Sound Health Policy or Highway Robbery: You Decide

The State has asked for permission to completely change the Medically Needy portion of Florida Medicaid.

If the State’s request is approved, most Medically Needy patients will quickly lose their access to Medicaid coverage, or become absolutely destitute trying to hold on to that coverage.
Medically Needy patients cannot qualify for regular Medicaid coverage because their family income is over the Medicaid limit. Instead, they can only qualify on a short-term basis for the months that they have catastrophic medical expenses (total medical bills that are almost as high as or higher than their income.)

Currently, Medically Needy patients do not have to pay all of those catastrophic medical expenses (also known as meeting their “Share of Cost”) directly out of their own pockets. That would be impossible, as almost all are low-income families with children, elderly, or disabled. Instead, once a patient can document medical bills – paid or unpaid – totaling their Share of Cost, Medicaid kicks in for the rest of the month.

After the first month of meeting Share of Cost the old way, a Medically Needy patient will be required from that point on to directly pay a premium each and every month in order to remain in the program and have any access to Medicaid coverage at all.

A Medically Needy patient’s monthly premiums would be the lower of two amounts:

1) His or her monthly Share of Cost, which is different for each individual. (The remaining familyincome for all other needs that month would be equal to 19% of the federal poverty level: $200-$300.)

2) The average monthly amount that the State actually expects to spend on care for that type ofpatient.

Either of these amounts will be beyond unaffordable for Medically Needy patients and their families.

Monthly premiums could be as high as $1,800 for a disabled individual (up to 90% of his/her income) and $538 for a parent with two children (up to half their income). Though some premiums will not be that high, virtually every patient in the Medically Needy program will be forced to try to pay a monthly premium they cannot afford. Click here for the examples of Medically Needy patients’ premiums if the waiver is approved.  
Medically Needy patients must pay the premium each and every month, even if they have no medical expenses at all. Once they miss a payment, the clock starts ticking. If they don’t pay that premium in full within 3 months, they will lose Medicaid coverage – no matter how sick they are.

The stated purpose of the change is to provide these patients with much-needed continuous coverage. The reality – one that the State knows very well – is that only a small percentage will remain covered after a few months, and those that do will spend far more they can afford.