• Florida’s Medicaid enrollment decreased by over 670,000 due to federal law changes and state-led eligibility reviews after the COVID-19 public health emergency.
• Democrat opposition and legal action are challenging the state’s aggressive removal of ineligible or unreachable Medicaid beneficiaries, with a federal judge to hear a related case in December.
• Despite extensive outreach efforts by state agencies, many recipients have been removed from Medicaid for not reapplying for eligibility.

Florida continues to see a significant shift in its Medicaid program, as enrollment numbers plummet following the end of a federal public-health emergency declared due to the COVID-19 pandemic. The most recent data from the state Agency for Health Care Administration (AHCA) reveals a drop of over 670,000 people, from a peak of 5.78 million in April to 5.11 million in October.

The decline is attributed to changes in federal law, in combination with the state’s aggressive efforts at eligibility redetermination, initiated immediately after the eligibility rules during the public-health emergency ended. During the pandemic “emergency” period, the federal government agreed to fund a larger share of Medicaid on the condition that states, including Florida, would not remove individuals from the program.

But over that span, Florida’s Medicaid enrollment surged from approximately 3.8 million in January 2020 to nearly 5.78 million by April 2023. Many of the new enrollees would have been ineligible under regular circumstances due to their income levels.

However, the state’s redetermination process, designed to reassess eligibility, has steadily decreased enrollment. Approximately 56,000 individuals were removed from September to October alone, with further reductions anticipated.

Progressive groups and elected Democrat officials have vigorously protested the state’s plan to return Medicaid to normal levels, arguing that AHCA has been too aggressive in dumping people off the rolls.

A potential class-action lawsuit is challenging the state’s handling of the Medicaid program. The plaintiffs, including two children and a mother, allege that the state has not provided adequate information to beneficiaries before removing them from the program. A federal judge will hear arguments on December 5 for a preliminary injunction demanding reinstatement of coverage for those removed and halting further terminations until sufficient information is provided. The case may also be certified as a class action.

In defense of the state’s redetermination process, AHCA and the Florida Department of Children and Families (DCF), which play pivotal roles in Medicaid administration and the redetermination process, deny any rights violation. They argue that granting the plaintiffs’ injunction would disrupt the program significantly, and they point out that state officials have been extremely aggressive in communicating to enrollees what they must do to protect eligibility.

Earlier this year, DCF highlighted efforts to assist eligible families in maintaining their Medicaid benefits, which included millions of phone calls, emails and other outreach efforts to alert enrolled Medicaid recipients about their responsibility to reapply for eligibility. Despite those efforts, about 10% of potentially eligible recipients did not respond to reapplication requests, risking automatic removal from the program.