Gov. Ron DeSantis is suing to toss new federal guidelines that require kids to keep their state-subsidized health care insurance even if their parents skip premium payments.
If parents don’t pay premiums and kids are allowed to stay on the state-subsidized insurance, as the feds are requiring, the new rules would be costly, the state contends. Estimates are that it could add up to nearly $30 million in unpaid premiums under the current system and nearly $50 million under the state’s expansion of Florida KidCare approved last year, according to a 411-page complaint the state filed in federal court.
Florida is the first state to file suit. According to critics, it’s another chapter in the contentious relationship between the DeSantis administration and the feds.
“The (Joe) Biden Administration unlawfully seeks to undermine that requirement (for premium payments) and turn the program into a free-for-all, threatening both its solvency and long-term stability,” the complaint reads. “Those actions threaten Florida’s expansion of the program to more children in need.”
Critics have noted the state led the nation in booting kids off Medicaid, the state’s insurance for the poor, at the conclusion of the pandemic. Florida was topped only by Texas, as more than 400,000 Florida children lost their health insurance as part of the Medicaid unwinding as 2023 wound down, noted Joan Alker, Executive Director of the Georgetown University Center for Children and Families.
In December, Florida was one of nine states that received a letter from Department of Health and Human Services Secretary Xavier Becerra raising the alarm about the number of people losing health insurance because of procedural issues.
And this is a continuation of the same pattern, Alker said.
“The Governor of Florida has filed suit asking a judge to give him special permission to kick children off (state health insurance for children) coverage for nonpayment of certain premiums and not comply with the federal law — which was designed to protect families from medical debt and ensure children have access to the health care they need,” Alker said in a prepared statement.
“If he is successful, the Governor will ensure that more children in Florida will spend more time being uninsured. This is harmful and puts children’s health and educational outcomes at risk in both the short and the long term.”
Currently, 119,000 children are covered by KidCare, which is made up of several government-subsidized health care plans, including Healthy Kids, the complaint says. KidCare, supported by both state and federal money, requires a small, monthly premium from recipient families and covers children, ages 5 to 18.
Legislation (HB 121) that passed unanimously in 2023 increased the eligibility threshold to include those earning up to 300% of the Federal Poverty Level (FPL), which is $93,000 for a family of four, up from the maximum household income of 200% of the FPL.
The expansion could put 26,000 more children on the state-subsidized insurance.
But the disagreement is holding up that expansion that was supposed to go into effect immediately. That’s because the federal government decreed that the expanded eligibility couldn’t take hold with a simple plan amendment. Instead, the feds required the state to apply for a waiver, triggering the showdown.
Centers for Medicare & Medicaid Services (CMS) “indicated it would not approve Florida’s proposed expansion without accompanying modifications to … provisions that allow the state to disenroll an eligible child for nonpayment of premiums during the continuous eligibility period,” the complaint reads.
The CMS rule, the complaint says, means “there is no consequence for failing to pay premiums, severely diminishing the incentive of participants to make any premiums after the first month (of enrollment). As a result, widespread nonpayment is a reasonable expectation.”
Holly Bullard, chief strategy and development officer for the Florida Policy Institute, lamented that the Sunshine State is the first to pursue this litigation against the federal government’s rule and feared the effect it could have on child health insurance across the country.
“This was a win for the Legislature and the kids and I hate to see a lawsuit between the state and the federal government delay even more access to care for tens of thousands of kids,” she said.