A Land O’ Lakes mom spent numerous hours preventing the state’s determination to revoke her son’s full Medicaid protection, however she began getting solutions solely after she complained to one among her state lawmakers.
Stacia Ennis is a mom of two who devotes her time to driving her 11-year-old son between remedy appointments and physician visits. She ready for months for her enchantment towards the Florida Division of Youngsters and Households’ determination to maneuver her son to a share-of-cost program, requiring the household to tackle $3,678 in medical debt each month earlier than Medicaid protection kicks in.
“I needed to give up my job of 20 years to make a it full-time job to advocate for my son and to ensure that he will get the therapies and medical doctors’ appointments. It was not possible to do with a full-time job,” Ennis mentioned in a cellphone interview with Florida Phoenix.
Her son has a staff of 18 medical doctors and specialists treating his congenital coronary heart defect, cerebral palsy, epilepsy, immune deficiency, autoimmune juvenile arthritis, and lack of imaginative and prescient precipitated throughout mind surgical procedure.
Assist from a lawmaker
On the morning of July 15, Ennis logged onto the digital listening to, prepared to point out information of a whole bunch of her son’s recurring bills that Medicaid beforehand coated. Then, a DCF worker mentioned there had been a change within the case and that her son would get full protection once more, Ennis mentioned.
“I actually really feel just like the factor that set us aside is that I opened up the official inquiry with my consultant,” Ennis mentioned. “I imply, you may even open a congressional inquiry, which I didn’t find out about. However I opened up an official inquiry with my consultant and that obtained me in contact with precise folks.”
The consultant she went to for assist was Pasco Republican Rep. Kevin Steele, and it was one among his aides who approached DCF. Steele was unavailable for an interview due to a loss of life in his household, however Ennis met the lawmaker when she traveled to Tallahassee with a delegation from Tampa Common Hospital to focus on affected person tales in 2023.
Hundreds of thousands of Floridians have handled the lack of Medicaid advantages following the top of steady protection beneath the COVID-19 federal public well being emergency. Folks misplaced protection to various levels. Whereas DCF moved some folks similar to Ennis’ son to the medically needy program, others misplaced protection altogether.
Moreover, errors in the way in which DCF calculated folks’s incomes and their family measurement, that are used to determine if individuals are eligible, based on proof and testimony introduced in a federal class motion final week. On prime of that, the company’s name middle was fully insufficient to the demand for help by way of staffing and the brokers’ information of Medicaid.
DCF blocked more than 700,000 calls in April from people who wanted to speak to a real person
Between Might and June, Ennis herself spent numerous hours on maintain with the DCF attempting to know why the company calculated a share of price virtually as excessive because the household’s $4,264 gross month-to-month earnings. It wasn’t till days after the mom made a plea to Steele’s workplace that a number of DCF workers referred to as her and emailed her to supply updates on her son’s case, based on paperwork obtained by the Phoenix.
Solely then did Ennis spot two errors in DCF’s calculation of the associated fee share: The month-to-month cost listed for the household’s major insurance coverage was $1 as a substitute of $983, and the display confirmed a $0 for recurring medical bills. Nonetheless, Ennis needed to wait three weeks after she introduced up these discrepancies for DCF to reinstate her son’s protection in the course of the listening to.
“Properly, you recognize that’s not correct since you guys have been paying a few of his recurring medical bills since 2019,” Ennis mentioned, referring to her discussions with DCF workers.
Acadia Jacob, advocacy director for Florida Voices for Well being, instructed the Phoenix that lawmakers have served as a invaluable useful resource for Floridians who’ve misplaced Medicaid advantages in the course of the post-COVID redetermination course of.
“There are very hard-working staff members, legislative aides, and legislators who’re making calls to DCF and getting of us related with name middle managers and higher-ups who can assist assess what has gone improper,” Jacob mentioned in a cellphone interview.
However circumstances like Ennis’ present a necessity for extra oversight for DCF, she mentioned.
“I believe they’ve had a extremely highly effective function, they usually do have the potential to maintain holding DCF accountable for guaranteeing that constituents have entry to a high quality well being care program,” Jacob mentioned.
How does the medically needy program work?
A part of what bothers Ennis in regards to the medically needy program is that the company took weeks to evaluate the medical payments she submitted, she mentioned. Households within the medically needy program need to submit their medical payments to DCF each month for Medicaid protection to activate after they meet their share of price.
When the mom referred to as the decision middle to precise her fear that her son would run out of his anti-seizure drugs, an agent instructed her to take her son to the emergency room, Ennis mentioned.
“I’ve to imagine that our policymakers didn’t intend to bankrupt the center class who’ve medically complicated youngsters, as a result of that’s basically what’s going to occur. We simply obtained performed with the infusion at this time,” she mentioned, referring to one of many 4 weekly therapies her son must handle his situation. “If it wasn’t for Medicaid kicking in, that may have been 5 grand.”
