7 Devastating problems Florida Medicaid recipients are facing right now

In this article, I'll share honest practical solutions to 7 main problems effecting Medicaid Florida recipients today. Thank you for being here and taking interest in this article. The Medicaid community is often over-looked or not thought of as a priority. As a result, fixing obvious issues are not always at the top of the list. If you find this article to be insightful, please consider subscribing for policy updates at the bottom of any page of this website. Ok, let's dive right in.

Problems Medicaid Recipients are facing in 2026

1) People Are Losing Coverage During Redeterminations

• After the COVID continuous-enrollment protections ended, Florida restarted regular eligibility checks. As a result, hundreds of thousands of people — including many children — have been disenrolled, often not because they weren’t eligible but due to administrative or procedural issues like lost letters or portal failures.

Solution

a. Pause or slow down redeterminations

Advocates urge Florida to temporarily halt or slow the eligibility reviews until technical and staffing problems are fixed to prevent inappropriate terminations. This would preserve coverage for eligible people while issues are resolved.

b. Accept federal CMS waivers to reduce red tape

CMS waivers could allow Florida to simplify renewal steps, reduce procedural denials, and use alternative verification methods so people aren’t dropped for missing minor paperwork.

c. Expand outreach and clear communication

Improve notifications (mail, email, text), increase multilingual notices, and ensure households understand deadlines. Recommendations include extending account closure notices from 10 days to 30 days to give families more time to respond.

Redetermination Information.pdf

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2) Major Problems With the MyACCESS Portal and Call Center

• A new online portal for Medicaid (and SNAP) has had glitches that block benefit renewals and applications, leading to people losing coverage or having eligibility wrongly denied.

  
  

• Spanish-speaking families face very long wait times, frequent disconnections, and language support failures when calling for help.

Solution

a. Redesign or overhaul the MyACCESS system

The portal needs to be reliable, mobile-friendly, and accessible for people without advanced digital skills. Many terminations stem from login and notification failures.

b. Integrate systems across agencies

Applications and renewals should flow between DCF, AHCA, and federal databases so that applicants don’t have to submit the same information multiple times.

Cómo solicitar Medicaid en Florida.pdf

Download PDF • 109KB

3) Administrative and Bureaucratic Barriers

• Recipients report being wrongly denied Medicaid due to clerical errors (e.g., income recorded incorrectly, assets miscounted) and then struggling for weeks or months to fix it. (These patterns show up in multiple firsthand accounts.)

• People waiting for renewals often have no coverage during the processing delay, even for urgent health needs like prenatal care.

Solution

a. Audit and quality-control workflows

Regular audits of eligibility decisions can catch errors before coverage is lost. This includes checking that income and asset data are correctly entered.

b. Delay procedural terminations while outreach is underway

Instead of immediate cuts for missing paperwork, hold coverage open short-term and provide intensive follow-up to help families comply.

4) Limited Access to Care Despite “Coverage”

• Even when enrolled, many recipients can’t find providers who accept Medicaid because reimbursement rates are low and networks are weak. This especially affects specialty care, mental health services, and pediatric care.

Solution

a. Improve provider payment rates and network adequacy

Raise Medicaid reimbursement rates to encourage more doctors, specialists, and mental health providers to see Medicaid patients. (Recommended by health policy advocates nationally, and evident in access reporting.)

b. Expand telehealth and digital support

Support equitable telehealth access with broadband and devices so recipients can use virtual appointments or portal support.

5) Waiting Lists for Medicaid Long-Term Support Services

• People who need home- and community-based long-term care often face long waiting lists due to workforce shortages and capped program slots.

Solution

a. Revisit Medicaid expansion or alternatives

Florida is blocked from expansion until at least 2028 under current ballot law and political conditions. However, policymakers could pursue targeted programs to cover near-poor adults to avoid coverage gaps.

b. Improve long-term services and workforce capacity

Invest in community care, home health staffing, and support services for aging and disabled populations to reduce pressure on institutional care.

6) Managed Care Transitions Create Disruptions

• Florida is transitioning major parts of its Medicaid managed-care contracts. Such transitions historically cause disruptions in continuity of care, provider authorizations, and pharmacy access.

Solution

• Active referrals, authorizations and ongoing treatments are temporarily honored when a member moves to a new plan, even if the provider isn’t initially in the new plan’s network.

• Plans are required to cover care for a defined period (e.g., 60–90 days) while new authorizations and network arrangements are put in place

• Pre-transition data sharing so new plans have up-to-date service and authorization information on enrollees.

• Dedicated transition teams to coordinate care plans between old and new plans and resolve disputes efficiently.

• Case managers assigned to oversee the switch.

• Advance notification to members about how their care will be managed.

• Priority outreach to ensure necessary medications and specialty care continue without interruption.

• Monitor performance indicators tied to continuity metrics (e.g., timely authorizations, provider network access).

• Impose penalties or corrective action plans if plans fail to meet continuity standards.

7) Broader Policy & Funding Pressures

• Proposed federal cuts to Medicaid and political resistance to expanding Medicaid to more low-income adults threaten future access and financial stability of the program.

Solution

• Expansion would bring significant federal dollars into Florida (potentially ~$3 billion or more under incentives like the American Rescue Plan) that help offset state costs and improve access.

• Expanding coverage reduces uncompensated care costs on hospitals and improves preventive care use, leading to lower long-term costs. (National evidence across states shows this effect.)

• Florida’s current ballot initiative for expansion has been delayed until 2028 due to new state law restrictions.

• Solutions: legal challenges to restrictive ballot initiative laws, legislative action to pass expansion directly, or targeted waiver approaches to cover near-poor adults.

• Aggressively pursue federal funds (e.g., Rural Health Transformation Program) to build provider capacity and health infrastructure without relying solely on state general revenue.

• Use Section 1115 waivers to innovate in care delivery and funding flexibility, such as covering additional services or populations that reduce costly emergency care. (Waivers must remain budget-neutral.)

• Strengthen actuarial accuracy and multi-year Medicaid spending forecasts to avoid mid-year shortfalls and reduce disruptive budget cuts.

Core Takeaway: Florida Medicaid recipients are not just dealing with eligibility rules — most of the current trouble stems from bureaucratic and technical failures (portal errors, call center bottlenecks, administrative churn) that cause people to lose or be denied coverage unfairly, compounded by access barriers once they do have insurance.

Summary:

The combination of administrative reforms (simplify renewals, reduce procedural churn), technology improvements (reliable portal and integrated systems), expanded support (call centers and navigators), and policy actions (waivers, network enhancements, and possible coverage expansions) would significantly reduce coverage loss and improve access. These are the core ways experts and advocates propose to address the systemic issues Florida Medicaid recipients face.

Disclaimer

This information was provided by the Agency for Healthcare Administration (AHCA). The "Ask Medicaid Florida" website is intended for informational purposes only. "Ask Medicaid Florida" is not associated with any state agency including Medicaid Florida. Find all AHCA archived alerts here. Please feel free to read our full disclaimer here. If you have received this message in error, please immediately notify us at info@askmedicaidflorida.com and delete the original message. We regret any inconvenience and appreciate your cooperation.