What happens to low-income families when federal COVID Medicaid requirement ends?
‘We are in worse shape than most of the country’
Protestors carry signs as they demonstrate against proposed cuts to Medicaid and Medicare in September 2011. Credit: Justin Sullivan/Getty Images
Health advocates in Florida are warning that millions of low-income residents could soon lose Medicaid health coverage, even as the COVID-19 pandemic continues.
The federal government has been requiring states to provide continuous Medicaid coverage for children and families to address gaps in coverage in vulnerable communities across the nation.
But that’s going away in a few months. The termination of what’s called the “continuous Medicaid coverage” requirement is scheduled for March 31.
And although the Biden administration is expected to extend what’s called the public health emergency for COVID-19 — an authorization that allows for health-related funds and measures — states will no longer be required to provide ongoing medical services, such as Medicaid, that many low-income families rely on.
That’s because a federal spending package approved by Congress and signed into law by President Joe Biden in December of 2022 eliminated the continuous coverage requirement.
Robin Rudowitz, a vice president and Medicaid program director at the Kaiser Family Foundation, told the Florida Phoenix that “it is likely that the public health emergency will get extended” but that won’t prevent states from ensuring ongoing Medicaid coverage because of the federal spending bill passed in Congress.
As a result of the new federal law eliminating the coverage requirement, the state will soon determine who is eligible for Medicaid and who could be kicked off if people don’t meet the criteria.
However, health policy groups and advocates are urging state officials to present a plan to ensure that eligible Floridians maintain Medicaid coverage and those who don’t qualify have alternatives to health care plans.
Florida still hasn’t presented a plan for its process of redetermining eligibility, said Miriam Harmatz, advocacy director and founder of the Florida Health Justice Project. Overall, more than 5.5 million people are enrolled in Florida’s Medicaid program, as of November 2022, according to the latest data released by the Florida Agency for Health Care Administration.
“We are still waiting on the state’s plan,” Harmatz told the Florida Phoenix. “We are in worse shape than most of the country.”
Continuous coverage ending
As of April 1, 2023, “states must begin returning to normal eligibility and operations and added some guardrails for transparency and reporting. However, states can begin the renewal process as early as February,” Harmatz said.
That means that states would be permitted to remove Medicaid recipients as soon as April 1, as previously reported by the Florida Phoenix. And enhanced federal funding used to keep people on Medicaid during the pandemic would begin to phase out.
“Over a million people will lose coverage because they are no longer eligible,” Harmatz said. “That is kind of the broad number.”
Harmatz estimated that “over 5 million Floridians will be going through renewals,” adding that parents and caregivers whose income is above the eligibility limit are most at risk of losing Medicaid coverage.
Based on a Kaiser Family Foundation report, Florida is one of 11 states that hasn’t adopted Medicaid expansion, an issue backed by many Democrats who have been pushing for the expansion in a Republican-led Legislature. But it will be even harder to pursue the Medicaid expansion following the November election, when the GOP-controlled Legislature became a supermajority.
The Orlando-based Florida Policy Institute noted that “parents cannot qualify for Medicaid in Florida if their household income is more than 30 percent of the federal poverty level, or $6,984 for a family of three.”
Calling on DeSantis to release a plan
April 1 is the beginning of the “unwinding” period for Medicaid, which would be “redetermining eligibility and seeing who keeps their Medicaid,” said Erica Li, a health policy analyst at the Florida Policy Institute.
The institute had sent a letter to Gov. Ron DeSantis on December of 2022, urging that the state publish a plan.
“We do have a sign-on letter, calling for the governor to present a plan on how the state will determine eligibility for Medicaid recipients. As of Jan. 10, the state hasn’t released a formal plan,” Li said.
Li said that many low-income families are at risk of losing access to a range of health services covered by Medicaid if they no longer meet the criteria. “Mostly they will not have medical care in general; they won’t be able to go to the doctor, people will lose dental coverage,” Li said.
She said children could be impacted as well. “It’s concerning, because in Florida, we have 2.8 million children enrolled in Medicaid,” Li said.
Scott Darius, executive director of Florida Voices for Health, said in an email to the Phoenix:
“Without a comprehensive community education effort, thousands of Floridians risk losing health coverage—many of whom may qualify for Medicaid, KidCare, or Marketplace plans. There’s also a fear that many of those who are ineligible are people who fall into the coverage gap and have no other options for care – because the state hasn’t expanded Medicaid to include those hardworking Floridians.”
‘Most pressing’ issue is Medicaid
During a health care-related House hearing last week, Republican Rep. Sam Garrison, representing part of Clay County in northeast Florida, called this the “most pressing” issue the Legislature will face this year.
“We have a large number of people enrolled in Medicaid coverage through the federal public health emergency. We’ve seen our Medicaid numbers shoot up during the federal public health emergency,” said Garrison, who chairs the particular subcommittee.
He added: “Future changes to the federal public health emergency and the state’s response to it, and how that affects continuous coverage, as well as the enhanced federal match, very likely will impact our future Medicaid expenditures. And we will be dealing with that this year.”
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