Recent guidance from the Centers for Medicare & Medicaid Services (CMS) allows states to require Medicaid recipients to work in order to receive their health coverage. If Florida were to adopt such an approach, as a growing number of states have begun to do, thousands of residents would likely lose their access to health care.1
While the premise of work requirements, that they will support the development of workplace skills and economic independence, may sound appealing, in fact, it is fundamentally flawed. First, it assumes that Medicaid recipients are not working, when in fact, 61% of adult Medicaid enrollees in Florida work. Nationally, of those who aren’t working, more than 80% are in school or report an illness, disability, or caregiving responsibilities that keep them from working.
Additionally, work requirements subject people to burdensome paperwork and documentation requirements, which too often lead ultimately to loss of coverage. In other words, work requirements cause recipients who are already working, or are duly exempt from work, to lose their Medicaid because of administrative errors, and/or the system’s inflexibility (e.g. late paperwork, administrative errors, insufficient work hours in a given month, or a brief spell between jobs). The remaining individuals, who are neither working nor ill, disabled, or caregiving, likely don’t lack motivation to work, but supports that make work possible such as child care, and access to transportation. Further, in a state like Florida, that has not expanded Medicaid; the pool of able-bodied adults who would be subject to work requirements is quite limited, further underscoring the illogic of work requirements here.
Having health care helps people work and look for work. Ironically, taking it away will make it more difficult for many people to keep their jobs, or find a new job. Anticipated coverage losses that would come with work requirements will make health outcomes worse, access to care more difficult, and will make any growth in employment rates among recipients highly unlikely. In fact, a recent study of the first ever Medicaid work requirements, implemented in Arkansas found precisely these outcomes: thousands of people lost their Medicaid while there was no significant change in employment. Work requirements, it turns out, don’t work.
If you or someone you know is on Medicaid and want to learn more about this potential change to the Florida program, please contact us.
1 When work requirements have been challenged in federal court, they have been twice struck down, in Arkansas and Kentucky.
Florida’s Medicaid program, public health insurance for certain low-income individuals, is jointly funded by the state and federal governments. Regardless of the program’s annual costs, federal dollars cover over 60% of the bill. Thanks to this reliable support, the State can meet the needs of all those who are eligible. But this could change.
The federal government is currently encouraging states to elect to “block grant” their Medicaid program. In contrast to the current guarantee of a “federal match,” a block grant would cap the federal contribution to Florida’s Medicaid program at a fixed amount. Beyond that cap, the state would bear all responsibility for program costs. The Administration’s move represents a major cut to federal Medicaid spending, with planned savings of $1.5 trillion from the national Medicaid budget over ten years. To lure states into accepting a potentially massive loss in necessary funding, the Administration is promising increased flexibility in the Medicaid program. But this is a misleading “inducement,” as states already have significant program flexibility. What Florida needs is not more flexibility but a reliable funding partner in the face of growing demands for health coverage.
Status and Impact
Florida’s Medicaid program currently guarantees coverage for children in low-income families and very low-income parents of minor children, pregnant women, and individuals who are blind, aged, or disabled. Over 4 million Floridians rely on Medicaid for their health care. If Florida opts-in to capped Medicaid funds, a budget shortfall will be inevitable. While the federal government will save money, the state’s costs will balloon. Medicaid in Florida already has one of the country’s lowest per enrollee spending rates. When the state decides it is unwilling or unable to take on additional costs, it will be forced to take ruthless measures: cut eligibility, reduce benefits, and/or establish waiting lists.
Florida’s residents already have serious economic challenges and health care needs that underscore the potential negative impact of a Medicaid block grant. For example, Florida is home to over 800,000 children living in families below the federal poverty level, has the second largest waiting list in the country for severely disabled residents requiring home and community based services in order to avoid institutionalization, and is tied for first among the states for the highest portion of senior residents. The state has one of the nation’s highest rates of HIV infection and a high rate of drug overdose mortality, and will be among the first in the nation to experience the wide-scale health impacts of climate change.
Capping federal health coverage funds will mean that many of these people, and likely those with the most expensive care needs, will find themselves without coverage for the care they require. A Medicaid shortfall would also threaten the state’s ability to cover high-cost prescription drugs, to address a public health emergency like the opioid epidemic or Zika, or to meet the needs of Floridians in an economic downturn. In short, a Medicaid block grant would spell disaster for the health of state residents and the viability of the providers who serve them.
In this issue:
FHJP submits comment on the notice of proposed rulemaking regarding Section 1557 of the Patient Protection and Affordable Care Act (ACA)
Advocates Urge Litigation, Congressional Action, to Protect Families
FOR IMMEDIATE RELEASE: August 13, 2019
Contact: Matt Childers, (619) 807-1724
Miami, FL — The Trump Administration has finalized a “public charge” rule that threatens the health of over 1,000,000 low-wealth Floridians, weaponizing health and human services programs against lawfully present immigrants and their families. The rule would harm over a hundred thousand U.S.-born children in Florida, as fear and confusion about this technical and complex rule may discourage many immigrant families from enrolling or keeping their children in public assistance programs that are vital for low-income families.
