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Florida sues feds over ban on removing children's health insurance enrollees


The Biden administration is requiring states give CHIP beneficiaries 12 months of continuous coverage, even if families don't pay monthly premiums. State lawyers say premiums are needed for expansion of coverage signed into law last year.

Gov. Ron DeSantis’ administration has filed suit to challenge a new federal requirement that specifies when children can be removed from the state’s Children’s Health Insurance Program.

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

At issue is a Biden administration rule that took effect Jan. 1 requiring states to provide 12 months of continuous eligibility for enrollees ages 18 and younger under Medicaid and CHIP, even if monthly premiums are not paid.

According to the lawsuit, the rule threatens a recent expansion of coverage through the Florida KidCare Program, which administers government plans for children from low-income families, including CHIP.

A measure signed into law by DeSantis last June expanded subsidized CHIP policies through the KidCare program. It was supposed to go into effect in January, but has already been delayed until April due to paperwork issues.

Under KidCare, families who do not qualify for Medicaid pay $15 or $20 a month in premiums, though most pay nothing at all, according to its website.

Failure to pay premiums, after a 30-day grace period, typically results in disenrollment. But guidance issued late last year by the Centers for Medicare and Medicaid Services prevents that.

States can only disenroll children for nonpayment after the 12-month period of continuous coverage ends, according to the new rule.

Health advocate Joan Alker, executive director of Georgetown University's Center for Children and Families, said the new protections are important to ensuring children have access to needed care.

"Even short gaps in coverage are very problematic for children," she said.

Florida's lawsuit could harm families who are struggling to make ends meet, said Alker.

"It doesn't make any sense in the short-term or the long-term to have children be uninsured," she said. "It's bad for their health, it exposes the family to medical debt, and we know children who don't access the care they need have worse long-term health and educational outcomes."

Florida has voluntarily provided CHIP participants 12 months of continuous care without eligibility review for nearly 20 years, state lawyers argue. But that was dependent on payment of premiums.

The premiums, according to the state, allow Florida to maintain a constitutionally required balanced budget and preserves CHIP “as a bridge between Medicaid and private insurance rather than an entitlement program.”

The federal government covers most of the program cost, noted Alker.

State lawyers are asking the court to allow states to ignore the CMS guidance about coverage for enrollees who fail to pay premiums, claiming the federal rule would turn the program “into a free-for-all.”

Florida's planned KidCare expansion subsidizes coverage for families of four with incomes up to 300 percent of the federal poverty level, or about $90,000 annually. It was previously 200 percent, or about $60,000 for a family of four.

It's unclear whether the lawsuit will further delay implementation.

As of October, KidCare covered more than 119,000 children from families just above the threshold to qualify for Medicaid.

That number is expected to grow, as Florida continues its first review of Medicaid eligibility.

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

“According to the state’s Medicaid redetermination plan, the final phase of this process (through March) will focus on eligibility of medically fragile children — those with illnesses like cancer and cerebral palsy. This lawsuit could have grave and life-threatening consequences as families between 200 and 300 percent of the federal poverty level will be unable to seamlessly transition to KidCare,” CEO Sadaf Knight said in a statement.

CMS did not comment, citing pending litigation.

Copyright 2024 WUSF 89.7

I’m the online producer for Health News Florida, a collaboration of public radio stations and NPR that delivers news about health care issues.
Stephanie Colombini joined WUSF Public Media in December 2016 as Producer of Florida Matters, WUSF’s public affairs show. She’s also a reporter for WUSF’s Health News Florida project.