Florida lawsuit against feds could delay expansion of child health insurance


A plan to make affordable health care available for more Florida children from low-income families could be delayed after the DeSantis administration last week sued the federal government over eligibility rules for KidCare, a federally subsidized children’s health insurance program.

The lawsuit, filed in a federal court in Tampa on Thursday by the state and the Florida Agency for Health Care Administration, accuses the U.S. Centers for Medicare and Medicaid of exceeding its authority by telling states they cannot kick kids off the program if their parents stop paying premiums.

That guidance was issued late last year in an advisory to states explaining new rules put in place as part of the 2023 Consolidated Appropriations Act, which requires states to give eligible children 12 months of continuous coverage once they pay their first premium.

Monthly premiums for KidCare are either $15 or $20 depending on household income, but most families pay nothing at all, according to the KidCare website. Children could be removed from the program for nonpayment of premiums once their 12-month continuous enrollment period ends, the guidance states.

But Florida’s lawsuit contends that the federal guidance wrongly conflates eligibility with enrollment. It is asking a court to rule that the guidance can be ignored.

“The Biden Administration unlawfully seeks to undermine that requirement and turn the program into a free-for-all, threatening both its solvency and long-term stability,” the lawsuit states.

Florida lawmakers voted in 2023 to raise the family income limit for children to qualify for KidCare from 200% to 300% of the federal poverty level. The move was estimated to provide health insurance for an additional 42,000 Florida children, according to an analysis of the bill.

The federal Children’s Health Insurance Program will cover about 72% of the cost, roughly $25 million per year, with the state picking up the remainder, estimated at about $10 million.

Expanding KidCare was seen as a riposte to health care advocates who have frequently criticized the state’s high uninsurance rates and its refusal to expand Medicaid. More than 325,000 children in Florida were uninsured in 2021, according to federal census data.

Florida is one of only 10 states that have not taken advantage of additional federal subsidies made available as part of the Affordable Care Act to expand Medicaid to most adults with incomes up to 138% of the federal poverty level.

But the KidCare expansion, which was scheduled to start in January, has already been delayed to at least April after the state failed to file for a waiver needed to obtain a federal subsidy.

It’s unclear whether the state’s lawsuit will mean a further delay.

“The Agency for Health Care Administration is filing a lawsuit against the Centers for Medicare and Medicaid Services to fight back against this federal overreach,” said agency spokesperson Brock Juarez. “Biden’s bureaucrats should ask themselves, are they pro-children or blindly pro-Medicaid expansion?”

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Arizona was also told by the federal government it must seek a waiver to expand its child health insurance program and has moved quickly to do so, said Joan Alker, executive director of the Georgetown University.

“This was a protection for children that Congress passed so children no matter where they lived would be assured of continuous health care,” Alker said. “It is extremely disappointing Gov. DeSantis is asking a judge for special permission to kick children off kids’ health coverage.”

KidCare serves more than 119,000 children, according to the lawsuit. Even without expansion, those numbers are projected to rise as the Florida Department of Children and Families is approaching the end of a yearlong assessment of the eligibility of roughly 5 million Floridians on Medicaid, the first review since the end of the pandemic.

Roughly 1.3 million Floridians have been terminated from the program since April, according to the Kaiser Family Foundation. That number includes more than 500,000 children, according to the Florida Policy Institute, an Orlando nonprofit that advocates for health care policies that provide more care for low-income families.

“After the important leap forward that state leaders took in prioritizing children’s health, this new lawsuit against CMS is a big step backward,” Florida Policy Institute CEO Sadaf Knight said in a statement. “Families in Florida are already facing a delay in implementing the KidCare expansion, and this lawsuit will only add to the delay.”


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