“This regulation forces millions of families across the country to choose between the things they need and the people they love. It’s created a chilling effect across our immigrant communities because many people are confused over who is targeted by the rule and who is not,” said Dr. Matt Childers, Director of Research and Policy at FHJP.
Isabel Vinent, Interim Executive Director of the Florida Immigrant Coalition, added that, “The ‘public charge’ proposal is another radical departure from past interpretations and policy impacting immigrants seeking to access a green card. This will dramatically impact the lives of immigrants, especially low-income people of color. These are hard-working families seeking to live to their fullest potential while vastly contributing to the U.S. culture and economy. The message behind this policy is clear: priority will be given to wealthy, white immigrants. That is not who we are as a nation.”
FHJP estimates that up to 107,000 U.S.-born children, in families where one or both parents are noncitizens, will lose their health insurance and up to 82,000 will lose access to Supplemental Nutrition Assistance Program (SNAP) benefits due to the rule’s chilling effect. South Florida will disproportionately feel the impact from this, as half of affected families live in Greater Miami. The Urban Institute shows that across the U.S., one out of seven immigrant families has already begun avoiding non-cash government assistance programs.
When the rule was proposed last fall, the public charge proposal drew more than 266,000 public comments, overwhelmingly in opposition. Organizations across Florida, including the Florida Health Justice Project (FHJP), Florida Immigrant Coalition (FLIC) and WeCount, opposed the plan, as did pediatricians, hospitals, health insurers, public health officials, local elected officials, and other health leaders.
“In this political environment, many immigrant families who are eligible for public benefits, regardless of this rule, are afraid to stay in or enroll in public assistance programs because they think that their legal status will change or worse, that they will be deported. It threatens our state’s public health and our economy and its consequences will disproportionately impact the Miami area,” Childers said.
The final regulation puts admissions to the U.S. or applications for a “green card” at risk for an immigrant or a member of an immigrant’s family if their wealth falls below 125% of the federal poverty level ($32,188 a year for a family of four) or if they use Medicaid, the Supplemental Nutrition Assistance Program (SNAP, formerly “Food Stamps”) or “Section 8” rent vouchers. Citizenship applications are not subject to the “public charge” regulation, and refugees, asylees, and other immigration statuses are also exempt. Conservative estimates peg the regulation’s impact at 26 million people nationwide. That includes the one-fourth of all children in the U.S. — the vast majority born here — who live in immigrant families. Experts expect unmet health care needs to rise, as well as hunger, child poverty, inadequate or unsafe housing, and other drivers of poor health outcomes. And because immigrants targeted by the Trump proposal are overwhelmingly immigrants of color, experts expect racial health disparities to widen.
FHJP, FLIC and WeCount urge litigation and immediate congressional action that will protect families and children by stopping the implementation of the Trump administration’s public charge rule. Otherwise, the rule announced on August 12, 2019, will go into effect on October 15, 2019.
Advocates file suit against Florida state agencies for improperly stripping Medicaid from patients whose original eligibility was related to their adoption or disabilities
FOR IMMEDIATE RELEASE
Public Relations Consultant, Jacksonville Area Legal Aid
Florida Auditor General cited failure to review or process more than 650,000 data exchanges and the potential risk of failure to provide benefits to eligible individuals
JACKSONVILLE, Fla., Aug. 7, 2019 – Several civil legal aid organizations today filed a federal class action lawsuit against the state agencies that operate Florida Medicaid after identifying a pattern of improperly terminating coverage of those whose eligibility originally stemmed from their qualification for federal disability benefits or their adoption through the state’s dependency system.
“This lawsuit seeks to rectify an issue we previously sought to address with the Florida Department of Children and Families to no avail,” said Katy DeBriere, legal director of Florida Health Justice Project. “In administering Florida’s Medicaid program on behalf of the Agency for Health Care Administration, DCF is systematically failing to provide federally guaranteed benefits to those whose eligibility criteria have changed but who nonetheless remain eligible for Medicaid. Furthermore, those affected by this failure have been put at risk of significant, irreparable injury by virtue of a lack of access to treatment for serious conditions including cystic fibrosis, cerebral palsy, epilepsy and schizophrenia.”
Federal law requires state Medicaid agencies to continue to provide coverage until a beneficiary has been determined to be ineligible under all eligibility categories. Additionally, the Florida Department of Children and Families (DCF) has to provide notice and an opportunity for a fair hearing to anyone whose Medicaid benefits are terminated.
In the cases of at least a dozen clients served by Jacksonville Area Legal Aid and Disability Rights Florida, all of whom were either adopted or have a disability, none of those things happened until the civil legal aid organizations intervened. The two organizations, together with the Florida Health Justice Project and the National Center for Law and Economic Justice, have filed the class action lawsuit in an effort to force AHCA and DCF to stop wrongfully denying Medicaid coverage to class members until their continued eligibility under all Medicaid categories has been determined and they have been provided proper notice in instances where DCF terminates Medicaid benefits.
