Analysis: Nearly 600,000 Florida children lose Medicaid, CHIP coverage during pandemic unwinding

There are 4.16 million fewer children enrolled in government-paid health care programs nationwide after COVID-19-related coverage protections were lifted. Nearly 600,000 of those children live in Florida, a new analysis released by the Center for Children and Families and Research shows.

Florida ranks second behind Texas in a list of states with the largest enrollment declines in Medicaid and the Children’s Health Insurance Program (CHIP), better known here as Florida KidCare. More than 1 million children lost coverage in Texas as that state unwound pandemic-related requirements that kept people enrolled in Medicaid.

Researchers were unable to determine how many of the children who were disenrolled from the health care programs ultimately became uninsured.

But Joan Alker, Executive Director at the Center for Children and Families and a Research Professor at the Georgetown McCourt School of Public Policy, said there is a concern that a “substantial” number of children may have become uninsured.

“Because they run Medicaid and CHIP the nation’s Governors, and to some degree their legislatures, but primarily the Governors, are ultimately responsible for how millions of children are faring during this process. They have made choices and these choices are reflected in the data we are presenting today,” Alker said.

To help ease the transition from post-pandemic to traditional Medicaid operations, the federal government offered the state flexibility. But Florida didn’t take advantage of any of those options, Alker said.

The analysis shows 3,093,191 children enrolled in Medicaid in April 2023 before the unwinding process. There were 2,503,520 enrolled in December 2023, which is 589,671 fewer children, or a 19% reduction.

South Dakota, Montana and Utah experienced percentage declines of 25% or more in the Medicaid and CHIP programs while Texas, Idaho, Arkansas, and New Hampshire had percentage declines of 20% or more.

Enrollment changes are measured by comparing the number of children enrolled in the month prior to enrollment compared to the number of children enrolled in December 2023. Because of differences in when states began unwinding, some states, including Florida, started unwinding in April, while others started unwinding in June or September. States with earlier unwindings have more months of data analyzed and, the authors note, “may show larger enrollment declines than states that started unwinding later in the year.”

Meanwhile, Alker said separate data indicate an increase in KidCare enrollment of 58,742 children since unwinding began and April 1, or about 12% of the overall loss in enrollment since Florida’s unwinding began.

The administration of Gov. Ron DeSantis did not immediately comment on the findings of the analysis.

Following publication of the article the Department of Children and Families, which determines Medicaid eligibility determination,  defended the unwinding process.
Deputy Chief of Staff Mallory McManus told Florida Politics that the outreach strategy “goes above and beyond federal requirements” resulting in a 40% higher response rate when compared to pre-pandemic levels.

“Any notion that Florida has failed in this process is false. States that have been found to be in non-compliance have been required by CMS to pause their processes until issues are remediated. Florida has never been one of those states. We haven’t just complied with all federal requirements; we have exceeded them. It is hard to fathom what additional measures the state could even take beyond the exhaustive measures that are already in place to support these individuals through the process,” McManus wrote in a lengthy statement to Florida Politics.  The full statement appears below.

Since the inception of the Medicaid program, recipients have been required to reapply annually to confirm continued eligibility.

Florida has completed 4.8 million redeterminations over the last 12 months, utilizing over 2,700 dedicated staff to process applications and renewals and provide support to recipients. We have one of the nation’s most robust and comprehensive redetermination plans, requiring no remediations from the Centers for Medicare and Medicaid Services (CMS). Our outreach strategy goes above and beyond federal requirements, which has resulted in a 40% higher response rate when compared to pre-pandemic levels, meaning approximately 90% of individuals responded to our redetermination requests. For those who were “procedurally disenrolled,” meaning they were unresponsive, the Department of Children and Families went above and beyond contacting them up to 13 times via phone, mail, email, and text before processing the disenrollment. Florida has one of the lowest procedural disenrollment rates in the nation and is well below the national average.

Our heightened outreach includes successfully contacting 93% of families of children with medically complex conditions to ensure they understand the process and creating a dedicated Medicaid line for all recipients needing help, which has maintained call wait times of less than 5 minutes for a majority of the time it has been in operation.

Any notion that Florida has failed in this process is false. States that have been found to be in non-compliance have been required by CMS to pause their processes until issues are remediated. Florida has never been one of those states. We haven’t just complied with all federal requirements; we have exceeded them. It is hard to fathom what additional measures the State could even take beyond the exhaustive measures that are already in place to support these individuals through the process.

The fact is Florida has been fighting to provide more children access to coverage under CHIP. As you are aware, in June of 2023 Governor Ron DeSantis signed bipartisan legislation that expanded the Florida KidCare program’s income eligibility requirements from 200% to 300 % of the federal poverty level giving Florida the ability to serve an additional 68,000 uninsured children.

Yet, to date, the Biden Administration is yet to approve Florida’s CHIP expansion. In late 2023, amid Florida’s work to implement the expansion of CHIP, the Biden Administration unlawfully intervened. CMS issued unfunded mandates through an FAQ that prohibited states from disenrolling for nonpayment of premiums even though – like any subsidized program – the viability of our program and its expansion depends on the collection of these premiums. Both federal and state laws supporting the termination of coverage for nonpayment of premiums remain intact today and have been in place for many years. The Agency for Health Care Administration anticipates this unlawful mandate would cost the State approximately $1 million each month and, according to CMS own FAQs, this additional burden would go entirely to the state with no matching funds from the federal government.

As of April 2024, more than 182,000 children have enrolled in Florida KidCare, representing a 66% increase in enrollment since May of 2023. Disenrollment in KidCare, including CHIP, has been consistent for years and occurs for a variety of reasons including children aging out of the program and families graduating on to private insurance as they find more gainful employment.

Additionally, we have seen enrollment in the Federal Marketplace increase by one million consumers over the last year, including a 50% growth in the number of children under 18. This is separate from the increases found within KidCare.

When reporting without bias, as every journalist should, it is impossible to not acknowledge the strength of Florida’s processes. We stand ready to assist all Floridians in finding one of the many options available to them. Thanks to an exceptionally strong economy here in Florida, many individuals’ circumstances have improved since the pause of redeterminations. With Florida’s thriving economy and low unemployment rate, it should be expected that families in a stronger financial situation would no longer be eligible. Florida will continue to be fiscally responsible while caring for its residents, ensuring that these vital programs serve those they are intended to.

We appreciate the opportunity to provide the facts and correct the false narrative espoused by the all-knowing “experts” of Georgetown. It’s important your readership know the truth about the great things we are accomplishing here in Florida.

Please include our response in your story in its entirety.