For a decade, Florida lawmakers have refused to expand eligibility for the public health insurance program, Medicaid, to all low-income adults as prescribed under the Affordable Care Act.
But this week, Florida received approval from federal regulators to extend Medicaid benefits for one group of residents for whom state legislators had requested additional coverage: new mothers.
Florida will join California, Kentucky and Oregon as states that are newly approved to extend postpartum Medicaid coverage for eligible women from 60 days to 12 months — a policy shift that will benefit an estimated 126,000 women in those four states, including 50,000 women in Florida.
Illinois, Louisiana, Michigan, New Jersey, South Carolina, Tennessee and Virginia already extended postpartum Medicaid and Children’s Health Insurance Program coverage for a year.
Critical for new mothers, infants
The extension is critical for ensuring maternal and infant health because most new mothers with Medicaid in Florida become uninsured once their 60-day coverage period ends, said Alison Yager, executive director of the nonprofit group Florida Health Justice Project, which took the lead lobbying state legislators for the coverage extension.
“When parents are covered, they’re more likely to get their kids to care,” said Yager, who added the Medicaid coverage extension will also help ensure that mothers have a chance to remain healthy in between pregnancies.
“One year of postpartum coverage is not sufficient to ensure that people who are giving birth remain healthy throughout their reproductive years,” she said. “Any obstetrician will tell you we need medical coverage before pregnancy, during pregnancy and after pregnancy.”
Florida legislators budgeted about $240 million for the Medicaid postpartum coverage extension, though the state will only pay about $89 million of that amount and the rest will be covered by the federal government. The extension is scheduled to take effect July 1.
Medicaid paid for nearly 50% of all Florida births in 2020, according to the Florida Department of Health, and extending health insurance coverage to those mothers will help them access doctors, care for chronic medical conditions, and find mental health services during the postpartum period.
Coverage to drop off after a year
After a year, however, it won’t be easy for mothers to keep Medicaid coverage in Florida. Pregnant women can qualify for coverage if they earn less than 196% of the federal poverty level, or about $26,500 a year for an individual.
Once the pregnancy coverage period ends, the same mother cannot earn more than 30% of the federal poverty level, or about $7,000 a year for a family of three people, to qualify for Medicaid in Florida.
Florida also has categorical exclusions for Medicaid coverage. Single adults with no dependent children or a physical disability cannot qualify. Only adults who meet the income limits and who also are pregnant or have dependent children, or who are blind or have a disability, or who are 65 and older can qualify.
Children whose parents meet the state’s income limits — between $31,000 and $46,000 for a family of three people — also qualify for Medicaid coverage in Florida.
More than 5.2 million Floridians were enrolled in Medicaid as of April and about half of them are children, according to the state’s Agency for Health Care Administration, which administers the program. Medicaid enrollment has grown steadily in Florida and elsewhere since the federal government declared a public health emergency over the COVID-19 pandemic in March 2020.
Due to the public health emergency, the federal government gave states a slight increase in their Medicaid payments. In return, states agreed not to remove anyone who had gained Medicaid coverage from the rolls, unless they moved out of state.
Millions of Floridians could lose health coverage
Once the public health emergency ends, possibly as soon as October, Florida’s AHCA will be tasked with restarting annual renewals for everyone in their Medicaid programs if they have not been able to verify eligibility — an enormous administrative undertaking that could lead to millions of Floridians, especially children, losing coverage.
Though many more Floridians have Medicaid coverage now than before the pandemic, Yager with the Florida Health Justice Project said it’s important to remember that health insurance coverage does not necessarily equate to access and care.
Many Floridians with Medicaid encounter long wait times to see a doctor or received special medical services, and Yager said it will be key to monitor whether there are enough doctors and other healthcare providers to serve the Medicaid population.
“Someone may have Medicaid, but are they able to find a healthcare provider who’s in their network in their area,” she said. “Are there enough mental health providers in a particular region? That’s something we’re going to want to keep our eyes on going forward.”