“Medicaid services, especially home and community-based services, are a critical factor in keeping individuals with disabilities healthy and safe in their own homes,” said Amanda Heystek, director of systems reform for Disability Rights Florida. “Ensuring the continued eligibility for these services is vital to their well-being. The problems addressed by this lawsuit have been raised to the Department of Children and Families before, and people who depend on Medicaid services deserve a solution.”
One of two named plaintiffs, Clayton Harrell of Jacksonville, lost his Medicaid benefits July 31 upon turning 18 because he is no longer eligible through the state’s adoption assistance program, although he remains eligible for Medicaid based on his age and household income as well as disability. Harrell, who was adopted out of foster care, has been diagnosed with multiple physical as well as mental health conditions.
Similarly, Lakeland resident Austin Trueblood, 31, who is diagnosed with Down Syndrome, had his Florida Medicaid benefits cut when the Social Security Administration approved his application for Disabled Adult Child (DAC) benefits, thus making him ineligible for the Supplemental Security Income that had originally qualified him for Florida Medicaid. Had DCF conducted a federally mandated review prior to cutting his Medicaid benefits, the agency would have discovered that he remained eligible for Medicaid based on his DAC benefits.
“AJ has been entitled to these Medicaid services since he was 18 years old,” said Suzanne Trueblood, Austin’s mother and guardian. “Just because his Social Security status was changed, he was kicked off the program when he should not have been. His needs have not changed at all, and he still needs this health care. We asked if the change would affect his Medicaid eligibility, and they said it wouldn’t. Yet, he was kicked off anyway. There is no way he would have been able to navigate this on his own. I am sure that others may have been kicked off erroneously, too, and they may not have anyone to help them get it reinstated.”
When the civil legal aid lawyers began researching the root cause for the systemic failure, they discovered a 2018 State of Florida Auditor General report stating that DCF had not, as of November 29, 2017, conducted a timely review of more than 650,000 data exchanges and that “the risk that eligible individuals may not receive timely benefits … is increased when data exchange responses are deleted or not timely reviewed and processed.”
Among the unreviewed data exchanges are those that occur between DCF databases and those of the Social Security Administration, which administers federal disability benefits, and the Florida Safe Families Network, through which benefits under state adoption agreements are administered. The 2018 Florida Auditor General report indicates that DCF has been repeatedly warned of the problem but has not successfully addressed it. In response, DCF cited insufficient staff.
Read the complaint
About Jacksonville Area Legal Aid
The mission of Jacksonville Area Legal Aid, Inc. is to obtain and provide high-quality legal assistance to low-income and other special-need groups and to stimulate and empower groups of poor people to accomplish energetic and affirmative advocacy, all to alleviate the circumstances, incidence and causes of poverty.
About Disability Rights Florida
Disability Rights Florida was founded in 1977 as the statewide designated protection and advocacy system for individuals with disabilities in the State of Florida. We provide free legal and advocacy services to people with disabilities through the authority and responsibility of nine federal grants. Our mission is to advance the quality of life, dignity, equality, self-determination, and freedom of choice for people with disabilities.
About Florida Health Justice Project
A new nonprofit advocacy organization, the Florida Health Justice Project seeks to improve access to affordable health care for Floridians, with a focus on vulnerable low-income populations. FHJP expands the advocacy community’s capacity to resolve individual access issues and educate consumers; identify and address systemic barriers to healthcare; and protect Medicaid and other safety-net programs.
About National Center for Law and Economic Justice
The mission of the National Center for Law and Economic Justice is to advance the cause of economic justice for low-income families, individuals, and communities across the country.
By Timothy Loftus, M.D., FHJP Law Clerk
On June 14, 2019, the U.S. Department of Health and Human Services officially published proposed changes to the nondiscrimination regulations under Section 1557 of the Affordable Care Act (ACA).1 The announcement triggered a 60-day public comment period. Section 1557, the nondiscrimination provision of the ACA, expands long-standing federal civil rights protections to certain healthcare programs and activities. The proposed rule changes will negatively impact multiple at-risk populations. Among other revisions, the changes would:
Health care policy professionals, providers, and advocates are weighing in on how these changes negatively impact women’s reproductive healthcare access, as well as healthcare access for the LGBT, HIV+, and LEP populations. Raising the stakes for Florida, the state ranks 3rd for size of Medicaid population,6 10th for highest LGBT population percentage7 and 3rd highest for HIV infection rate in the United States.8 Additionally, Florida’s LEP population ranks 4th largest in the country with 2.1 million individuals.
Florida Health Justice Project (FHJP) Next Steps
Alongside national, state and local partners, FHJP will be submitting official comments to the Department of Health of Human Services detailing the potential negative impact of the proposed changes on Floridians and discouraging implementation. In the coming days, FHJP will be gathering data and conducting research to inform our comments and conclusion. In addition, FHJP will share our research with other interested entities and encourage our partners to formally submit comments as well. Please contact Timothy Loftus, M.D., FHJP Law Clerk, at firstname.lastname@example.org for questions.
1. Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services. (June 2019). Nondiscrimination in Health and Health Education Programs or Activities. Retrieved from https://www.federalregister.gov/documents/2019/06/14/2019-11512/nondiscrimination-in-health-and-health-education-programs-or-activities. 14 June 2019.
