Legislature eyes changing Medicaid eligibility rules for people with intellectual disabilities

Yahoo

11-06-2025

House Speaker Daniel Perez (R) with House budget chief Rep. Lawrence McClure (L). (Photo by Jay Waagmeester/Florida Phoenix)
Florida could be poised to make it easier for people with developmental and intellectual disabilities (IDD) to maintain their Medicaid services.
The latest round of budget negotiations between the House and Senate includes a proposal by the House to eliminate a requirement for people with IDD to annually be redetermined eligible for the health care safety net program for the poor, elderly, and disabled.
If approved once, they would be presumptively eligible the rest of their lives unless they no longer qualify for Medicaid or their condition changes.
The proposal, if accepted by the Florida Senate, would require approval from the U.S. Centers for Medicare & Medicaid Services to take effect.
'I'd call it a game changer for our population,' Florida Developmental Disabilities Council Executive Director Valerie Breen told the Florida Phoenix Wednesday. The council aims to increase the capacity of individuals with IDD to be included in their communities.
The House health care budget conferees made the offer Tuesday. As of this publication, the budget negotiators had not met again.
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Breen said people with these disabilities face difficulties when they have to be re-determined Medicaid-eligible. She said people with IDD erroneously fell off the Medicaid rolls when, following the end of the public health emergency associated with Covid 19, people had to requalify for Medicaid. Breen guessed that as many as 1,000 people with IDD who were eligible for Medicaid erroneously lost their coverage.
For people with IDD the redetermination process requires the Department of Children and Families (DCF), which determines eligibility, to communicate with the state Agency for Health Care Administration (AHCA), which administers the Medicaid program, and the Agency for Persons with Disabilities (APD), which is charged with oversight of programs that serve these populations. Sometimes, Breen said, redetermination also included interaction with the Social Security Administration.
'Those were the critical components, and the agencies did not communicate with each other,' she said.
As a result people with IDD lost access to the home and community-based services that help them with the activities of daily living like eating and grooming.
'They were not able to access any of those services,' Breen said.
The Legislature was forced to extend the 2025 Session after legislative leadership couldn't reach an agreement on how much state money to spend in state fiscal year 2025-26, which begins July 1, and how much tax relief to provide residents.
House Speaker Daniel Perez and Senate President Ben Albritton ultimately agreed to extend the session until June 16 and to spend about $50 billion in general revenue, or state tax dollars, across various government agencies.
Most of the money will go to two areas: education and health care, with the former receiving more than $22 billion and the latter about $17.5 billion.
Budget negotiators have been meeting to try to hammer out the details of how the money should be spent.
The state budget must be printed and distributed to legislators by June 15 in order to vote on it by June 18. That's because of a constitutional provision that requires the budget to cool off for 72 hours before legislators can vote on it.
New law brings managed care to people with intellectual disabilities
The move to allow people with IDD to remain on Medicaid after initially being determined eligible is one of several proposals relating to people with IDD that are being championed by the House. Perez vowed to make those issues a priority during his two year tenure.
To that end, Perez championed HB 1103, a proposal to make a small managed care pilot program, available statewide for people with IDD. HB 1103 also requires APD to publicly publish reports regarding the number of people with IDD the state serves and the number of people on a wait list for the Medicaid services. Gov. Ron DeSantis has signed the legislation.
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