Florida kids lose Medicaid; DeSantis should slow down

In May, Gov. Ron DeSantis had this to say, after signing one of the toughest abortion bans in the nation: “One of the things I’m most proud of is that the state of Florida stands unequivocally in defense of the family, and in defense of our children. And we have done more to protect children than any state in the country.”

What DeSantis knew — what most Florida families probably did not know — was that even as he spoke, state officials were rushing to dump hundreds of thousands of Floridians off Medicaid rolls. Roughly one-third of those losing coverage are children. And as the Sentinel’s Caroline Catherman reported last week, some of those children are so sick they’re not supposed to lose coverage at all.

Dr. Candice Jones attends to her patient Nihmaya Farrell, 6, center, Nichaya Simmons, 13, left, and mother Natasha James at the Edgewater Pediatrics in Orlando, Fla., Thursday, Jan. 14, 2021. (Orlando Sentinel Photo/Willie J. Allen Jr.)

As far as DeSantis’ boast that no state does more, well, he’s a little bit right there. Florida has done more than any other state — to strip families and children of coverage. According to data compiled by the Kaiser Family Foundation, Florida has dropped twice as many people —more than 300,000 — from the Medicaid rolls as the next most-active state (Arizona, which has dropped 149,000). Even worse, Florida doesn’t appear to be using any of the tools the federal government has made available to keep more residents enrolled.

Is this what DeSantis calls “standing unequivocally” in children’s defense?

‘Unwinding’ post-COVID

The backstory on this one is a bit complicated. As COVID tightened its grip on the nation’s health care system, Congress passed a public-health aid package that included extra money for states to keep Medicaid recipients continuously enrolled, instead of requiring them to periodically prove they were still eligible for the need-based program. That period of continuous enrollment ended earlier this year.

Understanding that many families might not understand that they have to re-apply if they want to keep their coverage, the U.S. Department of Health and Human Services set out a generous timeline that was meant to give families plenty of leeway to understand what was going on, gather documentation and see if they were still eligible. States were supposed to start “unwinding” their COVID-swollen Medicaid rolls in the spring, but they have until December to finish. By going slow, families would have the best opportunity to keep coverage continuous.

HHS also set up more than a dozen waivers to Medicaid rules that will make it easier for families to re-qualify — including using data from applications for other aid such as food stamps, and multiple options to approve families without intensive income verification. Florida and Montana are the only two states that haven’t applied for a single waiver.

It’s hard to understand why Florida officials are so hell-bent on galloping ahead without giving Medicaid recipients the support they need to successfully reapply or find alternate coverage, advocates say.

Worst of all, Florida is one of the few states that refused to expand Medicaid to its lowest-income working families under the 2010 Affordable Care Act. That act of short-sighted cruelty — first by Gov. Rick Scott’s administration, then by DeSantis, despite opposition from Florida business and health care leaders — has created a desperation zone for low-income families who aren’t poor enough to qualify for Medicaid but don’t have enough income to buy subsidized coverage through “Obamacare” marketplaces.

Health advocacy groups ask Gov. DeSantis to pause Medicaid purge

Many parents may be able to obtain coverage for their children — though not themselves — through one of the programs under the Florida Kidcare program, which includes the subsidized insurance program Healthy Kids as well as options for “medically fragile” children with serious health problems who might be eligible for free or very low-cost coverage.
For some of these children, these programs spell the difference between life and death: Their medications can cost thousands of dollars a month, and some of them need teams of more than a dozen doctors to manage their care. The state promised that medically fragile children would be among the last to be disenrolled from Medicaid.

That promise is not being kept.

Kids’ health in the balance

Without enough time to match the right program with each family, many children who are losing Medicaid coverage are at imminent risk. Advocates say they’re hearing about very sick children whose coverage has already come to an end — including 2-year-old Charlotte Douberley, a 2-year-old with cystic fibrosis, who was cut off from Medicaid coverage May 31, and shifted to a program that doesn’t cover the expensive medication she needs, Catherman reported.

It doesn’t take many stories like Charlotte’s to realize that Florida is moving too quickly. But the big-data picture is also troubling.

A stern warning in June from HHS Secretary Xavier Becerra  targeted states that were posting a large number of “procedural” removals from Medicaid rolls — families that lost coverage not because they were no longer eligible, but because they failed to successfully get through the re-application process before their time ran out.

Data suggest that many of those being dropped would have been eligible to continue Medicaid coverage. Running totals compiled by the Kaiser Family Foundation shows that, among the more than 880,000 Floridians in the first group to be disenrolled, nearly 600,000 got through the process with coverage through Medicaid or Kidcare coverage intact. But among the 300,000 who were dropped, only 105,189 were determined to be ineligible. The rest fell into the procedural category.

That’s a red flag to HHS and groups like the Florida Health Justice Project and the Florida Policy Institute, two of several groups monitoring Florida’s unwinding.

And Becerra’s reaction is pretty straightforward. He wants to see more outreach, more assistance, more effort made to get in touch with families before they lose coverage. He’s not going to take excuses: States “must comply with federal rules…. and individuals must be afforded the due process to which they are entitled,” he wrote in June. “We take our oversight responsibilities extremely seriously, and while we know that states are working hard to meet the federal requirements, we will not hesitate to use the compliance authority provided by Congress.”

This is no time for DeSantis and state health officials to act with arrogant defiance — not when they are taking coverage from children who may die because of it. Florida leaders should slow down, offer more support and realize that the duty to defend children doesn’t stop when they are born.

The Orlando Sentinel Editorial Board consists of Opinion Editor Krys Fluker, Editor-in-Chief Julie Anderson and Viewpoints Editor Jay Reddick. Contact us at insight@orlandosentinel.com

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