2. Henry J. Kaiser Family Foundation. (June 2019). Summary of HHS’s Final Rule on Nondiscrimination in Health Programs and Activities. Retrieved from https://www.kff.org/disparities-policy/issue-brief/summary-of-hhss-final-rule-on-nondiscrimination-in-health-programs-and-activities/. 20 June 2019.
3. Justice in Aging. (May 2019). Justice in Aging’s Statement on Trump Administration’s Proposed Roll-back of Health Care Rights. Retrieved from https://www.justiceinaging.org/justice-in-agings-statement-on-trump-administrations-proposed-roll-back-of-health-care-rights/. 20 June 2019.
4. National Health Law Program. (May 2019). Administration Announces Proposed Regulation Change to Subvert ACA’s Civil Rights Protections. Retrieved from https://healthlaw.org/news/administration-announces-proposed-regulation-change-to-subvert-acas-civil-rights-protections/. 20 June 2019.
5. American Medical Association. (May 2019). AMA Advocacy Update. Retrieved from https://assets.ama-assn.org/sub/advocacy-update/2019-05-31.html. 20 June 2019.
6. Centers for Medicare and Medicaid Services, U.S. Department of Health and Human Services. (June 2019). March 2019 Medicaid and CHIP Enrollment Data Highlights. Retrieved from https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html. 17 June 2019.
7. LGBT Demographic Data Interactive. (2019). Los Angeles, CA: The Williams Institute, UCLA School of Law. Retrieved from https://williamsinstitute.law.ucla.edu/lgbtstats/. 17 June 2019.
8. Centers for Disease Control and Prevention. HIV Surveillance Report, 2017; vol. 29. http://www.cdc.gov/hiv/library/reports/hiv-surveillance.html. Published November 2018. Retrieved 17 June 2019.
9. Migration Policy Institute. (July 2015). The Limited English Proficient Population in the United States. Retrieved from https://www.migrationpolicy.org/article/limited-english-proficient-population-united-states. 20 June 2019.
By Andrea Faverio, Miram Harmatz, and Brett Brumund
Background on oral health coverage in Medicare:
When the Medicare Program was created in 1965, the major connection between oral health and overall wellness was not as well understood, and the Program excluded coverage of medically necessary dental care. While the connection between oral health and overall health outcomes is now proven, many people who rely on Medicare have limited access, or no access, to dental care.
Florida has over four (4) million Medicare beneficiaries.1 Many are on a fixed income. Although some Medicare beneficiaries have a limited dental benefit through their enrollment in a Medicare managed care plan, the coverage provided under those plans is limited, does not include all medically necessary dental care, and is costly for anything other than basic services like cleanings. While Florida took a huge step forward in expanding adult dental services for Medicaid recipients, most Medicare beneficiaries do not qualify for Florida’s limited Medicaid program.
Although the American Dental Association recommends at least one visit per year, almost half of all Medicare beneficiaries did not have a dental visit in 2016 and even higher rates were reported among those who are black or Hispanic, have low incomes, have poor health, and live in rural areas. Over 68% of elderly individuals suffer from periodontal disease which can lead to other health complications. Finally, it is now well established that poor oral health is linked to diabetes, heart diseases and other worsened health outcomes, particularly for the elderly who are at increased risk for these serious health conditions.2
Given the now well-understood importance of covering oral health care for Medicare beneficiaries, there are multiple efforts at the national level to address the need. These efforts include a bi-partisan administrative request, two Senate bills, and three House bills. Each is described below:
1) Bi-partisan administrative request
A bi-partisan request by members of Congress to the federal Agency that administers Medicare, the Centers for Medicare and Medicaid Services (CMS), has been submitted. Significantly, this request would not require a change to the law. Instead, it would provide a path to affordable dental care because CMS can authorize coverage for medically necessary dental benefits in limited circumstances where oral disease affects another Medicare-covered condition; for example, when oral infection prevents someone from safely undergoing surgery for another condition. While not comprehensive coverage, if adopted, this would provide dental services to those whose health is at most risk if the dental services are not provided.
A copy of the most recent bi-partisan request in the House of Representatives from September 17, 2018 is linked here. The most recent bi-partisan request in the Senate from September 20, 2018 is linked here.
Those leading this effort, including Representative Gus Bilirakis from Florida’s 12th Congressional District, underscore the need for bipartisanship. The plan for moving forward with this request is that for each Republican who signs on, there will be a Democratic signee, and vice versa. Continued pressure from Congress is necessary to keep this effort moving forward.
2) Senate bill: The Medicare Dental Benefit Act of 2019, S. 22
Senator Benjamin Cardin introduced the first major legislation that would provide for inclusion of a comprehensive dental benefit in Medicare Part B. Leading national advocacy groups sent a letter of support clearly spelling out the benefits of including a dental benefit in Medicare.
3) Companion House Bill: The Medicare Dental Benefit Act of 2019, H.R. 2951
Representative Nanette Diaz Barragán introduced this companion bill and the bill is supported by leading advocacy groups such as Families USA, American Association of Public Health Dentistry, American Dental Hygienists’ Association, Center for Medicare Advocacy, Children’s Dental Health Project, Community Catalyst, Justice in Aging, National Dental Association and the Santa Fe Group.
