In FocusFlorida's Medicaid Redetermination Issues, Coverage Losses in Spotlight

Florida’s Medicaid Redetermination Issues, Coverage Losses in Spotlight


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Health policy experts are highlighting a multitude of concerns regarding Florida’s Medicaid Redetermination process, claiming it results in a lack of coverage for eligible children and families.

During a media call on Tuesday, advocates argued despite the Florida Department of Children and Families’ stated plan to manage the unwinding of the public health emergency, the reality has been marked by chaos and confusion.

Official data released in late July by the U.S. Centers for Medicare and Medicaid Services show in the first month after federal continuous coverage provisions for Medicaid ended, 249,427 Floridians were disenrolled, 82% of whom had their cases closed for procedural or “red tape” reasons, such as failure to respond to a notice.

Erica Monet Li, policy analyst for the Florida Policy Institute, said the state’s call center wait time ranks among the worst of the 17 states initiating redeterminations in April.

“48% 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,” Monet reported.

The Florida Department of Children and Families has issued guidance on its website, however, advocates say some links to legal aid are not working, language translation from English to Spanish is confusing and needs improvement, and they said the website needs to be modernized with a mobile-friendly option to make it easier for Floridians to navigate.

According to the Centers for Medicare and Medicaid Services, every state must unveil a strategy to streamline Medicaid Redetermination, re-enrollment and reduce coverage losses.

Joan Alker, executive director of the Georgetown University Center for Children and Families, noted a mechanism called “ex-parte” renewals, intended to simplify income-based verification and auto-renewals, is only being implemented in Florida at approximately 19%.

She expressed concern the state’s Medicaid Redetermination processing methods might warrant investigation.

“Because Florida has a low ex-parte rate and a relatively high share of children, certainly Florida may be one of the states that is being investigated for this issue and we expect CMS enforcement to follow,” Alker noted.

Advocates said it is difficult to navigate such a complex process and are calling on Florida officials to issue a pause in medicaid redetermination until they fix the problems or able to properly execute the state’s plan.

Lynn Hearn, staff attorney for the Florida Health Justice Project, which has a dashboard on its website for tracking the redetermination process, said the group is hearing many stories of people being confused about notices from the state.

“The notice also does not clearly indicate how to appeal or correctly,” Hearn asserted. “The appeal instructions are deep in the notice, after a multipage notice, after a full page of QR codes for potentially other irrelevant other programs.”

Florida is the only state to not take advantage of the flexibilities offered by the Centers for Medicaid to remedy common issues and the groups are urging Florida’s leaders to focus on fixing current problems to ensure the state’s eligible children and families are not cut out of any needed coverage.

Problemas de redeterminación de Medicaid y pérdidas de cobertura de FL en la mira

Medicaid Redetermination

Los expertos en politicas de salud estan destacando una multitud de inquietudes con respecto al proceso de redeterminacion de Medicaid de Florida, alegando que esta dando como resultado una falta de cobertura para ninos y familias elegibles.

Durante una convocatoria de medios el martes, los defensores argumentaron que a pesar del plan declarado por el Departamento de Ninos y Familias de Florida para manejar la resolucion de la emergencia de salud publica, la realidad ha estado marcada por el caos y la confusion.

Los datos oficiales publicados a finales de julio por CMS muestran que en el primer mes despues de que terminaron las disposiciones federales de cobertura continua para Medicaid, 249,427 floridianos fueron dados de baja, el 82% de los cuales tenian sus casos cerrados por razones de procedimiento o “burocracia”, como la falta de respuesta a un aviso.

Erica Monet Li del Instituto de Politica de Florida, dice que el tiempo de espera del centro de llamadas del estado se encuentra entre los peores de los 17 estados que iniciaron redeterminaciones en abril.

“El 48% de las llamadas realizadas al DCF fueron abandonadas y el tiempo medio de espera para un primer contacto fue de 40 minutos antes de ser derivado a otra linea de ayuda,” informa Monet.

El Departamento de Ninos y Familias de Florida ha publicado una guia en su sitio web, sin embargo, los defensores dicen que algunos enlaces a la asistencia legal no funcionan, la traduccion del ingles al espanol es confusa y necesita mejorias, y dicen que el sitio web debe modernizarse con una opcion compatible con dispositivos moviles para facilitar la navegacion de los floridanos.

Segun los Centros de Servicios de Medicare y Medicaid, todos los estados deben presentar una estrategia para agilizar la reinscripcion y reducir las perdidas de cobertura.

Joan Alker, del Centro para Ninos y Familias de Georgetown, senala que un mecanismo denominado renovaciones “ex-parte”, destinado a simplificar la verificacion basada en los ingresos y las renovaciones automaticas, solo se esta aplicando en Florida en aproximadamente un 19%.

Ella expresa su preocupacion por la posibilidad de que los metodos de procesamiento del estado justifiquen una investigacion.

“Debido a que Florida tiene una tasa ex-parte baja y una proporcion relativamente alta de ninos, Florida puede ser uno de los estados que esta siendo investigado por este problema y esperamos que la aplicacion de CMS lo siga,” dice Alker.

Los defensores dicen que es dificil navegar por un proceso tan complejo y piden a los funcionarios de Florida que emitan una pausa en las redeterminaciones hasta que solucionen los problemas o puedan ejecutar adecuadamente el plan del estado.

Lynn Hearn del Florida Health Justice Project, que tiene un tablero en su sitio web para rastrear el proceso de redeterminacion, dice que escucha muchas historias de personas que estan confundidas acerca de los avisos del estado.

“El aviso tampoco indica claramente como apelar correctamente,” subraya Hearn, “las instrucciones de apelacion estan perdidas en el aviso, despues de un aviso de varias paginas, despues de una pagina completa de codigos QR para otros programas potencialmente irrelevantes.”

Florida es el unico estado que no ha aprovechado las flexibilidades ofrecidas por los Centros de Medicaid que solucionarian problemas comunes, y los grupos instan a los lideres de Florida a centrarse en solucionar los problemas actuales para garantizar que los ninos y las familias del estado que reunen los requisitos no se queden sin la cobertura necesaria.

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