Medically Unnecessary
This is part four of a four-part series titled “Medically Unnecessary’’ that has examined how children with complex medical needs are faring after losing Medicaid coverage and being pushed onto state-run health insurance not designed for their needs.
Submitted by Joe Mario Pederson Central
(Source Florida Courier)
The state holds the key to providing relief to Florida families struggling with mismatched public health insurance and getting disabled or chronically ill children the coverage they need.
Whether or not it will use that key remains to be seen.
In 2023, Florida legislators unanimously passed a bill that would expand the eligibility of subsidized KidCare from 200% to 300% of the federal poverty level. It was supposed to go into effect at the start of 2024. It still hasn’t.
“I have people calling me every day, ‘I need health insurance for my kids,” said a frustrated Rep. Robin Bartleman during a House Health Care subcommittee meeting in February. The Democrat from South Florida sponsored the bill for KidCare expansion.
The Florida Agency for Health Care Administration, which oversees the state’s children’s health insurance program (CHIP), has yet to enact the expansion due to an ongoing lawsuit the state filed against the federal government in January regarding newly finalized rules the Centers for Medicare and Medicaid Services established in November.
“In order to implement the expansion as passed, I believe, we need to let the litigation play out against the federal government,” said AHCA Medicaid deputy secretary Brian Meyer during a House Health Care subcommittee meeting in February.
Central Florida reached out to AHCA regarding the lawsuit and the delayed expansion, but it stated that it would not comment on open litigation. Court filings show the state has been reluctant to enact the expansion due to CMS’s newly finalized rules requiring states that rely on a premium system in their CHIP to provide 12 months of coverage to families that miss a monthly premium.
“Florida faces actual and imminent injury to its sovereign interest in implementing and enforcing its laws, and in the form of unrecoverable monetary loss,” according to the court filings.
Families are waiting for rescue
Meanwhile, families waiting for the expansion are stuck in limbo with no definitive date established as to when relief may come.
“Just make it happen,” said Orlando resident Erin Booth.
Her 9-year-old son, Landon, is a cancer survivor, but he lost Medicaid coverage just as his recovery began. As a result, he receives coverage through a CHIP program known as the Florida Healthy K13ooth has been fighting an uphill battle trying to get Landon his therapies but feels as though the state is much like a wall on his road to recovery.
“I believe he would make bigger strides if he didn’t have his therapies taken away,” she said.
Last year, about 500,000 children saw their Medicaid coverage terminated as part of a national effort, known as the “Medicaid redetermination” period, in which states reviewed the income eligibility for Medicaid recipients.
Florida agencies did not track what happened to the vast majority of children who lost coverage, but Florida’s CHIP did see an increase at the time of redetermination of about 80,000. State data does not distinguish if those children joined CHIP after losing Medicaid coverage, or if they were new arrivals to the program from outside the state, or if it was due to a change in status.
What experts have been able to confirm is that during the redetermination period, thousands of disabled children who lost Medicaid or Children’s Medical Services (CMS) – a low-premium public insurance for children with special needs – were referred to Florida Healthy Kids. The program’s statutes do not cover the expensive, habilitative services many of those kids need.
How would the expansion help Florida families?
But that’s where HB 121 comes in. The bill expands Florida’s KidCare premium tiered program.
Today, Florida KidCare has premiums of $15 to $20 for those with incomes between 134% and 200% of the federal poverty level, or FPL. Those over the threshold are on the “full pay plan” which isn’t subsidized and costs families about $250 a month.
Currently, there is a gap in coverage for those whose income is over 200% of the federal poverty level. Current KidCare requirements provide subsidized public health insurance for those making an income within 200% of the FPL.
HB 121 would increase the eligibility threshold from 200% to 300% above the FPL. The expansion would also serve families with disabled children as it would make the eligibility for Children’s Medical Services more accessible. The expansion would create a sliding scale of premiums that increases as families’ incomes grow, with premiums from $17 to $195 for those with wages between 134% and 300% of the FPL.
