POSSIBLE MEDICAID NIGHTMARE

declines to renew the coverage automatically, the recipient will receive a notice to reapply.

An estimated 900,000 Floridians will lose coverage in April due to their incomes being above the threshold, according to Casey Penn, DCF assistant secretary for economic self-sufficiency. Those will be the first recipients re -

The state divides recipients into seven groups based on age and health conditions and determines eligibility by annual income for a family of four in relation to the federal poverty level. For example, one group comprises home and community-based services, nursing homes and hospice. The eligibility threshold for that group is an annual income of $61,608 with a

The next group reviewed by DCF for eligibility will be about 850,000 recipients who have not responded to information requests or used Medicaid benefits in the past year. The review for the remaining recipients will come on their next regularly scheduled renewal date. Children with significant medical issues and other vulnerable populations will be the last group. All reviews will be completed by April 2024.

Community Health, Lakeview and other providers are scrambling to re-enroll their Medicaid recipients or find them other programs. Community Health CEO Chandra Smiley said a minimum of three employees would be hired to

"We're kind of expecting a 3-4 percent hit initially, but with our patient base and their understanding of the re-enrollment process, are they going to get the letter and enroll in time?" Smiley said. "I expect us to be hit more than (3-4 percent) by people not following through with the process."

By Tom St. Myer

Millions of Floridians will scramble to reenroll in Medicaid or find alternative options as federal funding dries up and the state prepares to return to pre-pandemic eligibility standards. Health care providers will potentially be financially impacted, too, with a decline in revenue generated from Medicaid recipients.

Medicaid is a federal program that partners with states to provide health care coverage to low-income children, families, elders and people with disabilities. A significant number of Medicaid recipients live in Escambia County—25.1% of all residents in 2021, topping the state average by about three percentage points.

Community Health of Northwest Florida CEO Chandra Smiley said 93,000 of its patients, roughly 60%, receive Medicaid coverage. LifeView Group CEO Allison Hill said Lakeview has 9,800 active patients covered by Medicaid, and about 4,000 are children.

"Many of our severe and persistent mentally ill clients qualify for Medicaid," Hill said, "and it's critical for most to keep their insurance so they can receive services, like seeing their doctor and getting their medication."

Vanishing Coverage

The number of Floridians enrolled in Medicaid increased by over 40% over the past three years. In March 2020, the Families First Coronavirus Response Act provided states with additional federal funding for continuous Medicaid coverage. The state promised not to drop anyone to keep the federal dollars, and the Florida program grew from nearly 3.8 million beneficiaries pre-COVID to over 5.6 million, a 49.1% enrollment increase.

But the continuous coverage requirement ends March 31, which spells trouble for everyone involved in the system. The federal government funds a significant portion of Medicaid's $36 billion budget in Florida, and the CARES Act provided a 6.2 percentage point increase in federal Medicaid matching funds. The 6% amount will decrease to 5% in April, down to 2.5% in June, 1% in October and will be eliminated on Jan. 1, 2024.

The Department of Children and Families (DCF) will review the Medicaid eligibility of nearly five million Floridians as the state reduces the number of recipients closer to the prepandemic 3.8 million. If DCF determines a recipient is still eligible, the agency will renew the coverage and send an approval letter. If DCF

Community Health's investment in new staff is well worth the cost if it mitigates the number of Medicaid recipients lost. Chief Financial Officer Jason Brewster said a 3% decrease in patients covered by Medicaid would cost Community Health over $1 million in lost revenue. An uninsured patient pays about $5, and Medicaid pays the remaining $145.

"If we lose 3,000 Medicaid visits, that's about a $400,000 cash-in-our-pocket loss," Brewster said. "But the part that's not included in that is if patients need X-rays or labs or any of the other things normally paid by Medicaid, we're going to need to pay that again."

Avoiding Disaster

Brewster advised Medicaid recipients to make sure their address is current. DCF will mail the letter about Medicaid re-enrollment to whatever address is on file. DCF's Florida Medicaid Redetermination Plan advises recipients to ensure their address is current through DCF virtual assistance or by signing into their accounts.

Other recommendations by DCF include recipients checking their redetermination date after Feb.28, providing a text number on their MyACCESS account to be reminded when redetermination is due and watching for a yellowstripe envelope that tells when renewal is due.

DCF advises recipients to review and apply for other coverage options if ineligible and consider Florida Healthy Kids for children.

