State officials expected to see an increase in Medicaid enrollment in April, when more than 2 million Floridians either lost their job or were furloughed by employers during the response to COVID-19.
Florida’s Agency for Health Care Administration (AHCA), which manages Florida’s $30 billion Medicaid program, estimated in April it expected 109,348 new enrollments during a three-month span ending June 30 as a result of the COVID-19 emergency.
In that same estimate, AHCA warned Medicaid costs for the current fiscal year, which ends June 30, could exceed the state’s Medicaid budget by $187 million if the estimated 109,348 additional people were to enroll.
AHCA, however, reported in data released Friday at least 155,721 people enrolled in the program in April.
The 4.14 percent enrollment surge, the biggest one-month jump since the state started publishing monthly Medicaid information online in 2015, could mean the state’s current Medicaid budget could fall as much as $250 million short if April’s pattern persisted into May and June.
AHCA’s analysis also noted the continuing COVID-19 emergency – another 2,000 new cases reported Sunday established a new daily high – could blow a $1 billion hole in the state’s fiscal year 2021 budget, which takes effect July 1.
According to AHCA, more than 3.9 million Floridians in April were enrolled in Medicaid, the largest of state safety-net health programs that serve nearly 4.3 million low-income state residents, including children.
More than 3 million are enrolled in the state’s 17 Medicaid managed care plans, although nearly 900,000 remain in a fee-for-service system.
According to AHCA, Medicaid enrollment in those 17 plans increased from 2.9 million in March to more than 3 million in April, when the state’s unemployment rate jumped from 4.4 percent to 12.9 percent.
April marked the first time enrollment in the state’s Medicaid managed medical assistance program topped 3 million since January 2019, according to AHCA.
The potential $187 million estimated shortfall included increased federal money permitted by the Centers for Medicare and Medicaid (CMS) in March when it approved a 6.2 percent hike in the federal share of the Federal Medicaid Assistance Percentage (FMAP).
Under the federal Families First Coronavirus Response Act, with the FMAP increase, Florida received an additional $1.2 billion in Medicaid funding in exchange for not restricting eligibility as rolls swelled with newly unemployed.
State officials also are hoping CMS will extend a Medicaid waiver through 2024 that allows the state to draw up to $1.5 billion annually in supplemental Low Income Pool (LIP) money within its managed care program.
In looking to extend the waiver, which expires in June 2022, the state is seeking clarity from CMS on what authority AHCA has in spending federal dollars allocated to the LIP program in its managed care system.
Florida has not requested its full LIP authority since 2015 after it became one of 14 states that refused to expand Medicaid under the Affordable Care Act, creating uncertainty about whether LIP money can be spent in the state’s managed care system.
Under then-Gov. Rick Scott, lawmakers overhauled Medicaid and put most patients in managed care to control costs. AHCA divided the state into 11 regions and negotiated with health plans by region.
AHCA twice has contracted with managed care plans. Its latest $90 billion, five-year agreement with managed care providers went into effect in December 2018 and expires Dec. 31, 2023.
