In January 2020, the Secretary of Health and Human Services declared a COVID-19 public health emergency (PHE) as part of the Families First Coronavirus Response Act. During this time, Floridians enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) were able to keep their coverage without having to re-enroll, a rule referred to as “continuous coverage.” On December 29, 2022, President Joe Biden signed into law the Consolidated Appropriations Act of 2023, which declared the continuous coverage provision of Medicaid to officially end on March 31, 2023. During the continuous coverage period, Florida’s Medicaid program grew by 1.4 million people to over 5.7 million individuals, when disenrollment was set to resume.
Because there were known issues with Medicaid enrollment and disenrollment before the ending of continuous coverage, also known as the “PHE unwind” or “Medicaid redetermination process,” advocates across the state wanted to ensure that people would not lose coverage for “procedural” reasons. Procedural disenrollment happens when individuals who are still eligible for Medicaid lose their coverage because of administrative or bureaucratic issues. This occurs, for example, if someone does not respond to mail or email, moves during the pandemic, or does not understand the redetermination process or renewal notices; procedural disenrollments also occur due to staff errors during redetermination. On the other hand, if someone was disenrolled because they were no longer eligible for Medicaid in Florida, advocates wanted to ensure that they would be able to seamlessly transition to new coverage without gaps in their care.
Because there were known issues with Medicaid enrollment and disenrollment before the ending of continuous coverage, also known as the “PHE unwind” or “Medicaid redetermination process,” advocates across the state wanted to ensure that people would not lose coverage for “procedural” reasons.
In spring 2022, a group of partners including Florida Policy Institute, Florida Health Justice Project, Florida Voices for Health, Florida Covering Kids and Families, and Catalyst Miami formed the “Florida Medicaid Unwind Collective.” UnidosUS and Southern Poverty Law Center later joined the coalition. This group possessed a diverse expertise in Medicaid and CHIP, known in the state as Florida KidCare. The group also had experts focused on the Affordable Care Act Federal Marketplace application and enrollment processes, the Medicaid coverage gap, health justice, health policy, and navigation work in Florida.
This coalition had many successes from spring 2022 to summer 2024 in raising awareness about the problems that individuals undergoing this process were facing. Florida Policy Institute collected and tracked renewal and outcome data and created a child coverage loss tracker, while Florida Health Justice Project and Florida Voices for Health told impactful stories about people losing coverage during this time. Florida Health Justice Project also provided legal advice and counsel to Medicaid recipients who believed they had been inappropriately deemed ineligible, and the organization is now — at the time of this blog’s publication — litigating a class action lawsuit on behalf of individuals who received notices that failed to comply with due process requirements. UnidosUS gave special attention to administrative issues with the Department of Children and Families’ (DCF’s) call centers, producing their own research on long wait times and dropped calls for individuals seeking help. Catalyst Miami and Covering Florida provided updates from their navigators working with recipients about the lived experiences of navigating the redetermination process. With all of these efforts combined, stories that would have been dismissed as isolated incidents were given public attention. This challenged DCF and the Agency for Healthcare Administration (AHCA) to be accountable for the plans they released for a smooth redetermination process.
The collective’s efforts resulted in broad media and legislative engagement, producing some of the following successes:
- State Reps. Kelly Skidmore and Robin Bartleman asked for a House oversight committee hearing on Medicaid coverage loss during the unwind.
- U.S Rep. Kathy Castor and the entire Florida Democratic Congressional Delegation urged the Centers for Medicare and Medicaid services to closely examine the massive health care coverage losses in Florida and provide aid to those who needed it.
- Florida Sen. Gayle Harrell raised concerns about long call center wait times as a result of UnidosUS’s August 2023 report. Continued engagement with lawmakers resulted in $12.2 million being added to the state budget specifically to address issues with the call center.
- The collective’s sign-on letters and continuous efforts received ample coverage in the news, helping to spur dozens of articles along with editorials from the Orlando Sentinel and Tampa Bay Times. This coverage reached thousands, keeping the public informed and helping individual families know what was going on.
Now What?
The collective found that Medicaid enrollment issues unaddressed before the PHE unwind were only exacerbated by the rapid pace and increased number of individuals undergoing redetermination within the 12 month redetermination process. Florida disenrolled over 1.3 million individuals from Medicaid during the PHE unwind period. Nearly half of those disenrolled (647,000) were children and youth under the age of 20. During this time, Florida was the only state in the nation that did not take advantage of federal flexibilities offered that would help people stay covered during the renewal process. Sixty-four percent of Floridians were disenrolled from Medicaid for procedural reasons, in contrast to the 36 percent who were disenrolled for no longer being eligible.
As a result, the collective is calling for continued advocacy efforts. Specifically, the state should:
- Increase its ex-parte or automatic renewals to reduce paperwork for Medicaid recipients and reduce the administrative burden for DCF staff.
- Generate public-facing monthly enrollment and disenrollment data from DCF disaggregated by race, gender, ethnicity, and age.
- Improve renewal notices to be better understood by the general public.
- Use the funds allocated in the state budget toward improving the call center (increased staff, more training, updated technology).
- Streamline the process of transitioning to marketplace coverage or Florida KidCare so individuals do not have gaps in coverage.
Through expert policy research, broad coalition building, and strong public champions, Florida can make meaningful progress in the areas noted above. These organizations will now take the lessons learned, and continue to advocate for policies that improve access to health care coverage for hundreds of thousands of Floridians.
