Why some Florida kids could lose Medicaid coverage even if they're still eligible

As many as 6.7 million children could lose health coverage as the COVID-19 public health emergency unwinds and states begin re-determining Medicaid eligibility, according to a new report from Georgetown University's Center for Children and Families.

The report finds roughly three-quarters of those kids will still be eligible for Medicaid, but could instead lose coverage due to administrative issues, like a renewal letter going to the wrong address.

Health News Florida's Stephanie Colombini talked with the center's executive director Joan Alker about why kids in this state are especially at risk.

Talk about the makeup of Florida’s Medicaid population when it comes to kids.

So in a state like Florida that doesn't cover very many adults [because it hasn't expanded Medicaid], the largest group by far of people on Florida's Medicaid program is children. And in fact, what our new report finds is that two-thirds of Florida's children are getting their health insurance through Medicaid and CHIP, which in Florida is called Healthy Kids, for children whose income is a little bit higher.

Georgetown University Health Policy Institute

And the state has identified just under two million cases of people that they think are likely to lose coverage during this process — that’s a lot of people. We don't know how many of them are children, but I'm going to guess at least half of those are children.

And what about the way Florida runs its Medicaid and CHIP programs could make it complicated for families as they're trying to renew eligibility for one or enrolling another?

A lot of states just have one program for kids with one easy front door. Florida doesn't. Florida has multiple programs; Florida also has premiums that are required to enroll in the Healthy Kids program, which for families who are low-income, that’s a barrier, particularly now with inflation being so high. And they're [Medicaid and CHIP] run by different systems and agencies. So there are a lot of moving parts here, and that's going to be confusing for families.

The governor and the state really need to step in, they need to think about children and think about children's well-being and try to simplify some of these complicated systems and make sure that there's enough staff and adequate call centers, adequate language support to ensure that families get through this process.

The state has a plan for redetermining Medicaid eligibility. Officials say they're hiring more support staff, doing bilingual outreach, phasing the process over the course of a year, etc. What more can be done to communicate to families that, you know, you as a parent might not be eligible for Medicaid anymore, but your child could be?

Yeah, that's a great question. And one place to start is to recognize that when messaging is being directed at parents, it's important to say, “Your child is probably still eligible for Medicaid.” That's not the messaging that we're seeing in the state.

When you hear about this issue — and this is true in Florida, but elsewhere, too — you hear a lot about, “Oh, people are on the program whose income went up, and so now they're eligible for their employer coverage, or the marketplace or Healthy Kids.” Well, that's really not the case for children. The vast majority of children, because the income eligibility levels are higher, are going to remain eligible for Medicaid. And so that's a key aspect of this messaging.

Whereas there seems to be a tone now of, “Oh wow, we've got, you know, about 2 million people that we think are going to get kicked off pretty quickly.” No, that's not the message we want. We want to hear, “We're here to help you make sure that your child keeps their Medicaid coverage.”

Now, the state can do as much as it can to use electronic data, available data, to make this renewal process easier for the families. But really the state is going to have to work with children and parents where they are in the community. So childcare centers, Head Start centers, schools, pediatricians — everybody who comes into contact with children — educating them about this process that's about to start and encouraging families to update their contact information.

Congress recently passed a new requirement where states are going to have to give all kids on Medicaid continuous coverage for a year. How will that affect things?

That will apply to Florida. Florida right now covers the very youngest children for a year (kids older than five are covered for six months). But the implementation date of that provision is Jan. 1, 2024. So one thing Florida could do if they wanted to make this a smoother process and ensure that more children retain their coverage would be to implement this requirement early. So they could implement that on July 1.

That would mean that when children are getting their coverage checked, they would retain that coverage for a year without any further red tape barriers or paperwork requirements. That's what that provision is about. So that's a choice that the state has. They're going to have to do it come Jan. 1, but they could choose to do it earlier if they wanted to support children throughout this process.

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