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Thousands of Florida children appear to not have coverage in Medicaid unwinding

A woman and her son sit in a toy home.
Joe Mario Pedersen
/
90.7 WMFE News
Erin Booth, and her 8-year-old son Landon, sit in the toy room of their Lake Como home. The two are surrounded by toys donated to Landon while he underwent Chemo treatments. In 2021, Landon was diagnosed with Leukemia. The two received a Medicaid redetermination letter from DCF last March, despite the agency saying patients with complex medical conditions would be last to be evaluated in 2024.

Nearly a quarter of a million children were ineligible for Medicaid as the state is about halfway through its redetermination process, in which the Department of Children and Family Services is reevaluating eligibility for 5.5 million Floridians.

So far, DCF has disenrolled around 260,000 children from Medicaid across the state. The state plan was to have those qualifying children enter Florida’s kid healthcare plan. Only 25,000 have enrolled.

The state doesn't have information on what's happened to the other 235,000.

During the Covid-19 Public Health Emergency, states were not allowed to drop people who no longer qualified for Medicaid under the continuous enrollment provision. That emergency order ended in May, meaning the state could begin narrowing its list of Medicaid recipients, such as 8-year-old Landon Booth.

Redetermination during Chemo

In March, Landon's mother Erin Booth received a troubling letter informing her that Landon's Medicaid case was going to be redetermined.

That was confusing. Booth was told before DCF's letter that children with complex medical issues would be redetermined toward the end of the process.

Landon was in the middle of chemotherapy when Booth received notice.

"Why was he chosen first? In the (Medicaid) handbook it says children under 21 with complex medical conditions to be redetermined last, which would be in March of next year 2024," Booth said.

Landon was diagnosed with Leukemia two years ago.

Booth began calling DCF for answers but couldn’t get in touch with anyone and had her call dropped multiple times.

After about two weeks and with help from a WKMG reporter, Booth got confirmation that Landon would instead be redetermined in 2024, and the letter was an error.

Landon's treatments are complete, and he's even had his chemo port removed, but the treatments have left him with several complex medical issues, including osteoporosis.

"He's gone to the bone clinic. We see a urologist. We see a lot of specialists and he has gone through therapies like OT, PT, and speech," Booth said. "Soon he'll probably be going through a psychologist for PTSD."

Trying to connect with DCF

Many families are struggling to reach DCF while redetermination is going on.

At a recent appropriations committee on health and human services, DCF Deputy Secretary Casey Penn told Florida legislators that DCF was experiencing 5-minute wait times on a specially designated hotline.

"We are not specifically sure of any dedicated Medicaid redetermination phone line that has a five-minute wait time at this moment," said Erica Monet Li a health policy analyst at the Florida Policy Institute. "We keep hearing 'I'm on hold with DCF for hours at a time. My call is dropped.' And 'I don't have time to get back and get back to help.'"

WMFE reached out to DCF about the hotline but it has not confirmed that this number exists.

On the bottom of DCF's Medicaid Redetermination page are three hotline numbers. All of them are emergency numbers for "abuse," "domestic violence," and "disaster distress." A number for "redetermination help" is not listed.

State data shows in July, over 2 million calls were received by DCF, and 42% of them were abandoned. The average wait time for callers was 41 minutes before being pushed to another helpline.

Florida ranks 45th of all states for call center wait times and abandonment rates. The top states had 2-minute average wait times

Monet Li is also concerned about Florida’s large procedural termination rate – or Medicaid terminations that occur when DCF does not hear back from recipients. As of September 51% of Floridians were disenrolled for procedural reasons. Unfortunately, the state does not keep track of what the specific reason is for a procedural termination.

 Of all people who were nationally disenrolled, 71% were terminated for procedural reasons. Of People Who Lost Coverage, the Share Disenrolled for Procedural Reasons (Orange) vs. the Share Determined Ineligible (Yellow).<br/><br/>
Kaiser Family Foundation
Of all people who were nationally disenrolled, 71% were terminated for procedural reasons. Of People Who Lost Coverage, the Share Disenrolled for Procedural Reasons (Orange) vs. the Share Determined Ineligible (Yellow).

Many of the disenrolled are children and still qualify for Medicaid due to wider income margins, said Joan Alker, the Co-Founder of the Georgetown Center for Children and Families which tracks the national Medicaid unwinding process.

"Federal researchers projected that three out of four children who would lose Medicaid would remain eligible," she said.

Alker said income margins were increased allowing more children to keep care. While some disenrolled families will move to options offered by their employer, Alker says that’s often cost-prohibitive for low-income families.

"A few of them may be going to the marketplace, but that's not a big place for children to get coverage in general," Alker said. "But overall I certainly worry that a good chunk of them is uninsured."

Another option would be Florida's Children's Health Insurance Program, or CHIP, but the program is run by a separate agency making transitioning difficult. Additionally, parents would be expected to pay a premium for the coverage.

Alker is worried about the many children who can't get on CHIP, and what the price of a medical bill might be without coverage.

"These kinds of gaps in coverage are problematic for children because they're not expensive to cover, but they are regular utilizers of care, as any parent knows," she said.

The cost without coverage

Back at Erin Booth’s home, she's concerned about next year and whether Landon will lose Medicaid due to her and her husband’s income being slightly over the limit. CHIP isn't a possibility either due to its premiums.

To make the matter more complicated, Booth recently learned Landon's neurological issues are due to a brain abnormality formed from treatment, she said.

Booth is willing to do whatever it takes for her son, but she knows she and her husband can't do it alone. Thanks to the assistance of Medicaid, the Booths were able to cover Landon's treatments, without insurance would have cost at least $2 million, she said.

 Landon Booth, 8 of Orlando, plays Roblox in the living room of his Lake Como home. His mother Erin, 38, sits in the background. Landon played the game often while receiving chemotreatments for Leukemia.
Joe Mario Pedersen
/
90.7 WMFE News
Landon Booth, 8 of Orlando, plays Roblox in the living room of his Lake Como home. His mother Erin, 38, sits in the background. Landon played the game often while receiving chemotreatments for Leukemia.

Between the mistaken redetermination letter and the ticking clock on the 2024 redetermination process, she feels the state has turned its back on her son.

"I'm just asking for my child sick child to have health care that is reasonable, where I can afford it. And I'm not going to have to declare bankruptcy or lose my house because I can't afford my mortgage," Booth said.

DCF has the option to pause its redetermination process, reevaluate, and even use $3.3 million allocated in the state budget to improve call centers and staff performance, Monet Li said but has not yet moved to do so.

During the Senate appropriations meeting last month, DCF said the unwinding process was going well.
Copyright 2023 WMFE. To see more, visit WMFE.

Joe Mario Pedersen
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