4) House Bill: Medicare Dental, Vision, and Hearing Benefit Act of 2019, H.R. 1393
Representative Lloyd Doggett introduced the bill to amend title XVIII of the Social Security Act to provide for coverage of dental, vision, and hearing care under the Medicare program. The bill was introduced in February of 2019.
5) House Bill: Seniors Have Eyes, Ears, and Teeth Act, H.R. 576
Representative Lucille Roybal-Allard introduced this bill to expand Medicare coverage to include eyeglasses, hearing aids, and dental care. Introduced in January of 2019, the bill has been referred to the Subcommittee on Health.
6) Senate Bill: Medicare and Medicaid Dental, Vision, and Hearing Benefit Act of 2019, S. 1423
Senator Robert Casey, Jr. introduced this bill to amend titles XVIII and XIX of the Social Security Act to provide for coverage of dental, vision, and hearing care under the Medicare and Medicaid programs. The bill was introduced in May of 2019 and has been referred to the Committee on Finance.
Oral health is an important part of health care, and until Medicare includes an oral health benefit, beneficiaries will continue to suffer. If you or a loved one has been impacted by the lack of dental coverage, we want to hear from you. Through the Florida Health Justice Project STORIES initiative, we will work with you in sharing your “story” with national leaders in oral health advocacy, including Justice in Aging and Families U.S.A.3
The work on this brief was supported through funding from The Florida Bar Foundation and Catalyst Miami.
1 Kaiser Family Foundation. 2018. https://www.kff.org/medicare/state-indicator/total-medicare-beneficiaries/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.
2 Kaiser Family Foundation. 2019. https://www.kff.org/medicare/issue-brief/drilling-down-on-dental-coverage-and-costs-for-medicare-beneficiaries/.
3 Two national nonprofits providing expertise and advocacy leadership at the national level include Justice in Aging (JIA) and Families USA. Both groups have helpful materials and updates on their websites.
By Miriam Harmatz and Andrea Faverio
Background on Retroactive Medicaid Eligibility (RME):
Under the federal Medicaid statute, states must provide up to three months of retroactive coverage to a successful Medicaid applicant if the individual was eligible for coverage when services were provided during those three months prior to application.1 This important consumer protection provision is referred to as “Retroactive Medicaid eligibility (RME).” Consistent with the Medicaid program’s objective to protect low-income persons who otherwise cannot afford needed health-care, Congress passed RME to alleviate financial risk for vulnerable individuals and ensure that those without insurance had an easier path to medical care.
In 2018, Florida received approval from the federal government to “waive” the RME section of the Medicaid statute for non-pregnant adults over 21 and to limit coverage to one month. This was done pursuant to what is referred to as an “1115 waiver” request.2 Because these waivers are time limited, the 2019 Florida Legislature attempted to permanently eliminate RME through a statutory amendment.3 Although the amendment ultimately failed to pass during the 2019 legislative session, Florida continues to utilize the section 1115 waiver to cut funding and limit access to RME.4
Status and Impact: Example of how the RME elimination impacts people and providers:
This elimination of RME is hurting low-income frail and disabled Floridians and critical safety net health care providers. Consider this hypothetical example: On March 15th, “Joe” suffered a sudden heart attack and was rushed to the hospital by ambulance. He was admitted, treated for four days, and sent home. Joe, who is 64 and uninsured, was already suffering from dementia. Since his heart attack, Joe’s dementia has gotten much worse, and his wife, Dora, cannot care for him at home. She calls a nearby nursing home and is told he needed to first apply for Medicaid and be found eligible before he could be admitted. She does not know how to use a computer and is unable to get through on the phone to a local agency for help in filing a Medicaid application. Meanwhile, Joe falls and is taken by ambulance to the hospital on April 15th. He is discharged after receiving a CAT scan and spending the night in the emergency room. Joe’s son, who is in the army and stationed overseas, finally files an application for Medicaid for Joe online on May 1st. Joe is found eligible on June 5th. Joe’s medical bills from May and June will be covered. However, his hospital bills from March and April totaling $35,000 are not covered by Medicaid. Under RME, those bills would have been covered, and it is also more likely that he could have gone straight to a nursing home.
Until RME is restored, a number of low-income, uninsured Floridians like “Joe” and his family will suffer. It is important for the public and policy makers to hear directly from those who are impacted. If you, a friend, or a loved one have been hurt by the loss of RME, we want to hear from you and work with you on the Florida Health Justice STORIES initiative.
1. 42 U.S.C. § 1396a(a)(34).
2. See, 42 U.S.C. § 1315(a).
3. Florida Policy Institute. 2019. https://www.fpi.institute/senate-bill-192-would-put-vulnerable-floridians-in-jeopardy/.
4. See Policy Transmittal Eliminating RME.
The LGBT population encompasses a highly diverse group of individuals that present unique healthcare challenges and barriers. Florida’s distinct demographics add further complexity to these challenges. This brief summarizes LGBT healthcare issues, highlights those challenges unique to Florida, and finally, suggests how expansion of Medicaid in Florida will benefit LGBT individuals in the state.
