Health agency officials provide update on Medicaid redetermination amid public scrutiny

by | Oct 11, 2023

  • Florida’s Department of Children and Families (DCF), Agency for Health Care Administration (AHCA), and Healthy Kids Corp. presented the status of the state’s Medicaid redetermination cycle to the Senate Health and Human Services Appropriations Committee.
  • The redetermination process will affect 4.6 million Medicaid recipients over a 12-month period, with vulnerable populations being addressed later.
  • The outreach strategy, which has received criticism, resulted in an 87 percent response rate, an improvement over pre-pandemic levels, with 73 percent of disenrollments occurring following non-responsiveness.

Florida’s Department of Children and Families (DCF), Agency for Health Care Administration (AHCA), and Healthy Kids Corp. on Wednesday delivered a presentation on the status of the state’s Medicaid redetermination cycle to the Senate Health and Human Services Appropriations Committee amidst heightened media attention on the process.

As outlined in the presentation, 4.6 million Medicaid recipients will have their cases redetermined by DCF over an ongoing 12-month unwinding period, with described vulnerable populations, including children with complex medical needs, being addressed later in the cycle.

During this period, DCF has requested eligibility information from recipients, adhering to annual federal income qualification verification standards, a process DCF Deputy Secretary Casey Penn stated has not been conducted in three years following a pandemic-era public health emergency order.

“Now we’re going back to the cycle, as required by the federal government, of every 12 months to determine eligibility,” Penn told lawmakers.

To determine eligibility, Penn outlined the department’s use of various communication methods, including email, text messages, and automated calls, with recipients receiving between 5 and 13 contact attempts.

In defense of the outreach strategy — which has received scrutiny over alleged inefficiencies by advocate organizations — Penn cited a response rate of 87 percent, which marks a sharp increase compared to pre-pandemic levels.

“Prior to the pandemic — we’re looking at 2019 data — we had about a 47 percent response rate, meaning there was a lot of churn. People would not respond, they’d be disenrolled, and they would then come in later after going to their doctor and realizing they’re no longer covered.”

Agency data from October 2 shows that 73 percent of disenrollments were due to procedural issues predicated upon non-responsiveness to requests. DCF metrics indicate that Florida ranks 9th nationally for having one of the lowest rates of procedural terminations.

“A procedural termination is someone that doesn’t respond to a request,” said Penn. “We send them a notice, we contact them up to 13 times and they don’t respond, or we ask them for additional information and they do not supply it for us to make an eligibility determination.”

The agency also praised its redetermination process as stable, with an average case taking 22 days, nearly three weeks shorter than the 45-day federal standard, and the Medicaid-specific phone line recording an average wait time of three minutes.

Between April and August of this year, more than 2.2 million individuals had their Medicaid eligibility redetermined. Of this total, 746,000 were found to be ineligible by failing to meet federal requirements, 243,000 qualified for Medically Needy coverage, and 1.5 million, constituting 67 percent, remained eligible.

Another further 2.4 million individuals will undergo redetermination between September 2023 and March 2024.

On Tuesday, a coalition of organizations called for an immediate pause on the Medicaid redetermination process, citing concerns over its alleged impact on the health of children in Florida.

In a letter addressed to Gov. Ron DeSantis, the group of 50 organizations and associations argued that the current redetermination process is plagued by procedural errors, long call center wait times, and a lack of adequate staffing at DCF, contending that the issues have led to an erroneous loss of health insurance coverage for many individuals.

“There are several issues that are causing families and individuals to erroneously lose coverage: long call-center wait times, inadequate staffing at DCF, inaccurate and difficult-to-understand language in administrative forms that families receive, and inappropriate use of household income to determine individual eligibility,” the letter, published by the Florida Policy Institute states. “This loss of health insurance coverage due to procedural errors and inefficiencies is unacceptable and preventable.”

During a period of questioning during Wednesday’s hearing, Sen. Gayle Harrell touched on complaints of inefficiency, stating that she received public comment regarding an extreme” wait time, particularly for Spanish-speaking individuals.

“I noticed in your presentation that there’s a max five-minute wait time,” said Harrell. “We’ve heard forty minutes up to two hours.”

In response, Penn stated that depending on the basis of the call, response times can vary.

“At any given time, there may be one specific phone line that has longer wait time than another just depending upon the number of callers that are needing that specific thing,” Penn said in response. “On average, we’re around thirty minutes. We want to be better than that.”

Penn subsequently elucidated that data shows a lack of disparity between race or ethnicity in re-enrollment rates.

“It is within three percentage points difference between whether you’re Hispanic, black, [or] white,” said Penn. “They’re pretty much right there. Same thing with Spanish and English.”


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