Melissa Black worked hard for most of her life, including 15 years as a pharmacy tech, but she was unable to continue working after suffering a serious car accident and major depression. She was found disabled in 2019. Soon thereafter, Melissa was hit hard by COVID and related respiratory complications and was hospitalized 3 times. She now suffers from long COVID. In spite of her many challenges, Melissa is grateful for life’s blessings–including her adopted teenage son. She is also grateful for the fact that during most of the pandemic she was on Medicaid and had access to the critical care she needed for her health problems.

Like many low-income Floridians who meet Florida’s categorical requirements for Medicaid (i.e. they have a minor child or are disabled) but are over income, Melissa and her husband James are enrolled in the Medically Needy program. People enrolled in the Medically Needy program are assigned a share of cost, which is like a deductible. If they incur medical bills equal to their share of cost, they become eligible for Medicaid on that day and for the rest of that single month.

During the pandemic-related ongoing coverage requirement, Medically Needy enrollees who met their share of cost DURING ONE SINGLE MONTH since March 2020 have remained on full Medicaid every month since. They have not had to meet their share of cost each month to stay on Medicaid. This has been an enormous benefit for people–especially those who, like Melissa, need ongoing health care.

Additionally, when Melissa became eligible for Medicare (which happens 2 years after an individual is found disabled), DCF enrolled her in the Qualified Medicare Beneficiary (QMB) program. QMB is a type of Medicare Savings Program, also called an “MSP.” (More information on all of the MSPs can be found here.

The ongoing coverage requirement ended on March 31, 2023, and over the next 12 months, everyone on Medicaid will need to renew their eligibility under pre-pandemic coverage rules. This includes Medically Needy enrollees who will now have to meet their actual share of cost each month to get on Medicaid.

But even before the end of March 2023, things started going badly for Melissa.

She began receiving confusing notices from her managed care provider saying she was no longer on the required “kind” of Medicaid and needed to find a new managed care company. She also received notices from DCF saying her share of cost was over $2,000. She was being charged copayments for necessary medical visits. She recently had to miss an long overdue appointment with a pulmonologist to treat her long COVID because she could not pay the $20 copayment. Even though all of her bills should have been covered by Medicaid, some have been sent to collections.

“I could tell something was wrong with my health care coverage because I started receiving all these confusing notices and bills, but I couldn’t figure out what had happened and couldn’t reach anyone from DCF on the phone,” Melissa explained. “But I don’t give up!” she added. “Now I worry about the hundreds of thousands of people who are going to have no idea what happened to the health care coverage they’ve had since the pandemic began.”

Melissa reached out to the Florida Health Justice Project (FHJP), and we worked together to decipher her confusing situation and notices and make sure that she’s back on full coverage. She is now re-enrolled with her old managed care company which confirmed she is on Medicaid; and with FHJP’s guidance she will begin the process of recouping her out-of-pocket costs which should have been covered by QMB.