Some Floridians in limbo over Medicaid coverage loss [Orlando Sentinel]

Now that the unwinding of Medicaid’s continuous enrollment provision has begun, Florida families are full of questions. They say they’ve received contradictory messaging and are anxious about whether they and their children will continue to receive access to crucial care if and when their benefits run out.

Orlando mom Erin Booth has spent hours online and on the phone with the Department of Children and Families trying to confirm how long her 4-year-old son, Landon, will continue to receive coverage. Landon was diagnosed with leukemia in March 2021.

“I’m not confident in anything right now,” Booth said. “I’ve been doing my homework but I’m still trying to figure out what’s going on.”

Florida DCF representatives have called Booth and told her that redetermination for kids under 21 with complex medical conditions, like Landon, will be postponed until next March. But for the past few weeks, Booth has received messaging that suggests Landon could lose coverage much earlier.

“Your child is at risk of losing their Medicaid coverage ... start the process to see if you still qualify. If you do not, your child’s plan will be canceled on April 30, 2023,” states an email Booth received Tuesday from her son’s government health insurance.

”It shouldn’t be that hard to process Medicaid. I just want my son to have the best chance possible to get well again,” Booth said. “You don’t understand how hard it is to know you might lose your medical coverage when your son has cancer.”

Landon has been on Medicaid since June 2021, and for most of that time, he didn’t undergo the traditional re-evaluation of eligibility for the program. After the COVID-19 public health emergency began, states were not allowed to disenroll recipients from the program for low-income and disabled people even if they became ineligible.

The pause on redeterminations was eventually unlinked from the public health emergency and ended April 1.

Over the next 12 months, the Florida Department of Children and Families will redetermine eligibility for most of the record 5.7 million Floridians currently on the Medicaid roster and terminate a projected 1 million, many of them unfamiliar with this process.

“We’ve had three years where people have not had to go through it. ... Now that’s changed. Providers, advocates, consumers and DCF are all very concerned and working hard to increase awareness,” said Miriam Harmatz, advocacy director and founder of the Florida Health Justice Project.

Children make up the majority of these recipients. As of February, over 345,501 children are enrolled in Medicaid in the Orlando area. Many will remain eligible, but experts estimate thousands may experience a coverage loss or interruption due to administrative or procedural issues, according to the Florida Health Justice Project.

Experts urge families not to try to figure this out on their own, especially if they receive a termination notice.

“If you’ve never really had to search for care that’s free, if you’ve never lost insurance before, you don’t know where to go and search for that,” said Abby Rice, vice president of operations at Shepherd’s Hope, a clinic for people at or below 200% of the federal poverty level who lack health insurance.

Families can reach out to DCF, nonprofits such as the Florida Health Justice Project at [email protected] and the Primary Care Access Network at https://www.coveringcfl.net/ or 1-877-564-5031.

Some in for a ‘rude awakening’

Some residents will be renewed automatically, but some will receive instructions on how to renew their coverage 45 days before their renewal date. Notices and instructions will come via letters, emails, texts and calls. DCF urges Floridians to update their information on their ACCESS Florida account so they are able to be reached. Their MyACCESS Account should also have information on when their redetermination is scheduled.

Of particular concern are Florida kids who turned 19 during the pandemic.

In a household of three with a child aged 6 to 18, the income limit to receive Medicaid is $2,860 a month. Once that child turns 19, the limit becomes $590 a month, according to the Florida Justice Project.

Many people don’t realize that a 19-year-old can remain eligible for Medicaid by filing as a household of one in some circumstances.

Another group in need of special attention are families who received care because they were deemed “medically needy,” said Florida Health Justice Project’s Harmatz.

Florida’s medically needy program allows people whose incomes are otherwise too high for Medicaid to receive Medicaid coverage if their monthly medical costs exceed a certain amount based on their income, called their “share of cost.”

Ordinarily, this medically needy Medicaid status would only last for the rest of the month that a family qualified. During the pandemic, however, if a family met medically needy status once, their medically needy Medicaid coverage lasted for the duration of the continuous coverage period.

“This is very confusing for everyone, especially these populations who have been on Medicaid via medically needy,” Harmatz said. “Now they’re in for a rude awakening.”

Some celebrate renewal notices

Some families have been able to successfully navigate the process.

Jacksonville mom Angela Keene on Wednesday got a notice that Medicaid coverage for her son, Keith, has been renewed until April 2024. Her 4-year-old son has ADHD and is on the autism spectrum, and this renewal allows him to keep seeing his pediatrician, psychiatrist and therapist and to receive medication that reduces his hyperactive episodes and disruptive behavior enough to start school in the fall.

Keith has been on Medicaid his whole life, with the majority of it during the pandemic. This renewal comes following weeks of anxiety for Keene, who hadn’t been sure if her recent marriage would make the family’s income too high to continue to qualify for Keith’s coverage. She wasn’t sure exactly when she’d find out if Keith’s coverage was renewed, either.

“I can now concentrate on getting Keith ready for kindergarten and summer camp ... and not worry about if he will be able to go to school or not,” Keene said over text Thursday.

Keene said she wishes DCF had been more accessible over the phone in the weeks leading up to this notice. Keith’s coverage, if not renewed, was set to expire at the end of May.

The system is very difficult for an average person to understand and navigate alone, said Anne Packham, the marketplace project director for the Primary Care Access Network in Orange County. Packham urges people to get in contact with local navigators who can speak specifically to the health care options offered in Central Florida.

“My number one mantra is: talk to a navigator. Talk to somebody in the know,” Packham said.

Roadmap uncertain after losing coverage

There’s no one-size-fits-all road map for how to proceed if a family does lose Medicaid coverage, Packham said.

One option, for some, is employer-provided insurance. Employers are required to offer employees a special health insurance enrollment period for 60 days from the day their coverage or their child’s Medicaid coverage is terminated. They do not have to wait until open enrollment, Packham said.

In addition, many who are taken off Florida’s Medicaid rolls may also be eligible for subsidized care. These people will be automatically referred to other programs such as the Affordable Care Act Marketplace or Florida KidCare, which provides low-cost health coverage for children who aren’t eligible for Medicaid but are still within certain income limits.

Financial concerns arise if a child’s current doctor doesn’t take KidCare’s insurance plan.

“That is a huge concern that I’ve heard in the community, especially with kids on the autism spectrum, because there is a difference between Medicaid and Florida KidCare,” said Packham.

Others will make too much to qualify for Medicaid but too little to qualify for subsidized care. Florida is one of few states that chose not to expand Medicaid eligibility to low-income, childless adults.

About 415,000 Floridians were stuck in this gap before the pandemic, a number expected to grow as disenrollments continue.

Others may lose coverage or fail to enroll properly in the health care marketplace even if they’re eligible, because there are tricks to the process that not everyone knows about, Packham said.

“People fill out the Marketplace Application incorrectly all the time, and they get the wrong answers,” Packham said.

[email protected]; @CECatherman Twitter

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