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Working Parents Could Lose Medicaid

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

About 45,000 low-income working parents in Florida will lose their Medicaid coverage at the end of this year and become uninsured unless they quit their jobs, a coalition of children's advocacy groups says.

KidsWell Florida says this is the surprising and unintended result of a change in the income-calculation system for Medicaid combined with the Florida Legislature's refusal to expand the insurance program for the poor under the Affordable Care Act.

The coalition explained the curious phenomenon in a letter to federal health officials on Wednesday asking them to do something to avert it.  The letter was addressed to Cindy Mann, director of the federal center that includes Medicaid and other children's health insurance programs.

"Ironically, the only way for these parents to retain the Medicaid coverage they need would be to halt their efforts to work and better provide for their children," the letter says.

It asks Mann to "take all available steps to preserve the Medicaid eligibility of those working parents who will otherwise lose it."

Those who signed the letter were Laura Goodhue of Florida CHAIN, Linda Merrell of Florida Child Healthcare Coalition, David Lawrence Jr. of The Children's Movement of Florida and Karen Woodall of the Florida Center for Fiscal and Economic Policy.

As their letter explains, the loss of coverage arises from a nationwide adoption of a uniform system of  determining eligibility for Medicaid. The new system is called MAGI -- for Modified Adjusted Gross Income.  The same system is to be used for determining subsidies for premiums and out-of-pocket expenses in the "Marketplace," the online health-insurance shopping site that opens Oct. 1.

The MAGI adoption was not supposed to result in a loss of Medicaid coverage, and it wouldn't have if all the states had expanded the program as called for under the Affordable Care Act.

But the U.S. Supreme Court ruled last year that Medicaid expansion could not be forced on the states. And about half have either refused to go along or are still arguing about it.

During Florida's legislative session that ended in May, the Senate passed a bill that would have covered more than 1 million low-income uninsured adults in the state -- people who don't qualify for Florida Medicaid even though their income is below the poverty level. The Senate bill would have used private-plan coverage instead of traditional Medicaid, which federal health officials had signaled was okay.

Because the federal matching-funds rate was to be higher than ever before -- 100 percent for three years, then tapering to 90 percent by 2020 and staying there -- many states found it a deal they couldn't refuse.

Researchers calculated that Florida would receive $51 billion in federal funds over a decade if it passed the bill, and that the state would end up having little or  no net expense. But House Republicans objected to accepting the money.

There is still time for Florida to change its mind in time for funds to flow in 2014, as the federal government reminded the state last month. But that would require a special session and a change of heart for House Speaker Will Weatherford. He has said he will not allow such a bill to pass.

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.