Los expertos en políticas de salud están destacando una multitud de inquietudes con respecto al proceso de redeterminación de Medicaid de Florida, alegando que está dando como resultado una falta de cobertura para niños y familias elegibles.

Durante una convocatoria de medios el martes, los defensores argumentaron que a pesar del plan declarado por el Departamento de Niños y Familias de Florida para manejar la resolución de la emergencia de salud pública, la realidad ha estado marcada por el caos y la confusión.

Los datos oficiales publicados a finales de julio por CMS muestran que en el primer mes después de que terminaron las disposiciones federales de cobertura continua para Medicaid, 249,427 floridianos fueron dados de baja, el 82% de los cuales tenían sus casos cerrados por razones de procedimiento o "burocracia", como la falta de respuesta a un aviso.

Erica Monet Li del Instituto de Política de Florida, dice que el tiempo de espera del centro de llamadas del estado se encuentra entre los peores de los 17 estados que iniciaron redeterminaciones en abril.


"El 48% de las llamadas realizadas al DCF fueron abandonadas y el tiempo medio de espera para un primer contacto fue de 40 minutos antes de ser derivado a otra línea de ayuda," informa Monet.

El Departamento de Niños y Familias de Florida ha publicado una guía en su sitio web, sin embargo, los defensores dicen que algunos enlaces a la asistencia legal no funcionan, la traducción del inglés al español es confusa y necesita mejorías, y dicen que el sitio web debe modernizarse con una opción compatible con dispositivos móviles para facilitar la navegación de los floridanos.

Según los Centros de Servicios de Medicare y Medicaid, todos los estados deben presentar una estrategia para agilizar la reinscripción y reducir las pérdidas de cobertura.

Joan Alker, del Centro para Niños y Familias de Georgetown, señala que un mecanismo denominado renovaciones "ex-parte", destinado a simplificar la verificación basada en los ingresos y las renovaciones automáticas, sólo se está aplicando en Florida en aproximadamente un 19%.

Ella expresa su preocupación por la posibilidad de que los métodos de procesamiento del estado justifiquen una investigación.

"Debido a que Florida tiene una tasa ex-parte baja y una proporción relativamente alta de niños, Florida puede ser uno de los estados que está siendo investigado por este problema y esperamos que la aplicación de CMS lo siga," dice Alker.

Los defensores dicen que es difícil navegar por un proceso tan complejo y piden a los funcionarios de Florida que emitan una pausa en las redeterminaciones hasta que solucionen los problemas o puedan ejecutar adecuadamente el plan del estado.

Lynn Hearn del Florida Health Justice Project, que tiene un tablero en su sitio web para rastrear el proceso de redeterminación, dice que escucha muchas historias de personas que están confundidas acerca de los avisos del estado.

"El aviso tampoco indica claramente como apelar correctamente," subraya Hearn, "las instrucciones de apelación están perdidas en el aviso, después de un aviso de varias páginas, después de una página completa de códigos QR para otros programas potencialmente irrelevantes."

Florida es el único estado que no ha aprovechado las flexibilidades ofrecidas por los Centros de Medicaid que solucionarían problemas comunes, y los grupos instan a los líderes de Florida a centrarse en solucionar los problemas actuales para garantizar que los niños y las familias del estado que reúnen los requisitos no se queden sin la cobertura necesaria.

After more than 50 years of use, some Michigan lawmakers say naloxone may not be the best choice in an overdose situation.

Naloxone is sometimes called the "Lazarus drug" because of its powerful ability to seemingly resurrect people after a drug overdose.

Sen. Kevin Hertel, D-St. Clair Shores, and some of his colleagues have introduced a bill which would open the door for what they say are more costly, but more powerful, antidotes.

"Given the prevalence of fentanyl in our communities, and how much stronger some of these drugs that we're now seeing are, we believe -- and in talking with others -- that there should be other tools to respond to an overdose," Hertel explained. "To make sure we're doing everything we can to save somebody's life."

Not everyone is on board with the proposed legislation, Senate Bill 542. Opponents argued the more expensive naloxone alternatives are not necessary, and using them would only increase profits for the pharmaceutical industry.

Jonathan Stoltman, director of the Opioid Policy Institute in Grand Rapids, said while the naloxone alternatives do help in overdose situations, they can also cause nasty side effects.

"The newer approaches, they put people into more severe withdrawal," Stoltman pointed out. "That's a pretty profound negative side effect. The one approach is very inexpensive and works great; the other approach is far more expensive and has this strong negative side effect."

Sponsors of the bill say they're hoping to give Michigan residents a chance to chime in on the issue in a public hearing sometime in June. Michigan saw more than 3,000 opioid overdose deaths in 2021.


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New Mexico saw record enrollment numbers for the Affordable Care Act this year and is now setting its sights on lowering out-of-pocket costs - those not reimbursed by insurance. More than 56,000 New Mexicans are enrolled in a medical health insurance plan on the state exchange - an increase of 12,000 people overall.

Colin Baillio, deputy superintendent with the state's Office of Insurance, said the state has boosted its outreach and made efforts to improve the overall consumer experience.

"We saw a 40% year-over-year increase, and New Mexico saw the biggest percentage increase during the open-enrollment period among all of the state-based marketplaces," he explained

Part of the enrollment increase is due to what's called the "unwinding" - a federal directive that required all states to redetermine Medicaid eligibility following a three-year pause on checks during the COVID pandemic. He said by using expanded tools made available by the federal and state government, 8% of New Mexico's population is now uninsured - down from 23% in 2010.

Following approval by lawmakers in the 2024 legislative session, the New Mexico governor signed seven health care-related bills into law - one of which requires annual reporting of prescription drug pricing. Baililo said the Affordable Care Act built the foundation that has allowed the state to pursue additional affordability initiatives.

"I'm really glad to see that there's so much interest in the next step of health reform, really leaning into these out-of-pocket cost issues and making it easier for people to afford to stay covered and see their doctors," he continued.

Two years ago, the state also passed a one-of-a-kind law that did away with behavioral health co-pays for people in certain insurance plans.

New York's medical aid-in-dying bill is gaining further support. The Medical Society of the State of New York is supporting the bill. New York's bill allows terminally ill people with only six months to live to use this option, with safeguards requiring two physicians' approval.

The bill's Assembly sponsor Amy Paulin, D-Westchester, said despite the growing support, other hurdles lie ahead.

"Now we have what I believe, if it came to the floor, a majority. There's still a hesitation on the part of leadership. You know, we need members to assure leadership that they no longer have reservations," she said.

Other newly resolved concerns center on making sure insurance companies and doctors who don't support this aren't held liable. She's optimistic the bill will pass after nine years in the Legislature. New York would be the 11th state along with Washington, D.C. to have medical aid in dying legislation.

Corinne Carey, senior New York campaign director with Compassion and Choices finds the pandemic drew a vivid picture of a person's end-of-life experience. There were images of people dying on ventilators, apart from loved ones, and unable to communicate. She said people began thinking about a "good death."

"And, what is a good death is being surrounded by loved ones, having some measure of control, experiencing the touch of your loved ones, and being the one in the driver's seat," she explained.

Now people have different options for end-of-life care, each of which presents various challenges. Polls show medical aid in dying has garnered considerable support since being introduced in 2015. A 2022 Compassion and Choices poll finds 57% of nurses support medical aid in dying professionally, although fewer support it personally.