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    St. Lucie County, FL


    After a series of incomprehensible notices incorrectly ending her children’s health coverage, Kirsten’s kids are finally back on Medicaid. But fixing the problem was incredibly time-consuming, and Kirsten is afraid it could happen again. 

  • Kirsten’s 2 minor children have been on Medicaid for over 10 years. This is a critically important benefit for the children, especially the 10-year-old who is on the autism spectrum. The family’s income varies, as Kirsten and her husband work in the local school system and are routinely laid off in the summer when their income is well below the federal poverty level.


    Kirsten knew about the end of the pandemic-related moratorium on Medicaid redeterminations and terminations, and she timely responded to DCF’s request for renewal in March 2023.


    But, Kirsten, like others, was unable to renew or make changes to her ACCESS account due to an account glitch. Instead, she was forced to miss work and go in person to her local DCF offices to renew multiple times.


    Then the notice confusion started.


    The first notice, dated May 26 stated her daughters did not qualify for Medicaid. The reason given was: “YOU ARE RECEIVING THE SAME TYPE OF ASSISTANCE FROM ANOTHER PROGRAM.” This reason made no sense. They had no such assistance. The notice said they were Medically Needy with a share of cost (like a deductible) that was more than their income, over $3986.00. Also confusing, the notice stated that her 16-year-old daughter would be on the Medicaid family planning waiver. But this is a program that only provides birth control-related services and makes no sense for a minor child who is eligible for full Medicaid.


    The second notice, also dated May 26 stated that they were not eligible for Medically Needy. That reason: YOU ARE RECEIVING THE SAME TYPE OF ASSISTANCE FROM ANOTHER PROGRAM.


    The third notice, dated June 12, 2023, informed her that both children would lose Medicaid as of June 30, 2023. The reason given this time was “YOUR HOUSEHOLD'S INCOME IS TOO HIGH TO QUALIFY FOR THIS PROGRAM. But the notice did not say what DCF thought the family income was or what the income limit is for minor children in a household of 4. If it had provided that key information, she would have been able to immediately see that the termination of her kids’ Medicaid was wrong because the family income was way below the relevant limit, $3450 for a household of 4. (see Household income limits for Medicaid.) The notice further confused her by stating that their share of cost increased to nearly $5500 and “Account Transfer to Florida Healthy Kids/Federally Facilitated Marketplace.”


    As a result of these confusing and notices and incorrect terminations, Kirsten enrolled her kids in KidCare. But she had to pay a premium (while Medicaid has no cost-sharing), and there was also a lag time, leaving the children uninsured for the month of July. Both daughters missed their dentist visits and Kirsten’s youngest missed a very important neurology appointment. Even worse, the children got Strep Throat and Kirsten had to take them to the emergency room as she had no coverage. “I totally understand that taking my kids to the emergency room for strep throat is not in anyone’s best interests,” said Kirsten, “ but I had no choice. Without coverage, that’s the only place I could take the kids for treatment.” Kirsten is now anxiously awaiting the bill from the hospital.


    And while the July ER bill should be covered because children are entitled to retroactive coverage, this illustrates how incorrect terminations result in either people going without necessary care–or getting care in the ER at huge expense.


    Finally in August, after over 4 hours on the phone over multiple times, Kirsten was able to get her ACCESS account corrected. On August 3rd, she received a new notice stating that both children were back on Medicaid.

    “I don't know what to do! The girls lost Medicaid and their dentist appointments were canceled, said Kirsten. “They have to wait over 6 months for a new one. Although DCF is now saying they are back on, I hope they still

    have coverage then. But I am so confused!

  • Though grateful for her kids finally getting back on Medicaid, Kirsten is understandably confused and concerned. Her notices were inconsistent and incomprehensible and her kids erroneously got kicked off the program and went a month without insurance. She had to go through all the hassle of finding providers who take KidCare only to be switched back to Medicaid. And she fears that the same thing will happen again.


    *Kirsten is a pseudonym of a Florida resident who wanted to share her story without using her real name 

    **Stock Photo

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  • We are grateful to the National Health Law Program (NHeLP) for their support of the

    "Medicaid | The Lived Experience" STORIES Project.

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