The COVID-19 public health emergency brought significant changes to numerous aspects of life, including healthcare and social assistance programs. For Florida residents relying on Medicaid, it’s crucial to understand how these changes have impacted their benefits and the application process. This guide provides a comprehensive overview of Florida Medicaid during the public health emergency, drawing from official sources to ensure accuracy and up-to-date information.
Medicaid Protection During the Public Health Emergency
From March 2020 until the end of the federal public health emergency, a continuous coverage provision was in place for Medicaid recipients. This meant that individuals enrolled in Medicaid as of March 18, 2020, would not lose their coverage during this period, even if they would normally become ineligible. The only exceptions to this were if someone ceased to be a Florida resident or voluntarily requested termination of their benefits. This measure was enacted under the Families First Coronavirus Response Act to ensure people maintained access to healthcare during the crisis.
This protection was a significant relief for many Floridians, ensuring continuous healthcare access amidst job losses and economic uncertainty. For individuals concerned about maintaining their health coverage, this policy provided much-needed stability. The Florida Agency for Health Care Administration (AHCA) and the Department of Children and Families (DCF) actively worked to inform recipients about these protections, especially those who might have received termination notices in March 2020, assuring them of benefit reinstatement.
Reinstatement of Medicaid Redetermination and Recertification
While continuous coverage was in place, it’s important to note that redetermination and recertification processes were eventually reinstated. Starting October 1, 2020, DCF began sending letters to Medicaid recipients to initiate case reviews. These reviews were necessary to verify ongoing eligibility for Medicaid and/or Medically Needy programs. AHCA urged recipients receiving these letters to respond promptly and take the necessary steps to re-apply if required.
It’s crucial to understand that while these reviews resumed, actual Medicaid coverage would still not be terminated during the public health emergency itself, reinforcing the continuous coverage protection. However, responding to these redetermination requests was essential to ensure smooth continuation of benefits once the emergency period concluded. For certain populations, like those with sole income from Social Security and SSI, DCF conducted “automated renewals” in January 2021, simplifying the process for them.
Changes to Medicaid Application Processing
The pandemic also brought temporary changes to the Medicaid application process itself. For applications filed in February 2020, the timeframe for submitting required documentation was extended to 120 days from the application date. This provided applicants with more flexibility during a challenging time to gather and submit necessary paperwork, and importantly, eligibility could still be effective from the first day of the application month.
However, this extended timeframe was rescinded effective July 1, 2021. For Medicaid applications submitted on or after this date, the standard processing deadlines resumed. Applications could be denied as early as 30 days after submission or the day after verification information is due. This change meant that applicants needed to be prepared to provide all required documentation promptly to avoid potential delays or denials. It’s worth noting that applications submitted before July 1, 2021, still benefited from the 120-day documentation window.
Income Considerations for Medicaid Eligibility During COVID-19
A significant aspect of Medicaid eligibility is income. During the pandemic, there were specific provisions regarding unemployment benefits and how they were considered for Medicaid eligibility. Notably, the additional $600 per week in unemployment insurance payments provided under the CARES Act was specifically excluded from income calculations for Medicaid eligibility purposes. This meant that individuals receiving this extra unemployment assistance would not have it counted against them when determining Medicaid eligibility.
It’s important to distinguish this from ACA marketplace subsidies, where these unemployment payments were considered income. This specific exclusion for Medicaid aimed to ensure that temporary increases in unemployment income during the crisis did not inadvertently disqualify individuals from essential healthcare coverage.
Expanded Medicaid Service Coverage During the State of Emergency
Florida Medicaid expanded its service coverage during the state of emergency to address the unique healthcare needs arising from the pandemic. Key expansions included:
- COVID-19 Testing and Treatment: Coverage for all medically necessary services related to COVID-19 testing and treatment was provided. This ensured that Medicaid recipients could access necessary care without financial barriers.
- Service Limit Waivers: Limits on certain services were waived when exceeding them was necessary to maintain the health and safety of recipients diagnosed with COVID-19 or to ensure they could safely remain at home. This offered greater flexibility in care delivery.
- Copayment Waivers: Copayments for all Medicaid services were waived, eliminating out-of-pocket costs for recipients during the emergency.
- Prescription Flexibility: Limits on early prescription refills were waived (except for controlled substances), and coverage for 90-day supplies of maintenance prescriptions was allowed when available, enhancing medication access.
- Out-of-State Provider Reimbursement: Out-of-state providers offering medically necessary services to Florida Medicaid beneficiaries were reimbursed, expanding access to care for those who may have been temporarily out of state or needed specialized services from out-of-state providers. However, “provisional enrollment” for out-of-state providers ended on July 1, 2021.
- Fair Hearing Delays: Delays in fair hearings were permitted in cases where recipients continued to receive services pending the hearing outcome, ensuring continuity of care during dispute resolution.
These expanded coverages were crucial in ensuring that Medicaid recipients could effectively access testing, treatment, and other necessary healthcare services throughout the public health emergency.
