Florida Sues Feds Over Ban On Removing Children's Health Insurance Enrollees

Gov. Ron DeSantis' administration has filed a lawsuit challenging a new federal rule determining when children can be excluded from the state's children's health insurance program.

Health care advocates are criticizing the lawsuit, saying it could lead to gaps in coverage for children.

At stake is a Biden administration rule that took effect Jan. 1 that requires states to provide 12 months of continuous eligibility for Medicaid and CHIP to enrollees 18 and younger, even if they do not pay monthly premiums.

According to the lawsuit, the deal threatens recent expansions of coverage through the Florida KidCare program, which administers the state's plans for low-income children, including CHIP.

READ MORE: Health Advocates Fear Florida's 'Elimination' of Medicaid Barriers Could Threaten Coverage for Children

The measure DeSantis signed last June expanded CHIP's subsidy policy through the KidCare program. It was supposed to come into force in January, but due to administrative problems it has already been postponed to April.

Under KidCare, families who don't qualify for Medicaid pay premiums of $15 or $20 a month, although most pay nothing, according to the website.

Failure to pay premiums after the 30-day delinquency period will generally result in disqualification from participation. But guidance released late last year by the Centers for Medicare and Medicaid Services prevents that from happening.

Under the new rule, states cannot exclude children from health insurance for nonpayment before the end of the 12-month continuous coverage period.

Joan Alker, a health activist and executive director of Georgetown University's Center for Children and Families, said the new protections are important to ensure children have access to the care they need.

“Even short breaks in care are very problematic for children,” she said.

The lawsuit, filed in Florida, could be detrimental to families struggling to make ends meet, Alker said.

“It makes no sense, in the short or long term, not to insure children,” he said. “It's bad for their health, puts families at risk for medical debt, and we know that children who don't have access to the care they need suffer from long-term health and education.”

READ MORE: With Medicaid expansion off the table, business owners and nonprofits are helping the uninsured in Florida.

Prosecutors allege Florida voluntarily provided CHIP participants with 12 months of continuing care without checking their eligibility for the program for nearly 20 years. However, this was subject to the payment of premiums.

The bonuses, the state says, allow Florida to maintain its constitutionally required balanced budget and keep CHIP "as a bridge between Medicaid and private insurance rather than an entitlement program."

The federal government covers most of the program's costs, Alker said.

Prosecutors are asking the court to allow states to ignore CMS guidance on covering enrollees who don't pay premiums, saying the federal rule would make the program a "free for all."

The planned expansion of KidCare in Florida would subsidize coverage for families of four with incomes up to 300 percent of the federal poverty level, or about $90,000 a year. Previously, it was 200 percent, or about $60,000 for a family of four.

It is unclear whether the lawsuit will further delay enforcement.

In October, KidCare served more than 119,000 children from families just above the Medicaid eligibility threshold.

This number is expected to grow as Florida continues its initial review of Medicaid eligibility.

More than 500,000 children have lost coverage since the post-pandemic era began last spring, according to the Florida Policy Institute.

“Under the state's Medicaid overhaul plan, the final phase of the process (through March) will focus on making eligible children who are medically fragile with conditions such as cancer and cerebral palsy. “This lawsuit could have serious, even life-threatening, consequences by preventing families at 200 to 300 percent of the federal poverty level from making a smooth transition to KidCare,” CEO Sadaf Knight said in a statement.

CMS had no comment, citing ongoing litigation.

Copyright WUSF 89.7 2024. For more information, see WUSF 89.7.

Children are disgusted when they are given this food for lunch at school.