Florida Has No Clue How Many Kids Have Lost Health Coverage Since DeSantis Refusal to Comply with Eligibility Rule

Florida’s top Medicaid official came before the Legislature Tuesday to update state senators on a pending legal battle with the federal government over expansion of the popular children’s health insurance program known as Florida KidCare.

But Brian Meyer couldn’t answer a simple question: How many children have been disenrolled from the program because their families haven’t paid the premiums, which is at the center of the tussle between the administration of Gov. Ron DeSantis and the federal Centers for Medicare and Medicaid Services (CMS)?

Meyer couldn’t answer another question during a hearing before the Senate Health Policy Committee: How many children would have been enrolled had the expansion been implemented as planned to cover children living in families that earn up to 300% of the federal poverty level, which amounts to $96,450 annually?  Now, only children living in families earning 200% of the federal poverty level qualify. The Legislature ordered the higher threshold in 2023 but the administration hasn’t complied.

“I don’t have that information handy, but I’d be certainly happy to work with our Florida Healthy Kids Corp. partners on that information,” Meyer said, responding to Boynton Beach Democrat Sen. Lori Berman’s questions.

The Florida Healthy Kids Corp. helps administer the state’s version of the federal children’s health insurance program, dubbed Florida KidCare.

The Florida Phoenix asked the state Agency for Health Care Administration, which administers the Medicaid program, and Florida Healthy Kids for disenrollment data but has received no response.

The Phoenix also asked those agencies for  Florida Kidcare disenrollment information in July but has received no data.

Florida KidCare is the umbrella name for the federal subsidized children’s health insurance program, which allows families that earn too much to qualify for traditional Medicaid to access affordable health insurance. Florida KidCare is an optional Medicaid expansion and families must contribute to the costs of care by paying monthly premiums.

Legal wrangling

Meyer’s presentation largely focused on legal wrangling with CMS over expanding the program. The dispute began under former President Joe Biden but continues to linger under President Donald Trump.

The state sued the federal government in February 2024 after being told the feds would approve the expansion but that the state would have to abide by a 12-month continuous eligibility requirement. That was dictated by the 2023 federal budget, as flagged in a “Frequently Asked Questions” document sent to Medicaid directors nationwide and later codified into rule.

It requires the state to keep eligible enrolled children in the program for a year even if their parents miss the state-mandated monthly premiums.

The DeSantis administration argued at the time that the federal government overstepped its authority with the requirement. Florida was the only state to challenge the rule.

The lawsuit has not moved much since first being filed. U.S. District Judge Mary Scriven in July ordered the parties to provide an update on the legal challenge by September. That’s when attorneys for the U.S. Department of Justice asked Scriven to keep the case open.

“We are continuing to have conversations related to kinda settling this that will be an amenable position to the state and also to the federal government, so we are hopeful we get somewhere hopefully in the near future,” he said.

Meyer said it’s difficult to predict the timeline on the litigation. “We are certainly committed to finding alternative pathways forward to implement the legislation,” he said, adding that the state is in discussions with the “higher levels” at CMS.

Several members of the committee expressed support for the state’s position. Stuart Republican Sen. Gayle Harrell said she didn’t understand the federal government tying the 12-month continuous eligibility with expansion approval.

“We are essentially being held hostage on implementation of raising the income eligibility to 300% of the federal poverty level under the [Medicaid] waiver because of this lawsuit,” Harrell said.

The continued delay in expanding access to Florida KidCare comes with the number of uninsured children in the state on the rise, with a new study showing that 8.5% of children in the state are uninsured, up from 7.4% in 2024. That’s an increase of about 67,000 uninsured children.

–Christine Sexton, Florida Phoenix