FL Legislature declined to provide health care coverage to 837,000 of the state’s neediest residents

By: - May 9, 2019 7:00 am

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Florida missed another opportunity this year to provide health care coverage to more than 800,000 low-income residents.

As expected, the 2019 Legislature never considered any effort to expand Medicaid, the federal-state health care program for the poor and disabled, under the federal Affordable Care Act. It was also never an item on first-year Republican Gov. Ron DeSantis’ legislative agenda.

Florida remains one of 14 states that has refused to take advantage of the federal offer to expand Medicaid to cover more of the state’s needy. The decision not to expand also means that the state won’t be taking  advantage of the federal government’s offer to pay 90 percent of the cost of the Medicaid expansion.The decision denies health care coverage to estimated 837,000 Floridians, according to a recent analysis by the nonprofit Kaiser Family Foundation.

More than eight out of every 10 of those residents are poor, childless adults who are not eligible for Florida’s Medicaid coverage unless they are disabled, according to the analysis.

More than half – 53 percent – are adults living below the federal poverty level, which is a little more than $12,000 a year for individuals in 2019. Expanding Medicaid  would provide health care to people who earn up $17,236 a year.

Some 32 percent are Hispanic residents and 22 percent are African-Americans. And about one in five are near-elderly residents, between the ages of 55 and 64, “who are more likely to have substantial health needs,” according to the Kaiser analysis.

Democrats, who are in the minority in the House and Senate, once again urged lawmakers to consider Medicaid expansion. They argued it could help with issues like improving mental health care and helping residents who are dealing with opioid addiction.

“These goals could largely be accomplished by a single act: expanding Medicaid in Florida,” said Sen. Audrey Gibson, leader of the Senate Democrats. “But the governor refuses to consider it, while nearly a million people languish with no place for their health needs except the emergency rooms.”

Democrats and health-care advocates also criticized a legislative decision to limit Medicaid patients’ ability to seek “retroactive” coverage of their medical bills when they qualify for the program.

Previously, Medicaid recipients could qualify for up to three months of retroactive coverage once they applied. But lawmakers eliminated the retroactive coverage in 2018. And the federal government approved the decision in November.

This year, lawmakers had to decide whether to continue banning retroactive coverage for Medicaid patients in the new budget year, which starts July 1. Lawmakers agreed to continue the ban for another year.

Some 11,466 adults received retroactive Medicaid coverage in 2017-18, according to the state Agency for Health Care Administration. Children and pregnant women continue to receive the coverage.

Sadaf Knight, head of the advocacy group, the Florida Policy Institute, said elderly Floridians and the disabled will “bear the brunt” of continuing the cut in Medicaid coverage.

“A healthy workforce is a productive one, and yet lawmakers have not expanded Medicaid to hundreds of thousands of low-income residents so that they can access affordable health care services. Instead, the House and Senate have moved in the opposite direction by cutting Medicaid for the people who need it the most,” she said in a statement, after lawmakers passed the new $91.1 billion state budget.

Without retroactive coverage, Knight said Medicaid patients “will face enormous medical debt from unanticipated catastrophic illnesses, injuries that require hospitalization and end-of-life nursing home care.”

Medicaid recipients would have faced even more challenges under a House plan that would have  required non-disabled adults to work in order to get health-care coverage under the government program. The House voted 71-44 for the measure (HB 955) that would have threatened the eligibility of some 500,000 Floridians who receive Medicaid.

But the proposal never gained ground in the Senate and would have faced a legal challenge. A federal judge blocked similar programs in Kentucky and Arkansas last month.

In another major health care development in the last week of the session, the Senate voted 26-13 to confirm DeSantis’ appointment of Mary Mayhew, who will oversee Florida’s $29 billion Medicaid program that provides coverage to some 3.9 million residents.

The majority of Senate Democrats opposed the confirmation, citing her controversial tenure as the top health care official in Maine.

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Lloyd Dunkelberger
Lloyd Dunkelberger

Lloyd Dunkelberger has been covering Florida government for over three decades. He’s reported and edited in Tallahassee for the New York Times Regional Newspapers group, Florida Politics, and the News Service of Florida. He grew up in Jacksonville and Palm Beach County and got his journalism degree at the University of Florida.