LGBT Health Concerns
The LGBT population as a whole experiences poorer health than its heterosexual counterpart. LGBT individuals exhibit higher prevalence, as well as earlier onset, of general disability. Studies show that the population experiences elevated rates of asthma, allergies, osteoarthritis, and gastrointestinal problems. The LGBT population also experiences higher risks of cardiovascular disease and some cancers.1 Additionally, gay and bisexual men continue to account for the highest rates of HIV and new HIV infection in the U.S. as well as other sexually transmitted infections.2, 3 Transgender women also face a higher prevalence of HIV.4 Lastly, LGBT persons experience higher rates of mental health conditions and substance abuse.1, 5 These statistics warrant particular attention to LGBT healthcare access.
Florida’s LGBT Population
LGBT individuals in Florida experience higher rates of unemployment, food insecurity, and low-income status than both their national LGBT counterparts and non-LGBT persons in the state. Similarly, lack of health insurance affects Florida LGBT persons at a higher rate. Furthermore, data show that Florida’s LGBT population includes a higher percentage of individuals over the age of 50 compared to national numbers (32% v. 23%). Florida’s LGBT population also consists of a higher percentage of Latino persons (30% v. 21%).6 These factors create a complex array of challenges affecting Florida’s LGBT population.
Sources: Bureau, U.S. Census. (2017). American Fact Finder. Retrieved from Factfinder.census.gov. 6 June 2019.
LGBT Demographic Data Interactive. (January 2019). Los Angeles, CA: The Williams Institute, UCLA School of Law. Retrieved from https://williamsinstitute.law.ucla.edu/lgbtstats/. 6 June 2019.
Impact of Florida Medicaid Expansion
Nationally, Medicaid expansion resulted in an estimated 511,000 additional LGB* individuals being covered thus far in those states opting to expand coverage.7 The Kaiser Family Foundation estimates that 837,000 total Florida residents may benefit from Medicaid expansion in the state. That total ranks second only to Texas of the fourteen states that have not expanded.8 The exact number of LGBT individuals included in Florida’s total remains unknown. However, with an estimated LGBT proportion of 4.6% in Florida, extrapolation yields that approximately 38,500 LGBT individuals might benefit from expansion. This significant number highlights the importance of Medicaid expansion to healthcare for Florida’s LGBT population.
*Transgender individuals not included.
1. Lick, D., Durso, L.E., & Johnson, K.L. (2013). Minority Stress and Physical Health Among Sexual Minorities. Pers on Psychological Sci 8(5): 521-548
2. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. (2019). HIV Among Gay and Bisexual Men. Retrieved from https://www.cdc.gov/nchhstp/newsroom/docs/factsheets/cdc-msm-508.pdf. 6 June 2019.
3. Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. (2016). Gay and Bisexual Men’s Health: Sexually Transmitted Diseases. Retrieved from https://www.cdc.gov/msmhealth/STD.htm. 6 June 2019.
4. Baral SD, et al. (2013). Worldwide burden of HIV in transgender women: a systematic review and meta-analysis. The Lancet Infectious Disease. 13(3): 214–222.
5. Cochran, S.D., Sullivan, J.G. & Mays, V.M. (2003). Prevalence of mental disorders, psychological distress, and mental health services use among Lesbian, Gay, and Bisexual adults in the United States. Journal of Consulting and Clinical Psychology71(1): 53-61.
6. LGBT Demographic Data Interactive. (2019). Los Angeles, CA: The Williams Institute, UCLA School of Law. Retrieved from https://williamsinstitute.law.ucla.edu/lgbtstats/. 6 June 2019.
7. L. Dawson, J. Kates, and A. Damico. (2018). Kaiser Family Foundation. The Affordable Care Act and Insurance Coverage Changes by Sexual Orientation. Retrieved from https://www.kff.org/disparities-policy/issue-brief/the-affordable-care-act-and-insurance-coverage-changes-by-sexual-orientation/. 12 June 2019.
8. Garfield, Rachel, Kendal Orgera, and Anthony Damico. (2019). The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid. Issue brief. Washington, D.C.: Kaiser Family Foundation. Retrieved from https://www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/. 13 June 2019.
In this issue:
Alison Yager, FHJP's Director of Policy Advocacy, contributed to the article "Fewer Florida Children Enrolled In Medicaid, CHIP in 2018, Report Says" published on the website of Health News Florida.
Go to article
For Immediate Release: Thursday, May 30, 2019
Contact: Sonia Lindell, Florida Policy Institute, 407.440.1421 ext. 702 or email@example.com
ALMOST 70,000 FEWER FLORIDA KIDS WERE COVERED BY MEDICAID, KIDCARE IN 2018
Florida and six other states accounted for 70 percent of the enrollment decline in the U.S. between 2017 and 2018
TALLAHASSEE, FL - A decline in child enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) — known as KidCare in Florida — is part of an alarming national trend, according to a new report by the Georgetown University Center for Children and Families (CCF). Between 2017 and 2018, found CCF, Florida saw one of the nation’s largest declines, with almost 70,000 fewer children covered by Medicaid and KidCare.
