In mid-May, Mandi Rokx had a 3-month-old baby and a letter from a Florida agency warning that they both would be cut from Medicaid, the health insurance program for people with low incomes or disabilities.<\/p>\n
Under a Florida law passed in 2021<\/a>, Rokx was supposed to receive 12 months of continuous coverage after giving birth. But the letter from Florida\u2019s Department of Children and Families said their coverage would end May 31.<\/p>\n The explanation: \u201cYou failed to complete or follow through with your Medicaid renewal.\u201d<\/p>\n Rokx said she didn\u2019t understand why the state was cutting coverage. She had provided everything it asked for, she said.<\/p>\n She worried about what losing Medicaid would mean for her daughter, Vernita. Initially after the coverage ended, Rokx said, she paid out-of-pocket for the infant\u2019s checkups. She then turned to a free health fair put on once a month by a local nonprofit<\/a> near her home in Melrose, Florida.<\/p>\n \u201cI just hope she doesn\u2019t get sick,\u201d she said.<\/p>\n An unknown number of mothers in Florida have abruptly lost Medicaid coverage after giving birth, despite being eligible, according to an ongoing federal lawsuit filed against the state in August 2023. The issue is linked to the state\u2019s computer eligibility system, run by Deloitte Consulting, according to trial testimony from state and Deloitte employees. It is yet one more example of problems<\/a> states and beneficiaries have encountered with Medicaid management systems operated by Deloitte, a giant consulting firm.<\/p>\n As of July, Florida had awarded the global firm contracts valued at more than $100 million to modernize, operate, and maintain the state\u2019s integrated eligibility system for Medicaid and other benefits.<\/p>\n Deloitte did not respond to requests for comment about its work in Florida.<\/p>\n In total, 25 states have awarded Deloitte eligibility system contracts, making the company the dominant player in this crucial slice of government business. These agreements, in which Deloitte commits to design, develop, or operate state-owned systems, are worth at least $6 billion, according to a KFF Health News analysis of state contracts.<\/p>\n The KFF investigation found that errors in Deloitte-run eligibility systems<\/a> can cost millions and take years to fix while denying benefits like health insurance to eligible people.<\/p>\n In response to the investigation, Deloitte spokesperson Karen Walsh said<\/a> the firm\u2019s clients \u2014 state governments \u2014 \u201cunderstand large system implementations are challenging due to the complexity of the programs they support and that all IT systems require ongoing maintenance, periodic enhancements and upgrades to software and hardware, and database management.\u201d<\/p>\n Senate Democrat John Fetterman of Pennsylvania, which is one of Deloitte\u2019s state clients, sees it much differently. \u201cLet\u2019s call this what it is: a racket,\u201d he said. \u201cThis isn\u2019t an occasional glitch. It\u2019s a pattern of systemic failure. And the worst part? We\u2019re paying them billions to do it.\u201d<\/p>\n In July, Kimber Taylor of Jacksonville<\/a> and Lily Mezquita of Orlando<\/a> testified in a federal courtroom in Florida that state officials removed them from Medicaid even though their pregnancies made them eligible. The class-action lawsuit alleges that Florida did not adequately explain to people with Medicaid the reason for cutting their health insurance, or explain to them that they could appeal the decision before losing coverage.<\/p>\n Florida has denied the allegations in court filings. But the trial revealed problems with the computer system the state uses to determine Medicaid eligibility and inform people that they are no longer eligible. Deloitte did not respond to questions about the trial, in which a judge\u2019s decision is pending.<\/p>\n Although Deloitte is not a named defendant in the lawsuit, an employee was called to testify about the firm\u2019s role in operating Florida\u2019s eligibility system. Harikumar Kallumkal, a Deloitte managing director who is responsible for Florida\u2019s system, said that a \u201cdefect\u201d may have led to coverage losses for new mothers.<\/p>\n William Roberts, a state worker who reviews Medicaid eligibility decisions, also testified that the agency learned about a \u201cglitch\u201d that cut postpartum coverage for eligible new mothers in April 2023 \u2014 the same month Florida launched a Medicaid eligibility review process known as \u201cunwinding,\u201d which all states undertook after pandemic-era coverage protections ended in March of that year. Kallumkal testified that Deloitte fixed the problem by April or May 2024.