With little advance notice to the community, the state of Florida announced in mid-November that it was moving next week (December 5th) to a new portal for eligibility for Medicaid, SNAP, child care and TANF; and that every person/household in the state accessing those benefits will need to create a new account.
Every person create a new account? Do you know how many people that is? Is it really everyone including people in long term care? Florida’s Medicaid enrollment has declined by over 600,000 people in the last six months due to the state’s aggressive push to get families off during unwinding, but enrollment is still over 5 million people as of October. 1 in 8 Floridians are receiving food assistance through SNAP – obviously there is overlap with Medicaid enrollment but still – we’re talking a good chunk of the population of Florida – and by definition people and families that are not likely to be swimming in Apple devices for this entirely online transaction.
Florida is in the midst of Medicaid unwinding and it has not gone well – with just under 300,000 net decline in child Medicaid enrollment and numerous stories of very sick children losing Medicaid they were clearly still eligible for. CHIP enrollment has not picked up much to account for this decline.
FAQ’s on the new system are here; Q 5 clarifies that everyone has to create a new account and once you do you can theoretically link to your current assistance case. Q. 9 is very clear that current accounts cannot be converted however – the user will have to do something to link their old account.
Q 16 notes that everyone needs an email address and Q 11 specifies that two-factor authentication must happen every time you log in. Two-factor authentication is often very hard to do for those who don’t have multiple devices on hand and/or are not tech savvy. It also makes it hard to help people with any online process – an experience that many of us have had when assisting elderly parents with online transactions. Undoubtedly this will make the process much, much, harder.
The FAQ’s leave many questions unanswered – like what happens if you don’t create a new account? What happens to people who are in the midst of the unwinding process right now? With procedural terminations already accounting for 73% of Medicaid unwinding coverage losses in Florida (a ratio that has been steadily ticking upwards) this is a recipe for disaster – with more eligible children and families losing Medicaid coverage.
Many of these improvements – like moving to a mobile-friendly site and making it easier to upload documents – are welcome improvements – but it is the timing of the move that is scary. The two-factor authentication is not common practice in Medicaid as far as we know and may create a new hurdle that is very difficult for many to clear, especially for those without multiple devices. Florida is already more than half way through unwinding so why not wait until unwinding is done? What about testing something like two-factor authentication with a small group of users first? Why not require your tech vendor to migrate accounts rather than putting the onus on individuals to navigate the complicated task themselves?”
Big technology transitions rarely go well. Florida’s system is already overloaded — with one of the longest call-center wait times in the country which precipitated a federal warning months ago that the state was out of compliance with federal law on Medicaid renewals. It is scary to think what will happen after December 5th; this is a holiday surprise that the most vulnerable families in Florida do not need.
Whether children become uninsured in large numbers during the Medicaid unwinding process is a result of state choices, and directly reflects Governor’s choices about their well-being. North Carolina just became the second state in the country (after Kentucky) to adopt an option to keep all children enrolled in Medicaid for an additional twelve months to protect them during the unwinding process since most will remain eligible. Florida seems determined to move in the opposite direction and throw fuel on the fire.
