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The Impact of Florida’s Lawsuit on Low-Income Children’s Healthcare

— March 18, 2024

The state’s new rule provides more healthcare access to some while, at the same time, restricting access to low-income families.

The termination of pandemic-era protections has led to the discontinuation of Medicaid coverage for over 17 million low-income Americans, and Florida is now contemplating changes to children’s health insurance provisions in the state for those in low- to moderate-income families. This move aims to enhance access for some while imposing limitations on others.

Since the initiation of Medicaid unwinding in the spring, Florida has relocated more than 420,000 children from Medicaid as well as from the CHIP (Children’s Health Insurance Program) rolls. CHIP ensures coverage for children who are from modest-incomed families that exceed Medicaid qualification thresholds. Simultaneously, Florida is contesting a federal law implemented at the beginning of the year, mandating states to offer 12 months of continued eligibility to children. The plaintiff state has also taken a number of steps in order to further enhance the eligibility for CHIP. It has done so by increasing the income threshold for families to qualify for children’s health insurance programs.

The Impact of Florida's Lawsuit on Low-Income Children's Healthcare
Photo by Pavel Danilyuk from Pexels

Some have suggested that Florida’s Children’s Health Insurance Program, like those in other states, caters to low and moderate-income families, including approximately 120,000 children last year. Florida is challenging the federal government’s authority to modify enrollment rules for children in the program.

The state asserts its right to disenroll children if parents fail to pay premiums, a stance challenged by recent federal regulations.

Florida contends that it should retain the ability to disenroll children from the CHIP if parents neglect premium payments, providing a 30-day grace period. The federal government, through the Centers for Medicare and Medicaid Services, declared that, effective January 1, children cannot be disenrolled for non-payment of premiums.

Furthermore, Florida alleges unfairness, insisting on its historical prerogative to disenroll children for non-payment, essential for funding the program. The state accuses the federal government of circumventing the necessary procedures for implementing new rules.

As of now, Florida stands as the sole state challenging the federal government’s new rule, although 18 other states utilize a similar process, considering disenrollment for non-payment of premiums. These states face the decision of adhering to the new federal regulations or aligning with Florida’s legal challenge.

In response to Florida’s lawsuit, the Biden administration emphasizes that the Consolidated Appropriations Act of 2023 instated two crucial rule changes. This legislation established the 12-month continuous eligibility period, affecting Medicaid as well as CHIP.

The Biden administration argues that continuous eligibility is no longer optional; it is now mandatory for both programs. States are no longer permitted to disenroll individuals, including children, for non-payment of premiums during this period.

Simultaneously, Florida has come under scrutiny for disenrolling a significant number of children from Medicaid rolls, totaling nearly 460,000 as of January. HHS Secretary Xavier Becerra expressed concern, urging the state to adopt strategies to retain coverage for children.

Suggestions included eliminating CHIP premiums and leveraging federal flexibilities during the unwinding process. Medicaid expansion, identified as a measure to improve children’s coverage, was also emphasized.

Despite the challenges and controversies, the Florida legislature voted to raise the family income limit to qualify for Kid Care, Florida’s CHIP equivalent. This expansion, signed into law by Governor DeSantis in June, aims to make an additional 40,000 children eligible for coverage.

However, the implementation of this expansion is pending, subject to comment periods.

Florida’s multifaceted approach includes legal challenges, adjustments to CHIP eligibility, and legislative efforts to expand coverage. The details of funding, premium collection, and the balance between expanding eligibility and disenrollment shows the complex cases of children’s health insurance in the state.


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