policyholder meets a monthly payment limit determined by household size and family income.

The department's website encourages people who will lose their insurance to use a federally qualified health center, which provides medical care for clients with limited or no health insurance on a sliding scale based on income. Foundcare and the health care district's C.L. Brumbeck clinics are some in Palm Beach County.

If you are eligible for insurance through the federal marketplace, you will receive a letter from the U.S. Department of Health and Human Services with instructions on how to complete an application for health care insurance.

Katherine Kokal is a journalist covering education at The Palm Beach Post. You can reach her at [email protected]. Help support our work, subscribe today!