<\/p>\n And yet Rokx\u2019s coverage was cut May 31.<\/p>\n During the unwinding, Florida disenrolled nearly 2 million people, including kids, from Medicaid, according to the Centers for Medicare & Medicaid Services.<\/p>\n Patient advocates say flaws in Florida\u2019s Deloitte-operated computer system prevented some of the state\u2019s most vulnerable residents from getting care they were entitled to receive.<\/p>\n \u201cFlorida\u2019s Medicaid officials knew from the start of the unwinding period that their system was not handling pregnancy and postpartum Medicaid correctly, and proceeded full steam ahead anyway,\u201d said Lynn Hearn<\/a>, an attorney with the Florida Health Justice Project, a nonprofit legal aid and advocacy group that together with the National Health Law Program represents the class-action plaintiffs. \u201cTo this day, we don\u2019t know that the problems have been fully corrected. The mothers of this state deserve better from their government.\u201d<\/p>\n Medicaid is the largest insurance payer for childbirths in Florida, covering nearly 98,000, or 44%, of all deliveries in 2022, according to the state health department. But it\u2019s unclear how many mothers have been cut from the Medicaid coverage they were entitled to receive. Florida\u2019s Department of Children and Families on Sept. 9 cashed a check from KFF Health News to cover the processing fee for records it requested about eligible mothers who were disenrolled. As of Nov. 22, the state had not released the records.<\/p>\n The state did provide an estimate during the trial, but that number was not made available by the state to KFF Health News. In a court filing, the plaintiffs cited the state\u2019s estimate as showing that 19,802 women were removed from pregnancy coverage as of March 2024, one year after Florida began unwinding. It\u2019s unclear how many of these women lost coverage incorrectly. The figure is probably a conservative estimate \u2014 it excludes anyone who was removed from coverage because of paperwork issues.<\/p>\n Mallory McManus, deputy chief of staff for the Department of Children and Families, told KFF Health News that after identifying the problem, agency workers \u201cmanually corrected cases until necessary system updates were in place.\u201d She added that the department also reviewed the system to \u201censure there were no gaps in coverage.\u201d<\/p>\n McManus said that Floridians who were disenrolled from Medicaid \u201cwere properly noticed and provided with information on requesting an appeal.\u201d<\/p>\n Rokx, Taylor, and Mezquita ultimately regained their Medicaid coverage after seeking help from the Florida Health Justice Project. Attorneys there have said they are often able to get coverage restored for eligible people by reaching out directly to the state agency\u2019s general counsel<\/a> \u2014 an avenue not known to most Floridians.<\/p>\n While the class-action lawsuit awaits a judgment, the problems revealed at trial echo those encountered in other states with Deloitte-run Medicaid eligibility systems, such as Arkansas, Colorado, Florida, Georgia, Kentucky, Michigan, Pennsylvania, Rhode Island, Tennessee, and Texas.<\/p>\n In Texas, according to a July report<\/a> by the U.S. Government Accountability Office, \u201cabout 100,000 eligible individuals had been disenrolled due to eligibility system errors,\u201d including denial of postpartum coverage for some eligible women.<\/p>\n The error-plagued systems and widespread denials of Medicaid for eligible people have caught the attention of lawmakers on congressional committees that oversee social programs. They blame state leaders who they say aren\u2019t holding vendors like Deloitte accountable.<\/p>\n \u201cAs the errors compound, contractors are rewarded with more billing hours and higher payouts,\u201d said Rep. Lloyd Doggett (D-Texas). \u201cThis is an alarming and unacceptable waste of taxpayer dollars.\u201d<\/p>\n Sen. Ron Wyden (D-Ore.), chairman of the Senate Finance Committee, which oversees Medicaid, said that too many people \u201ccan\u2019t even get in through the front door due to outdated and inaccurate eligibility systems.\u201d<\/p>\n And Rep. Kathy Castor (D-Fla.) said that \u201cthere\u2019s such a pattern of trying to discourage and inappropriately cutting families off of Medicaid in Florida.\u201d<\/p>\n \u201cIt appears to be intentional,\u201d she said, \u201cand I think it clearly is.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\nUSE OUR CONTENT<\/h3>\n