Is Florida’s children’s health insurance program compliant with the “big beautiful” law that President Donald Trump pushed through Congress?
The answer to that question depends on whom you ask.
While the law makes upward of $1 trillion in cuts to Medicaid and the Affordable Care Act, it unexpectedly did not repeal portions of a Biden administration rule meant to make children’s health insurance (CHIP) programs like Florida’s operate more like Medicaid by banning eligibility waiting periods and enrollment lockouts.
The rule, which went into effect last June, also requires a smooth transfer of children from Medicaid to the CHIP program to ensure none fall into a health care coverage gap.
“I think nobody knew this would happen, per se. It was very clear Republicans were trying to repeal this regulation,” Joan Alker, executive director of the Center for Children and Families and a Georgetown University McCourt School of Public Policy research professor, told the Florida Phoenix. “So, here we are.”
Florida statutes require children whose families voluntarily drop their private coverage to go uninsured for two months before applying for Florida’s CHIP program, which operates under the Florida Kidcare moniker. Florida Kidcare also has a 30-day waiting period before children can re-enroll after missing a monthly premium. The policies are set in statute and put the state out of compliance with federal requirements, Alker said.
A different point of viewHer take differs from top Florida Healthy Kids executives. Florida Healthy Kids helps administer Florida Kidcare.
“There hasn’t been any change in federal law, policies, or internal operational activities that affect or can shape the projections in any way. And our review of federal law includes HR 1, the ‘Big Beautiful Bill Act,’ and there is nothing in the bill that would have any impact on the Kidcare program,” Jeff Dykes, chief financial officer for Florida Healthy Kids. told Amy Baker, the state’s top economist, during a July 16 meeting.
Baker, though, questioned Dykes’ analysis, noting that the law does give states the option to retroactively cover for 45 days the health care costs of a CHIP-eligible child who hasn’t been enrolled in the program.
Florida Healthy Kids Chief Operating Officer Suzetta Furlong backed Dykes’ point of view. Although she acknowledged it was still the “early days” of understanding the new federal law, she said, “What we looked at so far, we don’t think there’s anything that’s going to change the way we do current business.”
Alker questions whether the Trump administration will enforce the new requirements.
The Centers for Medicare & Medicaid Services did not immediately respond to Florida Phoenix’s request for comment.
Florida Kidcare is an optional Medicaid expansion program for children whose families earn too much to qualify for the traditional Medicaid program. Congress set up the program in 1997 and agreed to pay states roughly 15 percentage points more than the traditional Medicaid match rate. The Florida Legislature agreed to establish the Florida Kidcare program a year later, and the federal government pays about 69 cents of every dollar spent on the program.
State laws requiring waiting periods were put in place more than 25 years ago, well before passage of the Affordable Care Act.
The policies were meant to address “crowd out,” or the idea that the people drop their private policies to enroll in other subsidized health care programs.
Florida’s coverage gap for children transitioning from Medicaid to Florida Kidcare is administrative-related: The Department of Children and Families determines whether children are Medicaid-eligible and forwards that information to the Agency for Health Care Administration, which administers the Medicaid program. DCF refers children who don’t qualify for Medicaid, or who lose their eligibility, to Florida Healthy Kids.
Dykes has previously said it’s a 60-to-90 day process to move a child from Medicaid to Kidcare, which means children go without health care for up to three months.
“We know that Florida has openly said that children simply can’t get from Medicaid to CHIP without a gap in coverage. And that’s not right. That’s something the state needs to fix ASAP,” Alker said. “It’s the only state we know of where it’s literally impossible to get from one program to another.”
An easy fix, Alker said, would be for the state to take advantage of the 45-day retroactive eligibility option.
“Everything blew up”
St. Petersburg resident Jordan Elmore’s son, Logan, was without health insurance coverage when he transitioned from MediKids to the Florida Healthy Kids in March when he turned five. Medikids and Florida Healthy Kids are both components of the Florida Kidcare program.
But Medikids is for children aged 1-4 and the benefits provided to enrollees mirror those in the Medicaid program. Florida Healthy Kids covers children five and older. FHK benefits aren’t as rich as those offered in Medikids.
Elmore recalls a case worker telling him in late January or early February that Logan would age out of Medikids when he turned five in March. But their case worker resigned soon thereafter and he recalls “everything blew up.”
There were calls to Florida Healthy Kids and the Agency for Health Care Administration regarding Logan who went without coverage for half the month of March and had therapy appointments canceled.
“Nothing was consistent, there was no good information and ultimately it all meant nothing because it was all wrong,” Elmore said of the back and forth information that FHK and AHCA provided him and his wife.
In that time Elmore said he worried that something would happen that would require Logan to see a physician.
“Anywhere we would have gone for an emergency or just a cold needing medicine, we wouldn’t have been able to get anything. We would have had to pay out of pocket.”
Legal update
In 2023, the Republican-led Florida Legislature agreed to expand the number of children eligible for Florida Kidcare by taking income-eligibility limits from 200% of the federal poverty level (or $64,300 for a family of four) to 300% of the FPL, or about $96,450 annually for a family of four.
The Biden administration approved the expansion with the caveat that Florida abide by another federal requirement that prevents the state from dropping eligible children from the program for nonpayment of premiums. The Biden administration also notified state Medicaid on notice they could lose federal funding if the state didn’t stop removing eligible children from the program for non payment of premium.
The DeSantis administration didn’t accept the conditions and took the Biden administration to court, alleging the eligibility 12 month continuous eligibility requirement “amounts to a backdoor expansion of no-cost health insurance that was never authorized by Congress.”
Eligibility is determined annually, and the state has argued that the mandate could require it to keep children in families that don’t pay premiums on the program for months.
The DeSantis administration and the new Trump administration have agreed to put the suit on hold with a federal judge this month agreeing to stay the litigation until Sept. 12 at the request of both the DeSantis and Trump administrations.
Florida Kidcare had been dropping from the program children in families that have missed premiums. Florida Kidcare marketing director Ashley Carr did not respond to Florida Phoenix’s request for information about whether children were continuing to be dropped from the program.
GET THE MORNING HEADLINES.SUBSCRIBE Florida Phoenix is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Florida Phoenix maintains editorial independence. Contact Editor Michael Moline for questions: info@floridaphoenix.com.
