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FL passed up $200M for uninsured kids

Over the past two years, Florida did such a good job of enrolling uninsured children in KidCare that the state could have qualified for as much as $200 million in federal bonuses – money that could have helped get more children into care.

But the state did not take the steps required to get the money. A spokesman for the Florida House said it appears the reason was the cost involved in making changes to certain agency rules, but was unable to offer specifics Friday morning. (This article will be updated with the state makes more information available).

Children’s advocates say half a million Florida children, about one in eight, still lack health coverage.

“It’s so frustrating,” said Jodi Ray, director of Florida Covering Kids and Families at the University of South Florida. “These kids need health services.”

Ray said the state now has 2 million children covered through Medicaid or Healthy Kids, a buy-in program for uninsured working families. (Collectively, the programs are sometimes called KidCare.)

She recently received a national awardfor her project, which recruits and trains volunteers to find and enroll uninsured children.

It’s surprisingly hard to find the children who qualify for assistance; families often don’t know the programs exist, let alone how to sign up. That’s why the Obama administration decided to offer states a financial incentive.

The bonuses, which have been awarded for 2010 and 2011, are supposed to run through 2013. However, an effort to end the bonuses has begun in the U.S. House of Representatives, which has a Republican majority. On Monday, the House Budget Committee plans to mark up a $115 billion package of health-care cuts that includes $400 million in bonus money for children’s enrollment, Politico reported.

Those who oppose the bonus program said it could lead to fraud, tempting states to get sloppy in checking whether families are really eligible for tax-supported programs. But children’s advocates are fuming.

“Quite simply, what could be more ‘American’ than to have all children with a real and caring relationship with a medical caregiver,” said Dave Lawrence, chair of The Children’s Movement of Florida. “A country that has spent more than $500 billion dollars over the past 10 years to bring democracy to Afghanistan surely could make sure that children have the basics that would give them a fair chance to succeed in school and in life. The very future of our children depends on such issues.”

The estimate of how much Florida has given up by not seeking bonuses comes from Tricia Brooks, senior fellow at Georgetown Center for Children and Families. Brooks said she calculated the 2010 bonus that Florida would have earned at between $95 million and $100 million.

While she did not repeat the calculations for 2011, Brooks said, Florida’s enrollment increases met the targets to qualify for a similar performance bonus.

To receive the bonus, a state must adopt at least five of eight measures that make it easier for eligible children to become and stay enrolled. Brooks said Florida meets two of those: It doesn’t require a face-to-face interview, and it has no asset test – in other words, it doesn’t look at whether children's families own a house or car.

Brooks said Florida partially meets two other measures: Creating standard forms and verification processes for Medicaid and Healthy Kids, and maintaining information from one year to the next without requiring families to start over on enrollment.

A fifth measure Florida could easily meet, Brooks said, is to make its premium-assistance program conform to one authorized by Congress. Premium-assistance programs help pay for employer coverage.

To accomplish these things, however, would have required not only action by several state agencies, but also the Legislature – the same Legislature that has forbidden agencies to accept money if it comes from the Affordable Care Act. The bonus money comes from a different funding stream, the Children's Health Insurance Program Reauthorization Act.

(Correction: An earlier version of this article misstated the source of the funds.)

To complicate things further, the Legislature will not meet again until March 2013, the last year the bonus program is supposed to operate.

Given the frustrations, child-advocacy groups are mobilizing under the banner of KidsWell Florida, part of a new national movement that wants to close gaps in public and private health insurance for children. The Florida groups will hold an organizing Webinar on May 30.

The groups involved include The Children’s Movement of Florida, Florida CHAIN, the Florida Center for Fiscal and Economic Policy, the Children’s Trust of Miami-Dade and the Florida Children’s Healthcare Coalition.

--Health News Florida is an independent online publication dedicated to journalism in the public interest. Editor Carol Gentry can be reached at 727-410-3266 or by e-mail.


Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.