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More people have been disenrolled from the state’s Medicaid program as a result of the unwinding process that began after the end of the Covid-19 pandemic than previously expected.
Matt Cooper, assistant secretary for health care data at the state Agency for Health Care Administration, said 478,940 fewer people are enrolled in the safety-net health care program than had been predicted.
Cooper told members of the state’s Social Services Estimating conference, a panel of economists from the Legislature and governor’s office, that an eligibility group “lost more than we anticipated.”
Medicaid, which is paid by both the state and federal government, is one of the largest components of Florida’s nearly $119 billion state budget. During the pandemic, Florida received extra federal money but was not allowed to remove people from the Medicaid rolls, a requirement that ended last year. Advocates for the poor and those who receive government services have criticized how Florida has reevaluating who is eligible for services.
The Department of Children and Families qualifies people for Medicaid in Florida. The exception is people who are Social Security Income (SSI) eligible. SSI eligibility is determined by the federal government. People who are SSI eligible are either aged, blind, or have a disability that prevents them from working. SSI eligibility triggers Florida Medicaid eligibility.
Applied behavior analysis
The lower-than-anticipated Medicaid enrollment, Cooper said, means the Legislature appropriated more money than necessary to provide the health care services. But while there was a dip in enrollment overall, state officials are worried about the growing costs of a therapy known as applied behavior analysis.
Applied behavior analysis (ABA) is based on the science of learning and behavior, according to Autism Speaks, an advocacy and education group that supports research into care for autistic individuals and their families, according to the group’s website.
To date, the state has not required ABA services to be provided through Medicaid managed care plans. Instead, they have been paid for on a fee for service basis, with payment paid for service provided.
Cooper said the Legislature anticipated spending $1.52 billion on ABA services but that economists later predicted it will cost closer to $1.63 billion. And that’s just for services between July 1 and February 2025.
The later date is when the state expects new statewide Medicaid managed care contracts to take effect. The new contracts require these plans to provide ABA services.
Economists predict it will cost the plans another $1 billion to provide ABA services to the enrollees who require the care for the remaining five months of the fiscal year.
In all, that brings the overall costs of ABA closer to $2.62 billion state in the current year, or about $1 billion more than included in the budget.
No shortfalls
Despite that, there aren’t any overall projected shortfalls.
“What that tells you is there’s another counterweight, another factor that is bringing that projection down further. … And that is really due to the decline in caseload from the unwinding, specifically the SSI eligibility group lost membership more than we anticipated,” he said, adding that the decrease in enrollment “outweighs” the increased costs for ABA.
Cooper said there also were some cost increases in the state’s long term care prepaid health program. The state needed to “dig into” the specifics to determine what’s happening, he said.
As of October 31, the lastest available data, 4,351,012 people were enrolled in Medicaid in Florida.