In an effort to save money and to encourage prompt Medicaid applications, Florida has petitioned the Centers for Medicare and Medicaid Services (CMS) to eliminate the current three-month retroactive Medicaid coverage for those Floridians who happen to qualify for benefits before they get a chance to apply. This would be a huge loss for the destitute and elderly who need Medicaid the most. It also especially hurts those who become unexpectedly ill or injured (and do not have the immediate ability to apply for Florida Medicaid).

Furthermore, Florida’s Medicaid eligibility criteria are extremely complex and not readily accessible to the public (which is why many choose to consult with a Medicaid-planning Elder Law Attorney). Also, a large number of people simply do not know they are currently Medicaid eligible or the circumstances when they would become eligible.

The activists at Justice in Aging have drafted a sample opposition letter that they are encouraging all concerned to utilize and send to CMS. Below is the letter I have sent and I encourage you to copy/paste and edit as you will and mail into the address indicated below. 

Opposition to Florida’s Medicaid Wavier Amendment to Eliminate Retroactive Coverage

Seema Verma, Administrator

The Centers for Medicare & Medicaid Services

7500 Security Boulevard

Baltimore, MD 21244

Dear Administrator Verma:

I/we write to oppose the Florida Agency for Health Care Administration’s proposal to waive the federal protection that provides up to three months of retroactive Medicaid coverage for Managed Medical Assistance (MMA) program recipients.  Under the proposal, the MMA program could provide coverage only as far back as the first day of the month of application.

Retroactive Medicaid Coverage Is Vital to Many Consumers.

Health care needs can be unpredictable.  No one can predict (for example) a stroke, a car accident, or a fall leading to a broken hip.  Once a person finds herself in a hospital or nursing facility, she may not be healthy enough to file a Medicaid application, or may not understand that a Medicaid application should be filed.  Furthermore, the process of preparing a Medicaid application may require many weeks — for example, an application for Medicaid nursing home coverage may require submitting five years of bank statements, brokerage statements, life insurance and annuity declarations pages, real estate deeds, proof of income (from the source) and more.

To protect consumers in situations such as these, federal Medicaid law requires that Medicaid coverage be retroactive up to three months prior to the application month, if the applicant met Medicaid eligibility standards for the month(s) in question.  This protection ensures that persons are not saddled with uncovered medical bills just because they received care close to the end of a month, and/or they were not able, due to medical condition or otherwise, to promptly file a Medicaid application. 

  • ‍[If you are a consumer, add examples of how unexpected medical bills have impacted or would impact your life if you didn’t have insurance coverage. If you are a provider, such as an ALF or nursing home administrator, explain the impact of patients/residents not being able to pay bills from services provided in the month(s) before they were able to file a Medicaid application.]

In addition, for those who are eligible for Medicaid coverage that helps pay for their Medicare premiums, eliminating retroactive coverage cannot meet a purported goal of encouraging individuals to acquire health insurance promptly as these individuals already have Medicare. Instead, this proposal would exacerbate the financial burden of health care costs for older and disabled individuals with low incomes.

Florida’s waiver amendment request states that in the 2015-2016 fiscal year, less than 1% of all Florida Medicaid recipients were made retroactively eligible. This seems to imply that the impact of eliminating retroactive eligibility would be small. I/We disagree. While the majority of Medicaid recipients may not utilize retroactive coverage, the impact would be enormous on each individual who needs retroactive eligibility but would not have access to it.

The Proposed Waiver Would Fail to Promote the Medicaid Program’s Objectives.

Under federal law, Medicaid demonstration waivers are allowed only if they are “likely to assist in promoting the objectives” of the Medicaid program.  This proposal fails to meet this standard. The application does not identify a specific proposition to be tested. Instead, the application states that the objective is to “enhance fiscal predictability,” but this is accomplished by denying health care coverage to persons who desperately need it. Waivers should be used to improve coverage, not to leave Medicaid-eligible persons without coverage when they have health care needs, especially when those needs are unpredictable.

The application could be read to imply that the state intends to test whether elimination of retroactive coverage would encourage Floridians to maintain coverage and apply for Medicaid as soon as they are eligible, but such a test would be contrary to the Medicaid program’s objective to protect low-income persons who otherwise cannot afford needed health care.

Furthermore, as discussed above, even if a person is able to start preparing an application for Medicaid as soon as they are eligible, the process may take weeks or months. Eliminating retroactive coverage would put Medicaid-eligible persons in grave financial risk and could mean they do not get necessary care because they cannot afford it.

Thank you for considering these comments. I urge CMS to reject this amendment — it would harm the low-income Floridians whom the Medicaid program should be protecting.

Sincerely,

Jason Neufeld

(obviously replace with your name)