Florida’s Deloitte-run computer system cut off new moms entitled to Medicaid – Tampa Bay Times

In mid-May, Mandy Locks, who has a 3-month-old baby, received a letter from a Florida government agency warning that both children would be removed from Medicaid, a health insurance program for people with low incomes and disabilities. It has arrived.

under Florida law passed in 2021Rokx was supposed to have continued coverage for 12 months after giving birth. But a letter from the Florida Department of Children and Families said their coverage would end May 31.

Description: “Medicaid renewal could not be completed or completed.”

Locks said she doesn't understand why the state would cut coverage. She provided everything asked, she said.

She worried about what losing Medicaid would mean for her daughter, Vernita. Rocks said she initially paid for the infant's medical exam out of pocket after insurance coverage ended. So she turned to free health fairs held once a month. local nonprofit organizations Near my home in Melrose, Florida.

“I just hope she doesn't get sick,” she said.

An unknown number of mothers who were eligible for Medicaid coverage in Florida suddenly lost their Medicaid coverage after giving birth, according to an ongoing federal lawsuit filed against the state in August 2023. It is. The issue relates to the state's computer certification system, which is run by Deloitte Consulting. According to trial testimony from state and Deloitte officials. There's still one more example problem States and beneficiaries are encountering a Medicaid management system run by the consulting giant Deloitte.

As of July, Florida had signed contracts worth more than $100 million with global companies to modernize, operate, and maintain the state's unified eligibility system for Medicaid and other benefits.

Deloitte did not respond to a request for comment about its Florida efforts.

A total of 25 states have contracted Deloitte's Eligibility Systems, making the company a dominant player in this important part of government business. These contracts, which commit Deloitte to design, develop and operate state-owned systems, are worth at least $6 billion, according to an analysis of state contracts by KFF Health News.

The KFF investigation revealed that Error in qualification system operated by Deloitte Fixing it could cost millions of dollars and take years, while denying benefits such as health insurance to eligible individuals.

As a result of the investigation, Deloitte spokeswoman Karen Walsh said: The company's clients, state governments, have noted that “large-scale systems are difficult to implement due to the complexity of the programs they support, and that all IT systems require ongoing maintenance, software and hardware We understand that regular enhancements and upgrades and database management are required.

Pennsylvania Senate Democrat John Fetterman, one of Deloitte's state clients, takes a much different view. “Let’s call it a racket,” he said. “This is not a random glitch. It's a pattern of system-wide failure. And the worst part? We're paying them billions of dollars to do it.”

In July, Kimber Taylor of Jacksonville and Lily Mesquita of Orlando She testified in federal court in Florida that state officials removed her from Medicaid even though she was eligible because of her pregnancy. The class action lawsuit alleges that Florida failed to properly explain to Medicaid enrollees the reasons for discontinuing their health insurance or that they could appeal the decision before losing coverage.

The state of Florida denies the charges in court filings. But the case revealed problems with the computer system the state uses to determine Medicaid eligibility and notify people when they are no longer eligible. Deloitte did not respond to questions about the case, which is pending a judge's decision.

Deloitte is not named as a defendant in the lawsuit, but employees were called to testify about the company's role in administering Florida's entitlement system. Harikumar Karmkar, a Deloitte managing director in charge of Florida's system, said “deficiencies” may have led to the loss of coverage for new mothers.

William Roberts, a state official who reviews Medicaid eligibility decisions, also testified that the agency learned in April 2023 of a “glitch” that would cut off postpartum coverage for eligible new mothers. That same month, Florida began a Medicaid eligibility review process known as “rewind.” ”, which all states implemented after pandemic-era insurance coverage protections ended in March of that year. Karamkar testified that Deloitte resolved the issue by April or May 2024.

Despite this, coverage of The Rocks was discontinued on May 31st.

During mitigation, Florida stripped nearly 2 million people from Medicaid, including children, according to the Centers for Medicare and Medicaid Services.

Patient advocates say a flaw in Florida's Deloitte computer system denied some of the state's most vulnerable residents the care they deserved.

“Florida's Medicaid officials knew from the beginning of the mitigation period that Florida's system was not handling pregnancy and postpartum Medicaid correctly, and they pushed ahead with all their might.” Lin Hahnan attorney with the Florida Health Justice Project. The Florida Health Justice Project is a nonprofit legal aid and advocacy organization that represents class action plaintiffs in collaboration with the National Health Law Program. “To this day, we don't know if the problem has been completely fixed. Mothers in this state deserve more from the government.”

Medicaid is the largest insurance payer for births in Florida, covering nearly 98,000 births, or 44% of all births, in 2022, according to the state Department of Health. But it's unclear how many mothers were excluded from the Medicaid coverage they were entitled to. On Sept. 9, the Florida Department of Children and Families cashed a check from KFF Health News to cover the cost of processing requested records for eligible mothers whose enrollments were revoked. As of Nov. 22, the state had not released the records.

The state provided estimates during the trial, but those numbers were not available from the state to KFF Health News. In their court filing, the plaintiffs cited state estimates showing that 19,802 women were excluded from pregnancy insurance coverage as of March 2024, one year after Florida began its relaxations. It's unclear how many of these women accidentally lost their insurance. This number is probably a conservative estimate and does not include people who were excluded due to administrative issues.

Mallory McManus, deputy chief of staff for the Department of Children and Families, told KFF Health News that after identifying the issue, agency officials “manually remediated the case until the necessary system updates were implemented.” Ta. She added that the ministry had also reviewed the system “to ensure there are no gaps in coverage.”

McManus said Floridians who were disenrolled from Medicaid were “appropriately recognized and provided with information to pursue an appeal.”

Locks, Taylor, and Mesquita sought help from the Florida Health Justice Project and eventually regained Medicaid coverage. Local lawyers said they can often recover compensation for affected people by contacting police directly. General Counsel for State Government Agencies — a street unknown to most Floridians.

While the class action lawsuit awaits a verdict, the issues uncovered in the trial are likely to be brought to light by Deloitte in states such as Arkansas, Colorado, Florida, Georgia, Kentucky, Michigan, Pennsylvania, Rhode Island, and Tennessee. It's the same problem encountered in other states with managed Medicaid eligibility systems. And Texas.

In Texas, according to some information, July report According to the U.S. General Accounting Office, “approximately 100,000 eligible women had their registration canceled due to errors in the eligibility system,” including the denial of postpartum benefits to some eligible women.

The error-plagued system and widespread denial of Medicaid to eligible people has drawn the attention of lawmakers on congressional committees that oversee social programs. They blame state leaders, who they say are not holding vendors like Deloitte accountable.

“Multiple mistakes reward contractors with longer billing times and higher payouts,” said Rep. Lloyd Doggett (D-Texas). “This is an amazing and unacceptable waste of taxpayers' money.”

Sen. Ron Wyden (D-Ore.), chairman of the Senate Finance Committee, which oversees Medicaid, said too many people “can't even get through the front door because of an outdated and inaccurate eligibility system.” Ta.

Additionally, Rep. Kathy Castor (D-Fla.) said, “Florida has a pattern of trying to keep families off Medicaid or inappropriately terminating families.''

“It seems intentional,” she said, “and I think it clearly is.”

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KFF Health News is a national news station that produces in-depth journalism about health issues. Along with policy analysis and polling, KFF Health News is one of KFF Health News' three main operating programs. KFF. KFF is a nonprofit nonprofit organization that provides information about health issues to the public.