Ronald and Steve
Florida
"Glitch" causes panic for long-term care Medicaid enrollees and caregivers.
Ronald was born with mental disabilities and limited function. He has never worked and has required care throughout his life. Now 80 years old, Ronald suffers from seizures and other complex health issues. Based on his low income and profound need for assistance, he is enrolled in a Medicaid managed care plan that provides services through Florida's Medicaid Long Term Care Program. One of those services includes payment to the assisted living facility (ALF) where Ronald now resides.
While life has been very difficult for Ronald, he is fortunate to have a dedicated advocate. Nearly 10 years ago, he crossed paths with Steve, who at the time worked for a non-profit that helped vulnerable people with housing. Steve later became Ronald's care manager and dedicated advocate.
A week before Christmas in 2023, the ALF called Steve with some shocking news. DCF had sent a notice to Ronald’s ALF stating that his LTC benefit would no longer be covered by Medicaid. Steve vividly remembers the caller saying: “I have a very important piece of mail here and you need to pay attention to this: He is being terminated from Medicaid!”
The ALF told Steve that when Ronald’s Medicaid ends, they would be forced to give a 45-day notice and then he would be evicted–even though that meant he would be put on the street. Steve said, “You can’t do that, he'll die!” The ALF representative said Steve needed to take care of this and suggested he try to call DCF and AHCA (Florida’s Medicaid Agency).
“I tried to call DCF and AHCA, and was on hold for hours. It was an absolute nightmare. I’d wait for hours and suddenly a recording says: ‘Please call back. We are experiencing heavy call volumes. Click.’ I only got through one time! Finally, I got hold of someone. But they had no clue I was his POA/MPOA even though I submitted these documents years ago, and they would not tell me anything.”
Unable to get any answers about why Ronalid’s Medicaid was being terminated, Steve sent all the documents required to prove Ronald’s Medicaid eligibility as well as proof of Steve having POA/ MPOA to DCF via certified mail and fax. He still received no response from DCF or Medicaid, and contacted Florida Health Justice Project (FHJP) right before Christmas.
FHJP explained that the managed care plan has a duty to assist enrollees with redetermination according to the contract it has with the Medicaid Agency, and suggested that Steve contact Ronald’s case manager at the plan. Steve immediately did so, and the case manager informed him that Ronald’s Medicaid had been reinstated. According to the case manager, there was a “glitch in the system” and a number of enrollees, including Ronald, had been accidentally terminated.
While Steve was immensely relieved, he was also understandably upset and concerned about what happened. He spent days in a “panicked frenzy”--unable to obtain any information from the state agencies responsible for managing the Medicaid programs for vulnerable Floridians, and worried that Ronald would end up on the street.
“There need to be safeguards in place so that vulnerable senior citizens like Ronald don't erroneously get cut off of Medicaid, and the people who are managing their care can more easily help resolve state ‘glitches!’”
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