DCF warns Medicaid recipients not to ignore a redetermination notice, file a new application before their redetermination date or forget to include any household members on the application. Recipients who lose coverage will be referred to alternatives, including Florida KidCare, the Medically Needy Program, federally qualified health centers, federally subsidized health programs and commercial coverage.

"There are a lot of alternatives for those right above the Medicaid level, but you really need to seek it out," Smiley said.

Florida Health Justice Project Executive Director Alison Yager voiced concern about a potential lapse in coverage for children across the state. She said Medicaid coverage served as a "critical lifeline" for children during the pandemic, and Medicaid serves about 54% of children in the state.

"For kids who have ongoing medical conditions, even one month without coverage could be terribly detrimental to that child's health and that family's finances," she said.

Health & Hope Clinic is an option for those in the Pensacola area who lose Medicaid and experience a lapse in coverage. The clinic provides accessible primary and preventive health care to the uninsured and medically underserved.

Health & Hope Executive Director Sally Bergosh is ramping up her recruitment of doctors for another possible increase in patients. The clinic tripled in patients during the pandemic and remains at that level.

"It hasn't slowed down,' Bergosh said. "We have 1,400 unique patients who would otherwise go to the ER for basic primary care."

Hill said Lakeview would utilize every measure possible to ensure patients maintain coverage. She noted this is nothing new for health care providers. Before COVID, Medicaid recertification occurred on an annual or bi-annual basis. Hill said Lakeview would provide recipients stepby-step directions on how to recertify and post notices in its outpatient areas reminding them of the upcoming re-enrollment period.

"If they need support from case management or their service provider, then we can provide guidance," Hill said. "Many times, we are asked to provide documentation to support the client's recertification, which we do with the client's permission.

She added, "Unfortunately, Medicaid eligibility is something that does change for individuals, so keeping up with the required paperwork and asking their caregivers for support with the process is critical." {in}

Uwf Students Join Protest

Last week, University of West Florida students joined with thousands on high school and college campuses across the state in protesting Gov. Ron DeSantis's education policies with a walkout. The statewide protest comes as the governor has dug deep into culture-war issues, among them reshaping public education in a way critics consider dangerous.

Although the walkout showing at UWF was small compared to other campuses around the state, a collection of students did gather in front of the John C. Pace Library on Cannon Green to raise awareness and sound the alarm bells about DeSantis's moves when it comes to education.

"We want to give voices to those who are kind of in fear of speaking out," said Laylah Curran, part of the leadership team of UWF's Student for Socialism chapter, sponsoring the local event.

Among the concerns of the students participating in the Feb. 23 protest against Gov. DeSantis is a fear the governor is targeting people of color and those in the LGBTQ+ community with repressive measures. In addition to the passage of the Stop Woke Act that limits the discussion of sexual orientation and gender identity in schools and workplaces, the governor also has public schools culled of books that pertain to issues of race, sexuality or gender and has ordered colleges to provide data on the gender-affirming care provided to students.

Off to the side of the protest, Sarah Brummet, a member of the Party of Socialism and Liberation, relayed how her work as a substitute teacher has provided some unique insight into how schools have adjusted to new state laws and teachers' worries about getting in trouble or even sued for teaching material found to be out of line with the state's evolving standards.

"I am an employee of the public school system," Brummet said, "and I'm seeing firsthand that teachers are fearful."

Brummet thinks that DeSantis' moves are meant to divide and distract and "really convince us that there's something wrong with LGBTQ people, that there's something wrong with under- standing Black history and that our schools are indoctrination camps."

As students began to pause on the green and listen, one speaker after the next took to a microphone on the library steps and talked about why they disagreed with the governor's moves. They spoke about "racists, bigoted attacks on our schools" and how "teachers are scraping rainbow stickers off their cars."

"Is that the kind of country we want to live in?" said Chiara, president of UWF's Young Democratic Socialist of America chapter. "When they say 'woke,' they mean queer. When they say 'woke,' they mean Black."

REDO SUPERINTENDENT Ellen Odom, the general counsel for the Escambia County School Board, has notified the Escambia County Commission that District 1 School Board member Kevin Adams has announced his intention to present a resolution to the School Board at its March 21 meeting to request a referendum to revert to an elected superintendent.

Escambia voters approved a referendum switching from elected to appointed in November 2018, 62,418-61,508. Quint Studer led the charge, with D.C. Reeves managing the pro-appointed initiative. Walker Wilson, former president of Pensacola Young Professionals, rallied his organization to work the polls in favor of the change.

