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  • Writer's pictureTom Cianflone

Are You Prepared for Medicaid Unwinding?

medicaid unwinding redetermination

If you are on Medicaid in Florida, it's important that you are paying attention to the reporting about Medicaid unwinding. What's "unwinding" and how did it get wound to begin with? At the start of the pandemic, Congress passed the Families First Coronavirus Response Act (FFCRA) which provided states with federal funding to continue the Medicaid coverage of individuals enrolled in the program. Since then, Medicaid beneficiaries were able to remain on Medicaid without the annual review of eligibility that was the norm before the pandemic. As a result, since March 2020, approximately a million Floridians who are no longer technically eligible for Medicaid have maintained their health coverage. Under FFCRA, states receiving the increased federal funding were required to maintain this moratorium on terminations until the end of the Public Health Emergency (also referred to as the “PHE”). The Consolidated Appropriations Act (CAA) of December 2022, amended FFCRA to decouple the requirement of continuous Medicaid from the end of the PHE. So, whether or not the PHE is still in effect, the continuous Medicaid coverage requirement will end on March 31, 2023. If you're a Medicaid recipient, you will be getting a Notice of Case Action letter from DCF (Department of Children and Families, the Medicaid agency in Florida) stating whether or not you will continue on Medicaid and at what level. Florida has chosen the ex parte (without representation) method for Medicaid unwinding, meaning the determination will be made by DCF based on whatever income records may be available to them.

Actionable dates in Florida:

  • March, 2023, is the first month unwinding-related renewals are initiated by DCF.

  • May, 2023, is the effective date of first anticipated terminations for procedural reasons. This is generally the first month that members who have not had their eligibility successfully renewed in the past 12 months may be disenrolled for procedural reasons, such as non-response to a renewal form, per CMS guidelines. Terminations for individuals DCF has redetermined as ineligible for Medicaid and CHIP may occur on or after April 1, 2023.

What does this mean for your health care coverage? If you are under 65 and not on Medicare as a result of a disability, you will have a special election period (SEP) to enroll in health insurance on the healthcare exchange marketplace If you are on Medicare and lose Medicaid coverage, you will have an SEP that will allow you to change plans from a Medicare/Medicaid plan (aka, dual special needs plan) to a Medicare only plan. As always, I'm available to help you to shop for and enroll in coverage either for plans or Medicare plans. There are excellent alternatives to plans that may be a better fit for you as well. For now, if you are enrolled in Medicaid, you should take the following steps to ensure DCF has the latest information when determining your case:

  • Apply with the Social Security Adminstration if you are disabled

  • Open an account at ACCESS Florida (the DCF website, link below)

  • Update your address and other information with DCF via the ACCESS portal

For an excellent presentation on Medicaid unwinding and how it affects Floridians, see the video prepared by the Florida Health Justice Project by clicking here.

To create an account with DCF or update your account information, access the DCF website by clicking here.


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