Medicaid ‘unwinding’ not what state expected
Medicaid torn newspaper headline on cash

Medicaid headline
About 7,000 more people are enrolling weekly in Medicaid than during the pandemic.

The number of Floridians enrolled in the state’s health care safety net program is not dropping as much as anticipated.

That’s in part because even as state officials remove people from Medicaid rolls, thousands more than expected are enrolling in the safety net program for the poor, elderly, and disabled.

While it doesn’t appear it will become a long-term trend, the current situation means there could be more people in Medicaid than state legislators anticipated when they put together this year’s state budget.

Florida, like other states, started “unwinding” Medicaid with the end of the public health emergency caused by the COVID-19 pandemic. This meant it could begin removing people from the rolls. Florida health care officials anticipated about 900,000 people would be disenrolled from the program by the end of June.

Agency for Health Care Administration (AHCA) Deputy Secretary of Health Care Finance Data Tom Wallace told the Social Services Estimating Conference members Wednesday morning that, instead, 640,000 people have been removed from the Medicaid program in the 12 weeks since the state started the “unwinding” process.

Over the same span,134,000 people have enrolled in the Medicaid program, Wallace said, noting the Medicaid rolls have been reduced by roughly 500,000.

According to Wallace, about 7,000 more people a week are enrolling in Medicaid than during the pandemic.

The spike in enrollment could result from the Department of Children and Families “doing (a) massive amount of outreach to stakeholders, working with our managed care plans and putting out (a) massive amount of outreach on this,” Wallace said. “This is what (the Centers for Medicare and Medicaid Services) wants to have done. CMS is doing outreach, too,” he said.

Wallace acknowledged some of the “joiners” aren’t necessarily “new” enrollees and that some were removed from the Medicaid program during the redetermination process and later re-enrolled. People who lose coverage have 90 days to reapply.

Amy Baker, Director of the Office of Economic and Demographic Research, pressed Wallace about the joiners and how many were removed during re-determination for procedural reasons. Health care advocates also expressed concerns about the state’s re-determination process after the first month of unwinding.

“You are going to match them at some point, right?” Baker asked. “That’s probably an important thing to ferret out because it’s an oddness. You would think that they were being disenrolled because they really weren’t eligible for the program. And if they are trying to get back in, they are going to have a hard time.”

Wallace downplayed Baker’s concerns, saying that before the pandemic and subsequent unwinding, as many as 30% of Medicaid enrollees would be disenrolled from the program for failing to submit the necessary paperwork to continue their coverage.

“This is happening now like it’s happening previously as well,” he said.

The higher-than-expected enrollment means there could be more people in the safety net program in the Fiscal Year 2023-24 budget than lawmakers expected and budgeted for.

“We are over the budget by 245,000 people,” Wallace said.

Wallace attributed the increase in enrollment to the state and federal government’s outreach efforts during the unwinding period, which Baker acknowledged could be a factor.

“Perhaps that’s shifted the (Medicaid) take-up rate,” Baker said.

But she also said there could be other issues in play.

“That’s an economic issue,” she said, adding that the cost of food and housing have skyrocketed. “Inflation tends to hurt lower-income people far more than anybody else. So, with elevated inflation … they may really be struggling more than anybody else in this society. So, we may see ‘joiners’ that are joining because they are in distress.”

Because Medicaid is countercyclical, enrollment in the program spikes when the economy worsens. During the public health emergency, Congress agreed to increase the amount of federal funds for state Medicaid programs by 6.2%.

Those additional federal funds will stop flowing into Florida’s coffers at the end of December, halfway through the FY 2023-24 budget.

Christine Jordan Sexton

Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.


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