Coalition Urges Florida Governor to Address Harmful Medicaid Re-Eligibility Process

Dear Governor DeSantis,

We write because we are very concerned about the impact of Florida’s Medicaid redetermination process on the health and well-being of Florida’s children. With more than half of the children in the state insured by Medicaid, the stakes are very high. There are several issues that are causing families and individuals to erroneously lose coverage: long call-center wait times, inadequate staffing at the Department of Children and Families (DCF), inaccurate and difficult to understand language in administrative forms that families receive, and inappropriate use of household income to determine individual eligibility. This loss of health insurance coverage due to procedural errors and inefficiencies is unacceptable and preventable.

According to AHCA enrollment data, Florida has disenrolled at least a quarter of a million youth aged 0 to 20 (257,901) from Medicaid since the redetermination process began in April, and as of September, Florida KidCare enrollment has only increased by 14,267. Many youth likely remain eligible for Medicaid as most were not determined ineligible but lost for procedural reasons. It is difficult to determine how many have moved to the Marketplace; however, based upon the data published so far, it is only a fraction of those terminated from Medicaid. Employer sponsored insurance for low wage workers rarely offers affordable dependent coverage. Additional problems have been recorded within the state’s Marketplace Assister Community, which is designed to help newly determined Medicaid ineligible Floridians find coverage.

While children are not expensive to cover, they require regular care — including well-baby and well-child visits, treatments for asthma and ear infections, and stitches when they take a fall on the playground. Moreover, children and adolescents are facing a mental health crisis, and Medicaid is the primary payer for treatment.

Florida’s own data, as reported to the federal Centers for Medicaid and Medicare Services (CMS), backs up the stories shared by Floridians having difficulty getting through to DCF by phone to get help with their redeterminations: in April, 48 percent of the calls made to DCF were abandoned, and the average wait time for an initial contact was 40 minutes before being pushed to another helpline. Florida’s call center metrics were among the worst in the 17 states that started their redetermination process in April. Florida ranked 16th for its wait times and had the highest call abandonment rate. Advocates report that call center wait times are worse for those who do not speak English, specifically recounting calls that took 4 hours to resolve for Spanish speakers. The June data, released September 29, shows that there were over 2.2 million calls made, and 36 percent of those were abandoned. Of the 50 states that submitted data, Florida ranked 45th in both call center wait times and abandonment rates.

Despite these persistent problems, it has been reported that the state has yet to use the $3.3 million allocated for improving the call centers in the current fiscal year’s budget. DCF’s plan outlined strategies to enhance call center performance by “onboarding additional call center agents” and “hiring vendor staff to assist with overflow call volume,” however, it is yet to be verified that these strategies have been implemented. If they have, they have been insufficient. Additionally, there was to be a staffed technical assistance line put in place to ensure those having difficulties or confusion could more readily access customer support when needed.

Although DCF’s redetermination plan stated that Medicaid enrollees under the age of 21 “diagnosed with a medically complex condition” would not be redetermined until February 2024, children with critical care needs have already lost coverage despite remaining eligible. Furthermore, while the state touted in its plan “changes to ex-parte processes to increase the number of cases that will allow renewal based on data matching,” of the 2.3 million people who were scheduled to have their eligibility checked through August, only 18 percent of renewals were completed using the ex-parte process. As a result, a majority of families undergoing redetermination are being burdened with administrative paperwork in order to complete the process and do not have enough options to help them.

Florida is the only state in the nation that has not taken any of the 23 flexibilities offered by the federal Centers for Medicare and Medicaid Services to help mitigate the impacts of the unprecedented Medicaid redetermination process.

We, the undersigned organizations, are calling upon DCF to immediately implement the following changes to Florida’s Medicaid redetermination process, and we encourage the state of Florida to adopt CMS-proffered flexibilities to ensure that eligible Floridians keep their health insurance. We also want to ensure that those who are determined ineligible for Medicaid due to income changes are seamlessly transitioned to alternative forms of coverage without delay.

1. Provide 12 months of continuous coverage for all children currently being redetermined for health insurance and temporarily waive premiums for those newly enrolling in KidCare as Georgia has done.
2. Immediately reinstate coverage for children who have been disenrolled for procedural reasons
3. Pause the redetermination process until the department can successfully execute the goals outlined in its plan and as required by CMS, including:
   • Fully staffing the DCF call center and implementing training to DCF staff to regularly audit wait times and effectively field the high volume of calls, including in Spanish and Haitian/ Creole.
   • Applying for and implementing waiver strategies to conduct automatic renewals of individuals with no income or income below 100 percent of the poverty level (Strategies 3 and 4 from CMS).
   • Reevaluating DCF’s outreach methods to ensure that individuals are receiving the proper yellow-striped envelopes in the mail or via email (and that the mail is not going to spam).
4. Increase transparency by creating a public-facing dashboard to be updated monthly with data on the redetermination process, disaggregated by age group.
5. Once the redetermination process resumes, implement changes to make the transition to alternative coverage smoother:
   • Increase the Medicaid 10-day account closure notice to 30-day notice to give people time to find other coverage.
   • Delay procedural terminations for beneficiaries by 30 days while the state conducts targeted renewal outreach.