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Why Florida children have a high risk of losing Medicaid coverage after the federal emergency ends

Pediatrician listening to the heart beat of a young boy during a doctor's visit.
Matt York
/
AP

Children in Florida are some of the most at risk of losing health insurance when the federal government eventually lifts an emergency declaration associated with the coronavirus pandemic, according to a report that finds 6.7 million kids nationwide could be affected by the change.

As part of the public health emergency first enacted during the Trump administration in 2020 and extended by the Biden administration, the federal government has been giving states a 6.2% boost in Medicaid funding to help cover more people due to job loss or other factors. That funding came with a continuous coverage requirement, barring states from kicking people off Medicaid even if their incomes improved and they would otherwise be ineligible.

Once the emergency expires later this year, the funding and continuous coverage requirement will go away. Experts expect it will happen in July, but that could change if the government extends the emergency again. Republicans in Congress have pressured the administration not to.

States will have to scramble to redetermine Medicaid eligibility, and a report from Georgetown University’s Center for Children and Families cautions millions of kids could experience coverage disruptions in the process.

“Florida, unfortunately, has all the characteristics of a state where a lot of kids may lose coverage and become uninsured,” said the center’s executive director, Joan Alker.

READ: Check out the full report

One reason for that, Alker said, is that Florida has low rates of automatic Medicaid renewals, or “ex parte” renewals, where states use existing data sources to determine eligibility before reaching out to families and requiring they respond with documents. She said families could experience disruptions in coverage if there are communication problems when the state reevaluates their eligibility.

“The No. 1 thing the state can and should be doing right now is developing a very careful plan and working with stakeholders so pediatricians, community-based organizations, particularly those that are speaking in Spanish and other languages, health plans — anybody who is interacting with families and make sure they update their contact information,” said Alker.

“This is a very simple issue, but it’s something that could lead to thousands and thousands of children losing their coverage because there’s been so much instability during the pandemic, folks have moved around or perhaps been evicted. The state may not have their updated contact information and something as simple as a letter getting lost in the mail could result in a child becoming uninsured.”

Other issues relate to the state-run Children’s Health Insurance Program, known as Florida KidCare, which offers coverage to low-income families who earn too much for Medicaid.

Unlike some other states, Florida runs this program separately from Medicaid. According to the report, eligibility information in Florida has to be transferred from Medicaid to the Florida Healthy Kids Corp., the agency that administers CHIP. Alker said these added steps can make navigating the transition more difficult for families.

Florida also charges premiums for its CHIP program, and Alker said some families may not be able to afford them. She suggested the state can mitigate potential losses in coverage by temporarily or permanently pausing these premiums.

“They can do a lot of work to get ready for this and also commit to providing data — shining some ‘sun’ on this process as it unfolds, so we know how many children are losing coverage,” said Alker. “And if it appears that a lot of children are losing coverage, then the state needs to hit the pause button and see what’s going on here before any more bad outcomes occur.”

According to the report, Florida experienced a 14.7% increase in the number of kids enrolled in Medicaid and CHIP between February 2020 and June 2021. At that time, there were nearly 2.8 million kids receiving coverage through these programs.

Alker said because Florida hasn’t expanded Medicaid, it’s largely up to Gov. Ron DeSantis and state health officials to ensure smooth transitions for these children after the public health emergency ends.

Health News Florida reached out to the Department of Children and Families, which is responsible for determining Medicaid eligibility, as well as the governor’s office to learn more about how the state is preparing for the eventual change. A DCF spokesperson said they were working on fulfilling the request for comment.

Other states where children are at the highest risk of losing coverage include Delaware, Georgia, Missouri, Nevada and Texas.

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