The School Board and the County Commission will both have to pass resolutions asking the state legislature to put a referendum on the Presidential Preference Primary ballot on March 19, 2024.

The Presidential Preference primaries have a much lower turnout than the general election.

The 2020 Presidential Preference Primary only had 53,605 votes cast, while the 2018 November general election had 123,926 people vote on the referendum.

Wilson told Inweekly that he opposed holding the referendum during a primary. "I wholeheartedly disagree that the right time to ask this question is during a presidential primary election when you see way less voter turnout. If you're going to ask this question again, it needs to be on that gen- eral election ballot like we saw before, and let as many folks in our community be able to weigh in on this issue."

STATE BUDGET The state budget is growing as rapidly as the population in Florida. But what happens when the growth finally slows down?

Florida TaxWatch Executive Director Tony Carvajal spoke on that topic and dozens of others related to the budget on Friday, Feb. 24, at the Greater Pensacola Chamber Legislative Luncheon. Carvajal offered his expertise from 36 years of strategic planning, nonprofit management and business leadership.

The Florida economy is booming as the population continues to skyrocket. Florida is the fastest-growing state in the country with an average growth of over 900 people per day, and its economy is the 15th largest in the world. Sales tax is the primary revenue source at $28 billion. Next is motor fuel taxes at $2.8 billion.

"For 29 straight months, (our economy) has been growing, and it's not just regular growth," Carvajal said. "We have been growing faster than the estimates of the smart people who say, 'This is what our target is.' They have adjusted it five different times, and we're still exceeding (estimates)."

To align with that economic growth, Gov. Ron DeSantis is proposing a $114.8 billion budget this legislative session. That is an increase of almost $5 billion from last year and about $45 billion from just 10 years ago.

"Where does this normalize?" Carvajal said. "It's great to have a growing economy but not necessarily a growing state budget. If we are not careful when the days of reckoning come in, we have to worry about how we balance that out."

Carvajal explained how the money is budgeted. He said health and human services account for about half of the budget and that Medicaid alone is about one-third of the expenditures. Another quarter of the budget is devoted to education. He noted the budget calls for an increase in the level of reserves from $12 billion to about $15.7 billion.

The proposed budget includes about $2 billion in tax cuts. Permanent reductions include baby and toddler necessities, gas stoves and overthe-counter pet medicines. One-year reductions include children's books, toys and athletic equipment, oral and dental hygiene, cosmetics and toiletries, household items for less than $25, ENERGY STAR appliances, and pet foods.

"These are not just giveaways," Carvajal said. "These are ways we can get dollars back in consumers' hands, and each of you is probably touched directly or directly by some of these things."

Any form of tax relief will be welcomed by the hundreds of thousands of Floridians who barely earn enough to pay for housing. Carvajal said the state under-invested in the building of houses over a 10-year period and the proposed budget incentivizes rehabilitation of properties and expansion of workforce housing.

"There are more than 825,000 people in this state right now who are burdened with housing issues," he said. "That means they're either paying way too much on a day-to-day basis or they don't have a place to live."

EDUCATION & TRANSPORTATION

At his Feb. 21 presser, Pensacola Mayor D.C. Reeves touched on education and transportation. He said the recent $1.7 million grant from the Escambia Children's Trust would be used for after-school programs.

"That'll allow us to offer some after-school programs for our city children at no cost for families who qualify for free or reduced lunch," Reeves said. "The city can do more to be an active participant in our children's education for city residents. We're excited about that."

The mayor shared that he has begun meeting regional leaders about restoring Amtrak to passenger rail service to Pensacola. On Friday, Feb. 17, he had a conference call with 30 people ranging from public officials to train operators. "Really, just to say, 'Hey, guys, we're here to help take the baton, and let's just move it another inch forward, another foot forward,' and that's what we're going to do."

The city faces a March 23 deadline to apply for a $500,000 Federal Railroad Administration grant. The grant would be used to assess the potential for restoring service to the area.

This isn't the first time local and regional officials have looked at the possibility of restoring passenger rail service to routes long abandoned. But this time is different. Now, stressed Reeves, money is being put on the table.

"If we get to a point where it doesn't make sense for the city of Pensacola, then that's OK," the mayor said, "but this is the time to look at it now, with all of this federal money coming down and the federal government looking to expand service, really, significantly, on their dime."

DISAPPOINTMENT Escambia County Commissioner Lumon May is disappointed that the $5.1 million handed out by the Escambia Children's Trust in February didn't focus on the children living in pockets of poverty. He believes the staff and application review committee tried to spread the money around the county.

