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Health advocate fears hurdles in Florida's Medicaid 'unwinding' is jeopardizing kids' coverage


Health advocates are renewing calls for Florida to pause its Medicaid "unwinding" process.

A coalition of 50 organizations sent a letter to Gov. Ron DeSantis on Tuesday that also urges officials to reinstate children who have been disenrolled for procedural reasons, which can include missing a deadline or submitting incorrect forms.

They cite recent state data that shows more than 250,000 youths 20 and younger were removed from Medicaid since April, when federal “continuous coverage” protections implemented early in the COVID-19 pandemic ended.

Kids are so far accounting for nearly half of all disenrollments, which concerns national experts like Joan Alker, executive director for the Center for Children and Families at Georgetown University’s McCourt School of Public Policy.

“Because we know, generally speaking, most of these children probably remain eligible for Medicaid and they don't have another source of coverage,” said Alker. “So that's why we're very worried that many of these children are actually becoming uninsured.”

Adding to their worry is that there has been a much smaller net growth in enrollment for Florida's children’s health insurance program (CHIP), which is administered by nonprofit Florida Healthy Kids Corp. Advocates projected more children would either remain on Medicaid or move to that program by now.

The state, which also faces a lawsuit and civil rights complaint over its handling of the Medicaid unwinding, pushed back on that criticism on Wednesday during hearing of the state Senate Health and Human Services Appropriations Committee

Officials argue staff are working to refer ineligible families to Florida Healthy Kids and other coverage options, and said Florida’s procedural termination rate is lower than the national average.

“Many Floridians’ circumstances have improved since the pause of redeterminations, and with an unemployment rate of 2.7%, it should be expected that families in a stronger financial situation would no longer be eligible,” Miguel Nevarez, press secretary for the Department of Children and Families, wrote in an email to Health News Florida.

Data presented by state agencies during Wednesday’s hearing show Florida Healthy Kids experienced a roughly 27,000 net increase in enrollment from April through August, while new enrollment during that period was just over 67,000.

It’s unclear how many children may have transitioned to other insurance programs, but advocates suspect thousands of kids risk experiencing disruptions in coverage and argue the state should do more to support families.

Alker, who spoke to Health News Florida, prior to Wednesday’s hearing, shared some of her concerns:

What worries you about Florida’s Medicaid unwinding process?

We're extremely concerned about what's happening to families in Florida. It is one of the states where we've seen the largest number of children affected so far in the country.

 Joan Alker is the executive director of Georgetown University's Center for Children and Families.
Georgetown University Health Policy Institute
Joan Alker is the executive director of Georgetown University's Center for Children and Families.

People who aren't eligible for Medicaid can't be on Medicaid, those are the rules. But what we're seeing now is the vast majority of families losing coverage in Medicaid, and children in particular, it’s not because they've been determined to be not eligible. It's simply because they're not making it through all of the hurdles to get through the process.

And you hear a lot that, “Oh, families are just not reading their mail, they're not returning their mail.” Well, I can tell you the support system to help families with this complicated process, to understand these confusing notices they're getting, is not working as it should be.

That's one of the things advocates are complaining about, that getting help from the state's call centers can be a real headache.

We just saw new data that the federal government released, and Florida's call center in June alone received 2 million calls, which knocked my socks off, that was the highest number by far.

We know there's particularly a problem for Spanish language speakers. The wait times are a lot higher. And there has been a complaint filed, I believe, with the Office of Civil Rights about that. So the federal government is definitely taking a look at this, and that's very troubling.

The state is saying that every child determined ineligible for Medicaid is getting referred to Florida Healthy Kids, or CHIP, another insurance program for kids with low incomes. But we're only seeing a small increase in CHIP enrollment.

Yeah, that's a great point. So this is a key question: We know children are losing Medicaid, where are they going? Because if they were getting other sources of affordable coverage, we wouldn't worry so much.

But it's clear from looking at the state's own data that very few children are making it from Medicaid to CHIP. So I think that once again suggests that many of these children remain Medicaid-eligible. But also, Florida is famous for the complexity and the difficult hurdles families have to jump over to get into Healthy Kids. The two sources of coverage for children just don't work very smoothly together.

Many states in the country simply have one program for children, so they don't even have this problem at all. And unfortunately, Florida has a very complicated system that makes it hard for families to get from one coverage source to another.

The other problem is that if a family does make it over to CHIP, the family still has to pay a premium. That may not sound like a big deal, but first of all, the families may not know that, and if they don't pay the premium, they're going to get dropped.

Now, Gov. [Brian] Kemp in Georgia has temporarily halted premiums in their CHIP program to avoid this barrier for families. And I think that's something that Gov. DeSantis could easily do when we see these huge coverage losses for children in Florida.

It's been really heartbreaking. I've personally had a handful of families reach out to me and asked me for help. One family shared all of their notices that they got with me. And they were so confusing. And this might have been a child who was supposed to move over to CHIP. But it was just virtually incomprehensible to figure that out.

And people like yourself and lots of health care navigators here in Florida are helping families get through this. But help explain how a brief disruption in coverage can affect these families.

Fortunately, children are generally healthy, and they're not expensive to cover, but they need regular care. And I think any parent remembers, particularly those early days with babies and toddlers, you're constantly at the doctor's office. They need their well baby care, they need their well child care, they need their shots to go to school.

But there are many chronic conditions for children, like asthma. Asthma is very common, and if you can get the medications you need, a child can control their asthma. But if they can't, it gets out of control. They miss school, and they wind up in the emergency room. And this just has many negative consequences.

In the short term, families incur medical debt that's very hard to keep up with. Even one trip to the emergency room is going to set back a low-wage working family for months, if not years.

And then of course, there are some children who have serious medical problems. We've heard of many examples in Florida, of children who clearly should remain eligible with serious medical conditions like cystic fibrosis, Crohn’s disease, cancer, etc., who lost their coverage.

And look, you know, I'm sure there are many folks who work for the state who are trying their best and are working hard. To me, this a governor-level decision. You have got to have elected officials stand up and take responsibility for protecting children during this process, and we just haven't seen that.


DCF has more information about Medicaid redeterminations on its website.

Disability Rights Florida offers tips to beneficiaries about handling Medicaid redeterminations and includes contacts for health care navigators who can help with renewals.

The Florida Health Justice Project has an online toolkit that can help families determine if and how they should appeal a Medicaid termination.

Copyright 2023 WUSF 89.7. To see more, visit WUSF 89.7.

Stephanie Colombini joined WUSF Public Media in December 2016 as Producer of Florida Matters,WUSF’s public affairs show. She’s also a reporter for WUSF’s Health News Florida project.
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