Florida low-income children’s health insurance expansion delayed after paperwork issue [Orlando Sentinel]

Florida families hoping to get their children on a state subsidized insurance plan in January will have to wait three months longer.

The reason: The agency didn’t submit paperwork required by the Centers for Medicare and Medicaid Services, a snafu revealed during a Monday conference with state agencies in charge of the rollout. A spokesperson from the Florida Agency for Health Care Administration blamed the federal government for the delay.

“The federal government from the start of our discussions has consistently used the levers of bureaucracy to do all it can to prevent Florida from providing more families with the ability to purchase affordable health insurance for their children,” read a statement emailed from AHCA. “It is unacceptable and completely absurd. We hope to find a resolution soon as we continue our work to improve the lives of each and every Floridian.”

Florida lawmakers authorized an expansion of the state’s KidCare program in the 2023 legislative session by unanimously passing HB 121, which among other things, raised the family income limit from 200% to 300% of the federal poverty line for subsidized child health insurance. This would mean a family of four could make up to $90,000 and get subsidized care, compared to the previous $60,000 cap. The expansion was set to take effect Jan. 1 and was predicted to extend coverage to over 42,000 uninsured kids. Now it is set to take place in April.

Policy experts praised the expansion overall but are concerned that children who lack insurance will have to spend at least three more months without this option. Families could enroll their kids via the federal health care marketplace, but programs tailored to children like this one are better fits, said Joan Alker, executive director of Georgetown University Center for Children and Families.

“This is a great step forward that Florida is taking, expanding their program,” Alker said. “It’s unfortunate this [delay] has happened in the 11th hour.”

Florida KidCare is intended to help working families who make too much to qualify for Medicaid but struggle to afford employer-based plans.

What went wrong?

For years, states that want to make changes to federally supplemented children’s insurance programs like this have had to get federal permission to alter a contract called an 1115 Waiver.

But Florida AHCA was unaware this waiver was necessary to make this change, said Florida Agency for Health Care Administration’s Tom Wallace during a Monday state social services estimating conference.

“We had thought we could do a state plan amendment and get approval,” Wallace said during the conference. “But that had changed and we need to go ahead and do an 1115 waiver to get that federal approval.”

Changes require a lengthy public comment period and can take a while to finalize. Wallace said the department is now “shooting” for an April 1 implementation date.

The Orlando Sentinel asked the AHCA if and when the federal government communicated this requirement and when the state agency became aware of it. AHCA did not address that in its answer.

Florida had still not submitted its waiver as of Wednesday morning, according to Medicaid.gov records.

Alker said there’s a widespread lack of awareness about this waiver requirement, a problem the Georgetown University Center for Children and Families has repeatedly pointed out over the past several years.

“I feared this was going to happen, and there wasn’t any public discussion about it, which was surprising to me,” Alker said.

This has been an issue in other states, too.  Arizona voted to expand its children’s insurance program effective Nov. 1, but the state didn’t submit its 1115 waiver until mid-November.

The Centers for Medicare and Medicaid Services did not respond by deadline to questions from the Orlando Sentinel about when it communicated this requirement to Florida and whether there was a broad communication campaign to make states aware of it.

What happens next?

The expansion has the potential to help thousands of children who recently lost Medicaid coverage as states scaled back pandemic-era changes to the broader program.

“It’s unfortunate for Florida families and kids that implementation of the KidCare expansion will be delayed until April,” said Sadaf Knight, CEO of Florida Policy Institute.

Nearly 300,000 Florida kids aged 0-18 have lost Medicaid from April to November as part of the nationwide Medicaid unwinding process following the end of the pandemic’s continuous enrollment requirement.

Since then, there’s been an enrollment increase of about 33,000 increase in Florida’s children’s health insurance program, administered by the nonprofit Florida Healthy Kids Corp. Advocates projected more children would have enrolled by now.

Healthy Kids spokesperson Ashley Carr said the group was planning to reach more families through a marketing campaign for the expansion set to launch Jan 1. The group is still prepared to launch a campaign to spread awareness, beginning on the first day families can sign up for the expansion, Carr said.

Ccatherman@orlandosentinel.com; @CECatherman Twitter

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