Access to COVID-19 Vaccines for Medicaid Enrollees
Vaccination became a cornerstone of the pandemic response, and Florida Medicaid played a role in ensuring access to vaccines for its enrollees. Following Governor DeSantis’ executive orders, vaccine eligibility expanded to include all Floridians. Medicaid enrollees were encouraged to utilize the myvaccine.fl.gov website to locate vaccine distribution sites and schedule appointments.
Recognizing transportation as a potential barrier, AHCA also provided guidance on Medicaid transportation services for vaccine appointments. Medicaid enrollees could request transportation assistance from their Medicaid plan to get to vaccine sites at no cost. For those not enrolled in a plan, a Medicaid Helpline (1-877-254-1055) was available to connect them with transportation services. Furthermore, a specialized email system ([email protected]) was launched to bring vaccines to homebound seniors, further enhancing accessibility.
Telehealth and Behavioral Health Services
Telehealth emerged as a vital tool for healthcare delivery during the pandemic, and Florida Medicaid expanded its telehealth coverage. AHCA issued guidance on telemedicine for medical, behavioral health, and early intervention services providers. Additionally, coverage restrictions were loosened for behavioral health services. Prior authorization requirements for mental health and substance use disorder treatment were waived, and service limitations were lifted temporarily. While these waivers and lifted limits were initially in place, service limits were reinstated on July 1, 2021, and prior authorization requirements for behavioral health services were reinstated on July 15, 2021.
For well-child visits, telemedicine reimbursement was extended to children older than 24 months through age 20 during the state of emergency. However, providers were instructed to schedule follow-up in-person visits for immunizations and physical exam components that could not be done via telemedicine.
Public Charge Rule and Medicaid for COVID-19
It’s important to note that the federal public charge rule, which can affect immigration status based on public benefit use, was explicitly stated not to apply to immigrants’ use of Medicaid benefits for COVID-19 testing and treatment. This clarification aimed to remove any immigration-related concerns that might deter individuals from seeking necessary COVID-19 related healthcare.
Home and Community-Based Services (HCBS) Waivers
For individuals receiving Home and Community-Based Services (HCBS) through Medicaid waivers, such as the Long Term Care and Developmental Disabilities programs, temporary changes were implemented. These changes, effective retroactively from January 27, 2020, to January 26, 2021, aimed to ensure continued access to these crucial services while adapting to pandemic conditions.
These flexibilities included:
- Virtual evaluations, assessments, and care planning meetings.
- Electronic signatures for documentation.
- Lifted service limits to address health and welfare needs.
- Adjusted service prior authorization requirements.
- Temporary expansion of service settings.
- Payments for support services in hospitals or short-term institutional settings.
- Visitor restrictions in residential settings to minimize infection spread.
These adjustments were critical in maintaining HCBS program continuity and ensuring the well-being of enrollees during the public health emergency.
Resources for the Uninsured and Vaccine Access
While Florida Medicaid expanded coverage for its enrollees, it’s important to address resources for uninsured individuals as well. Florida did not opt for 100% federal Medicaid funding for COVID-19 testing, treatment, and vaccines for the uninsured, even though this option was available under the American Rescue Plan Act. As a result, uninsured Floridians had to rely on a patchwork of resources.
AHCA advised uninsured individuals to seek free testing from county health departments or federally qualified health centers and to inquire about free testing at community testing sites. Resources for free treatment were less clearly defined at the state level, but organizations like Florida Health Justice provided information on potential sources.
Regarding vaccines, a significant policy change occurred on April 29, 2021, when Florida clarified that residency proof was no longer required at state-run and federally supported vaccination sites. This policy change broadened vaccine access, including for migrants present in Florida. Vaccines were available to “a Florida resident” or someone “who is present in Florida for the purpose of providing goods or services for the benefits of residents and visitors of the State of Florida.”
ACA Marketplace Access for Unemployment Recipients
Finally, for individuals who experienced unemployment in 2021, the Affordable Care Act (ACA) marketplace offered a special enrollment opportunity for free or reduced-cost health insurance plans. The American Rescue Plan significantly reduced premiums for many with low to moderate incomes. Those who received or were approved for unemployment compensation in 2021 could access these enhanced ACA marketplace plans, regardless of current income, by enrolling by August 15, 2021. Resources like Covering Florida (877-813-9115) were available to assist with enrollment.
Conclusion
The COVID-19 public health emergency brought about numerous temporary changes to Florida Medicaid, aimed at ensuring continuous coverage, expanding access to COVID-19 related services, and adapting service delivery to the challenging circumstances. While many of these changes were temporary and tied to the duration of the public health emergency, understanding these policies is crucial for anyone navigating Florida’s Medicaid system during this period. For the most up-to-date information and specific guidance related to your situation, always consult official sources like AHCA and DCF websites or contact the Medicaid Helpline directly. And for those seeking food assistance in Florida, programs like SNAP (Supplemental Nutrition Assistance Program, also known as food stamps) are also available to provide crucial support. You can find information on applying for Florida food stamps through the Department of Children and Families ACCESS website.