"I've said this multiple times that it's very unfortunate that the children in the inner city and the urban core were used on all the propaganda material to get this tax passed," he said on WCOA. "Overwhelmingly, it was supported by people living in these pockets of poverty—32501, 32053, 32505—because they had lost hope and needed an opportunity."

Commissioner May continued, "I think we want to help all children of Escambia County, but we must be laser-focused on designated areas. I certainly think that the emphasis should have been put on those utilized to get the tax passed and those in the greatest need."

According to the gap analysis done by the UWF Haas Center for the Florida Chamber, the ZIP codes 32501 and 32505 have 2,880 children under the age of 12 living in poverty. Three of the five elementary schools serving those children are among the lowest-performing elementary schools in the entire state—Global Learning, Montclair and Oakcrest.

It's not difficult to understand Commissioner May's disappointment.

TIP OF THE SPEAR The City of Pensacola, Escambia County and ST Engineering held a ribboncutting ceremony for the aviation company's second hangar for maintenance, repair and overhaul at the Pensacola International Airport on Monday, Feb. 27.

Former Mayor Grover Robinson told Inweekly that the training program that ST Engineering and Pensacola State College are developing would make Pensacola a worldwide leader in aviation mechanics. He said, "If you want to become involved in aviation on the mechanical side, you're going to come to Pensacola, Florida and attend Pensacola State. This really sets Pensacola decades in the future for being a place that people want to come."

Robinson continued, "If you are the leader in education and establishing the talent, the jobs will find you. I think the ST Engineering MRO campus puts us at the tip of the spear for talent in aviation."

MENTAL HEALTH OF TEEN GIRLS According to new CDC data released last month, nearly three in five U.S. teen girls felt persistently sad or hopeless in 2021, double that of boys. Almost a third of female teens seriously considered attempting suicide—up nearly 60% from a decade ago.

"High school should be a time for trailblazing, not trauma. These data show our kids need far more support to cope, hope and thrive," Debra Houry, M.D., M.P.H., CDC's Chief Medical Officer and Deputy Director for Program and Science. "Proven school prevention programs can offer teens a vital lifeline in these growing waves of trauma."

Janet Garrett, director of Lakeview Center's children's outpatient services, told Inweekly, "We have seen an increase in anxiety and depression, not just with girls but with everyone around. We've noticed an increase of more children coming in seeking help for the after-effects of the pandemic."

She pointed out that teens had to deal with their social factors being taken away and losing family members and loved ones to the COVID-19 virus. The losses of friendship, social life, family members and normalcy have stacked up for them.

Garrett said, "We are seeing some more girls with depression and with anxiety. If I had to pick between the two, anxiety would be the one where we see more girls."

Anxiety comes from being away from the classroom for nearly two years while attending school via Zoom and then being put back in class. "They're having to come back and socialize, and the fear of being able to fit in and get along can cause anxiety, as well as the fear of not being able to do well in school."

She recommended that parents should look for changes in their teen's behavior, such as changes in sleep and eating patterns and in their friendships. Garrett said, "The key thing for parents is to have an open line of communication with their children and have those hard conversations about what depression and anxiety look like because they may not know how to verbalize it."

If parents notice changes, they can get help by calling Lakeview's central client registration at (850) 469-3500.

FIESTA-MAYOKI BREAKUP Fiesta Pensacola has notified the Mayokis that it will no longer hold a Landing Ceremony or formally send its court to the Mayoki Ball or pub crawl.

Why? Fiesta wrote, "Fiesta's tacit endorsement of Mayokis presents a public relations, reputational and potential financial risk to Fiesta that we are no longer willing to bear."

The fictitious Mayoki Indian tribe has participated in Fiesta Pensacola activities since 1961. The all-White group dresses up in feathered headdresses, skimpy outfits and war paint and parades around town during the Fiesta activities. The Fiesta court traditionally has been met at Quietwater Beach by the Mayoki court the Saturday before the Fiesta Coronation Ball.

Many have questioned the appropriateness of non-Native people wearing dressing in costumes, mimicking tribal dances and using Native American-sounding names. The Fiesta board stated in its letter that the Mayoki "royalty" would continue to be presented at the Fiesta Coronation Ball. However, they are requested to wear formal attire in lieu of Mayoki costumes.

The letter closed, "Our friendship goes back over 60 years, and we all want that to continue. We hope that everyone in your organization can understand why we are making this decision. We value you and are not suggesting you change. We simply must control what is best for Fiesta." {in}