Florida to Reduce Retroactive Eligibility to 30 Days Effective February 1

February 2019 ~

Effective February 1, Florida will reduce retroactive Medicaid eligibility from 90 to 30 days, excluding pregnant women and children.

According to conditions imposed by lawmakers and CMS in late 2018, the state’s Agency for Health Care Administration (AHCA) will be required to submit a four-month evaluation of the policy before it can be permanently implemented.

The revision was first incorporated into House Bill 5003, the General Appropriations Bill, during the 2018 legislative session. The measure was then approved by the House in a vote of 94-11, the by the Senate in a vote of 30-6 on the last day of the session.

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.

Verma addressed in a cover letter approving the state’s request, stating, “All of the comments were in opposition of the waiver of retroactive eligibility. 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.”

The new rule was initially scheduled to go into effect on July 1, but did not receive a needed endorsement from the CMS until November. 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.

AHCA has predicted that this change will impact approximately 39,000 Florida residents, and has the potential to save the state an estimated $98 million.

Source(s): Watch Dog; CBS Miami; HMA Weekly Roundup January 30, 2019