State Politics

Senate committee votes to permanently shorten retroactive Medicaid eligibility

Activists deliver petition for Medicaid expansion to Rep. Jose Oliva

Demonstrators delivered 30,000 signatures to the office of state Rep. Jose Oliva, whose district includes the Hialeah ZIP Code with the highest Obamacare enrollment in the country, urging him to support Medicaid expansion. Charles Trainor Jr/Miami
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Demonstrators delivered 30,000 signatures to the office of state Rep. Jose Oliva, whose district includes the Hialeah ZIP Code with the highest Obamacare enrollment in the country, urging him to support Medicaid expansion. Charles Trainor Jr/Miami

A bill that would permanently shorten how long patients can have Medicaid cover past healthcare bills narrowly cleared its first state Senate committee hearing Monday, advancing an estimated $104 million policy that could affect about 11,500 Floridians’ care.

SB 192, which passed 6-4 in the Senate Health Policy committee on party lines, would cement a policy that restricts the period patients are eligible for Medicaid coverage to the calendar month before their application. The prior policy, which the Legislature changed last year, allowed patients to have the safety net program cover healthcare costs up to three months before the date they applied for coverage.

Though the Legislature voted to shorten the retroactive window last March, the policy went into effect last month after the federal government approved the change in November. The policy requires the Legislature to approve the change again for it to remain in effect past June 30.

The bill advanced Monday directs the state Agency for Health Care Administration to tell federal officials by mid-May that it has the Legislature’s authority to keep the policy in place, if passed. There’s a lot of money at stake: $104 million for AHCA’s budget for Medicaid coverage, and including federal funds.

“We get better results when people are proactive with their healthcare rather than reactive,” said Sen. Aaron Bean, R-Fernandina Beach, who sponsored the bill. He cast the bill as “a little more of a paperwork change” to encourage people to apply quickly for Medicaid coverage. “This will be a little encouragement to get them to sign up early.”

Opponents of the policy change have said it disproportionately hurts the poor, people with disabilities and seniors, particularly those in nursing homes who rely on Medicaid to help cover the cost of their long-term care. They have also argued that limiting the potential coverage period to the start of a calendar month means those who become eligible later in a month have less time to submit necessary paperwork.

But Beth Kidder, AHCA’s Medicaid director, told lawmakers that the change is only intended to have providers more quickly sign up eligible patients for care.

State officials are estimating that the policy change would affect about 11,500 Floridians, a steep decline from the 39,000 they estimated might be impacted last year. Kidder said that the incorrect count was a result of accidentally duplicating the number of patients who requested retroactive coverage from month to month. The estimate of how much money the policy change would save the state increased only slightly to a total $104 million, including federal funds.

Several Democrats on the Senate committee raised concerns about bills that might go uncovered should the policy change be made permanent, and some suggested holding off on cementing the policy, pointing to the short period of time the change has been in effect.

Both Sens. Darryl Rouson of Port Richey and Lori Berman of Lantana asked how clearly the impact of the policy was understood after one month of its taking effect. Berman also questioned Kidder about a requirement in the federal government’s approval of the change that directed the state to evaluate the results of shortening retroactive coverage within four months of gaining approval.

Kidder acknowledged it would be a “couple years out” before the change would show results, and that the agency had not yet begun an evaluation. “If it were, we’d only have a month’s data at this point.”

Multiple speakers questioned what might happen to patients who had a fall or other health calamity at the end of the month and missed the calendar deadline for applying for coverage of that month’s bills.

“This cuts eligibility and coverage for three months before an application is filed,” said Anne Swerlick, a health policy expert at the Florida Policy Institute, criticizing AHCA’s position that the change is largely procedural. She warned that providing less retroactive coverage would result in higher insurance premiums, hospital costs, and uncompensated care across the board.

Nursing homes are also opposing the bill, saying that changing treatment plans and the shortened window for applying toward the end of a month make it more difficult to submit the paperwork in time.

Though actually submitting the paperwork is not difficult, convincing patients who do not realize they may need long-term care can be harder, said Cliff Bauer, systems vice president for Miami Jewish Health, one of the largest nursing homes in the state. He pointed as an example to residents who do not immediately realize they may need to stay in a nursing home longer to fully recover from a catastrophic injury.

“What’s difficult is getting the person to say I’ll fill it out,” he said, referring to the Medicaid paperwork. “I have residents in my nursing home today and their bills are over $450,000.”

The Florida Health Care Association, the largest nursing home trade group in the state, is also opposing the bill and has asked lawmakers to at least consider increasing retroactive coverage partially to give facilities more time.

Berman told reporters afterward that she also thought returning to the original policy was unlikely. But she said she hoped the Legislature might at least extend the retroactive window for coverage to a minimum of 30 days, or wait for data on how the policy change would affect patients.

“This issue is not ripe yet,” she said. “Let’s see what the evaluation numbers are.”

The bill does not yet have a House companion. It must pass two more committees before it can be taken up by the full Senate.

Elizabeth Koh is a state government reporter in the Miami Herald and Tampa Bay Times’ Tallahassee bureau, where she covers state politics and policy. A Brown University graduate, she has also covered local politics for the Washington Post and national politics for the Dallas Morning News’ D.C. bureau.