The report found little evidence to support claims that the improving economy was responsible for the decline in child Medicaid and CHIP enrollment.
Most low-income children rely on Medicaid and CHIP-funded programs, such as Florida KidCare, to meet their health needs, explained Tricia Brooks, author of the report and a senior fellow at CCF. She added that it’s unlikely that all of the children who lost public coverage were enrolled in private health insurance plans.
“Florida experienced important gains in the share of insured residents after provisions of the Affordable Care Act first went into effect in 2014,” said Sadaf Knight, CEO of the nonpartisan Florida Policy Institute. “We have not seen the same commitment to coverage under the current federal Administration. Florida already has a growing number of children becoming uninsured, and these declining enrollments in children’s Medicaid and KidCare is a sign that it is getting worse.”
“When kids lose health coverage, they lose critical access to health care,” said Alison Yager, director of policy advocacy for Florida Health Justice Project. “Yet health care is an essential ingredient in a child’s ability to thrive. We know from the research that Medicaid and CHIP coverage contribute to long-term positive outcomes not just in health, but also in school performance, educational attainment, and economic success.”
While data is not yet available on the number of uninsured children in Florida for 2018, Florida was among the states that saw an increase in 2017, the first time in nearly a decade that the uninsured rate for children increased nationwide. Florida saw a statistically significant increase with about 37,000 more children lacking insurance in 2017 than in 2016.
“There are clearly many factors at play that are putting children at risk,” said Brooks. “The Trump Administration took several steps that undermined enrollment including cutting outreach and consumer assistance funding. Proposed immigration policies also have kept many eligible families from seeking or renewing coverage for their children.”
The report found that the enrollment decline was uneven across the states. Combined enrollment in Medicaid and CHIP dropped in 38 states by 912,000 children in 2018. Enrollment declines were concentrated in seven states – California, Florida, Illinois, Missouri, Ohio, Tennessee, and Texas – which account for nearly 70 percent of the losses.
State-specific policy and practices also likely influenced the declines in child Medicaid and CHIP enrollment including cumbersome processes for enrollment and renewal, and stricter rules or more frequent reviews of eligibility, according to the report authors. In Florida, for instance, lack of 12-month continuous eligibility for children on Medicaid can result in breaks in health coverage, known as “churn,” which can disrupt care and exacerbate the seriousness of existing health conditions.
Required monthly premiums also contribute to program churn. Research shows that during 2017, more than 60,000 children were denied eligibility for non-payment. Florida is one of a handful of states that charges premiums for families with income below 150 percent of the poverty level-- just $31,170 per year for a three-person household. In addition, Florida’s income eligibility for its CHIP program — Florida Healthy Kids — is low compared to the national average and other southern states.
“The fact that so many children lost Medicaid and CHIP coverage is very alarming,” said Joan Alker, executive director of CCF. “This report puts policymakers on notice that the success the U.S. has achieved on children’s health coverage is in jeopardy. Federal and state leaders must acknowledge the problem, investigate its causes, and take immediate action to ensure children have the health coverage they need to succeed.”
The CCF is an independent, nonpartisan policy and research center founded in 2005 with a mission to expand and improve high-quality, affordable coverage for America’s children and families. CCF is based at the McCourt School of Public Policy.
Florida Policy Institute is an independent, nonpartisan and nonprofit organization dedicated to advancing state policies and budgets that improve the economic mobility and quality of life for all Floridians.
Florida Health Justice Project, a nonprofit advocacy organization, seeks to improve access to affordable healthcare for Floridians, with a focus on vulnerable low-income populations.
In this issue:
By Miriam Harmatz, Alison Yager, and Matt Childers
BACKGROUND ON MEDICAID EXPANSION
The Affordable Care Act (ACA or Obamacare) provided two “paths to coverage” for people with low to moderate incomes. First, people with moderate incomes (100 to 400% of the federal poverty level) could receive subsidies to help pay for insurance in the new Healthcare Marketplace. Second, the law provided that very low-income, uninsured adults between the ages of 19 and 65 would get health care coverage through an expanded Medicaid program, to be largely paid for by the federal government. The expansion extended coverage to adults below 138% of the federal poverty level (FPL) and eliminated Medicaid’s “categorical requirement,” which limited adult coverage to pregnant women, parents and people who were aged, blind or disabled. Although Medicaid expansion was meant to be national in scale, the Supreme Court ruled in 2012 that the federal government could not force states to expand their Medicaid program, but rather expansion must be a state “option.”
STATUS AND IMPACT
Florida is one of only 14 states that have not expanded Medicaid. As a result, approximately 445,000(1) Floridians fall into the “Coverage Gap,” meaning they have no path to affordable coverage. For example, a working parent with one child who earns just $500/month (35% of the Federal Poverty Level) is above the income threshold, and therefore ineligible, for Florida’s very limited Medicaid coverage, and at the same time is below the income cut-off for, and therefore unable to purchase, Marketplace coverage. Additionally, approximately 392,000(2) low-income Floridians who do qualify for Marketplace insurance (those between 100 and 138% FPL) are severely burdened by out-of-pocket costs and challenges in accessing care, many of which would be resolved with Medicaid expansion.
