A controversial revision that reduces "retroactive eligibility” for Medicaid coverage from 90 to 30 days goes into effect Feb. 1, but will only remain in place until June 30 unless state lawmakers vote to extend it.
According to conditions imposed by lawmakers last year and the federal Centers for Medicare & Medicaid Services (CMS) in November, the state’s Agency for Health Care Administration (AHCA) must also conduct a four-month evaluation of the rule-change before it can be permanently implemented.
During the 2018 legislative session, the measure was incorporated into House Bill 5003, the 117-page General Appropriations Bill. It was approved by House 94-11 and the Senate 30-6 on the last day of the session.
The AHCA maintains eliminating retroactive eligibility would “enhance fiscal predictability” and save the state an estimated $98 million in removing approximately 39,000 adults over the age of 21 – less than 1 percent of the state’s Medicaid recipients – from the subsidized rolls.
The new rule was scheduled to go into effect on July 1 but did not receive a needed endorsement from the CMS until November.
CMS Administrator Seema Verma approved the state’s request to waive the 90-day retroactive eligibility allowance despite receiving more than 150 comments from the public opposing the change.
"All of the comments were in opposition of the waiver of retroactive eligibility.,” Verma wrote in a cover letter approving the state's request. “Commenters’ main concerns were about the harm to patients, worsened health outcomes, financial hardship on beneficiaries and providers, and the asserted failure of the proposal to promote Medicaid objectives. Some commenters voiced concern about the waiver request not increasing access to care or testing innovative approaches to delivering care.”
CMS allows states to accord Medicaid beneficiaries up to three months of retroactive coverage from the date they apply to enroll in the Medicaid program if they are deemed eligible for Medicaid when they applied. Florida is among a half dozen states that are seeking to eliminate the provision.
Beginning Feb. 1, instead of paying for 90 days of past medical bills, Medicaid eligibility will begin the month people apply for coverage. The change does not apply to children or pregnant women.
CMS has approved requests by Iowa and Kentucky to eliminate retroactive coverage in their states – although, unlike Florida, both are among the 31 states that have opted for Medicaid expansion.
AHCA will be required to submit a four-month evaluation of the revised rule and submit it to CMS to secure approval beyond this fiscal year.
"Florida will be required to test its hypothesis that the waiver will incentivize individuals to obtain and maintain health coverage, even when healthy, or to apply for coverage as soon as possible after the finding or diagnosis that gives rise to their Medicaid eligibility," Verma wrote.
The change was approved by the Legislature as part of the final year 2019 state budget, which expires June 30. It must be renewed in the upcoming session or will not be implemented after July 1.
The retroactive eligibility rollback was among issues discussed last week by various House and Senate committees in pre-session primers that will resume in early February in Tallahassee.