A large body of data and evidence show that those states which have chosen to expand Medicaid under the ACA have witnessed improved healthcare access and individual financial stability, as well as economic benefits for states, local communities and providers.
Until Florida expands Medicaid, policy makers and the public must hear from uninsured residents about the suffering and loss that comes with lacking health coverage. The Florida Health Justice Project is working with impacted individuals, advocates and health care providers to help bring these stories to light through our Florida Health Justice STORIES initiative.
1 Garfield, Rachel, Kendal Orgera, and Anthony Damico. 2019. “The Coverage Gap: Uninsured Poor Adults in States That Do Not Expand Medicaid.” Issue brief. Washington, D.C.: Kaiser Family Foundation. https://www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/.
In this issue:
FHJP presented at Catalyst Miami's 4th Annual Oral Health Equity Summit on March 29th, 2019. Executive Director, Miriam Harmatz, discussed policy proposals that could affect oral health in Miami-Dade County. A big thank you to Catalyst Miami for including us in this wonderful event.
Click the button below to download the powerpoint presentation.
FHJP was invited to present at the Alliance For Aging's New Face of Again Conference on March 14, 2019 in Miami. Our presentation on Florida’s Medicaid Long-Term Care Waiver, provided an overview of this complex and critical program, including recent changes to the Medicaid Managed Care contracts and updates to the LTC Advocate’s Guide.
Click the button below to download the presentation.
Florida Health Justice Project Files Comments Related to Florida Medicaid Eligibility Determinations
Florida Health Justice Project Files Comments Opposing the Trump Administration’s Proposed Changes to the “Public Charge” Rule
Florida Health Justice Project Featured in the Miami Herald's Editorial Opposing The Trump Administration's Proposed Changes to the "Public Charge" Rule
The Florida Health Justice Project was featured in an editorial piece regarding the proposed Public Charge rule. The article contains direct quotes from our Executive Director, Miriam Harmatz, and Board Member, Dr. Fred Anderson, that discuss the present and future effects of this rule. Information on how to submit a comment online is also provided in the article.
To read more, click here.
Proposed Changes To the Public Charge Rule will Cause Significant Loss of Health Care Coverage for Florida Children (Updated)
By Matt Childers, Ph.D.
Updated November 14, 2018
On October 10, 2018, the Trump Administration published proposed changes to the “public charge” immigration rules that govern how the use of public benefits affect an immigrant’s legal status. These changes are likely to harm millions of immigrant families across the nation, but states with large immigrant populations will disproportionately feel the impact. In this brief, we analyze the effects that the proposed changes will have on healthcare coverage among U.S.-born children in “mixed-status” families in Florida and its major metropolitan areas (by “mixed-status,” we refer to families whose children are citizens, but one or both of the parents are not). We find that over 107,000 kids will lose health insurance in Florida and over half of them reside in the Miami metropolitan area.
Proposed Changes to the Public Charge Rule Will Push Thousands of Florida’s Children Out of the Supplemental Nutrition Assistance Program (SNAP)
By Matt Childers, Ph.D.
Updated November 14, 2018
On October 10, 2018, the Trump Administration published proposed changes to the “public charge” immigration rules that govern how the use of public benefits affect an immigrant’s legal status. These changes are likely to harm millions of immigrant families across the country, but states with large immigrant populations will be disproportionately affected. In this brief, we analyze the impacts that the proposed changes will have on SNAP enrollment (food stamps) among U.S.-born children in “mixed-status” families in Florida and its major metropolitan areas. (By “mixed-status,” we refer to families whose children are citizens, but one or both of the parents are not.) We find that over 80,000 kids will lose SNAP benefits across the state and over half of them reside in the Miami metropolitan area.
The changing global climate is already creating far-reaching impacts on population health in Florida that, paired with barriers to affordable healthcare access, will impact Florida’s most vulnerable populations. One particular concern is the increased threat of vector-borne diseases. Thanks to South Florida’s unique environment and status as an international gateway, Florida is particularly vulnerable to vector-borne diseases. The public health impacts of this threat are compounded by the fact that many cannot access affordable health coverage, including over 20% of adult Floridians. This brief explains the increasing threat of vector-borne disease in Florida as a result of the changing climate and the available public-sector responses, including expanding Florida’s Medicaid program under the Affordable Care Act (ACA).
Vector-borne diseases are transmitted through a vector species, such as a mosquito, usually through a bite. Several biological and environmental factors control the transmission and spread of vector-borne diseases. While some factors are capable of human control, Florida also faces major environmental factors, including temperature and rainfall, which impact pathogen infectivity and survival as well vector species breeding. Hurricanes also provide an opportunity for vector-borne diseases to spread—heavy rains, storm surge, and damage create breeding opportunities for disease-carrying mosquitoes.
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The Florida Health Justice Project, a nonprofit organization, recognizes that access to quality and affordable health care is a human right and engages in comprehensive advocacy to expand healthcare access and promote health equity for vulnerable Floridians.
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