Gov. Ron DeSantis health officials to delay KidCare expansion until after Trump takes office

TALLAHASSEE — Florida health care officials are in no hurry to provide medical coverage for thousands of needy children, even after the Biden Administration last week approved the state's plan to extend low cost health insurance to them.

The approval issued Monday by the federal Centers for Medicare and Medicaid Services would enable 42,000 Florida families to get health insurance for their children at reduced rates through an expansion of the state's KidCare health insurance program.

But that approval is contingent on Florida complying with a federal rule that would prohibit the state from dropping children's coverage during a 12-month period even if they missed a premium payment. Florida is the only state to challenge that rule, and it lost in court.

Gov. Ron DeSantis' health care administrators want to wait until Trump is in office, and to understand what his administration thinks of the "continuous coverage rule," before acting.

The federal agency is "making a concerted effort to advance the political priorities of the Biden Administration," said Alecia Collins, deputy chief of staff for the Florida Agency for Health Care Administration.

"It would be wise for CMS to show deference to the incoming administration by allowing them the opportunity to review and approve significant policy initiatives that are likely to impact their time in office," Collins said.

The state agency plans to ask for a 30-day extension of its deadline "to ensure we have an opportunity to work with the new administration on this issue," she added.

But child advocates say families have already waited nearly two years since the Legislature approved the expansion, and the state should jump at the federal offer.

"This is truly welcome news for tens of thousands of children in Florida, especially those with medically complex conditions who have been going without the health care coverage they need due to Florida's delay in implementing the expansion," said Alison Yager, executive director of the Florida Health Justice Project.

"Florida leaders should accept the terms to this waiver approval, including preserving 12 months of continuous health care coverage for children, no matter what," agreed Sadif Knight, CEO of the Florida Policy Institute.

Holly Bullard, chief strategy and development officer at the institute, said Florida's response to this week's decision was "another delay tactic" and suggests state administrators "expect the new administration to overturn the continuous coverage provision."

The federal government's decision this week comes on the heels of the state canceling Medicaid for some 532,000 children due to a controversial Medicaid redetermination process called "unwinding" that critics decried as flawed and inhumane.

The continuous coverage rule, which was supposed to go into effect Jan. 1, applies to Medicaid recipients who are under 18 as well as KidCare recipients. It means that states can no longer disenroll participants during periods of continuous eligibility, except in certain circumstances. It applies to current recipients whose income is between 133 percent and 200 percent of the federal income level for a family of three, as well as those who would be eligible under the expansion.

Florida has admitted it has continued to disenroll children whose parents failed to meet the premium payments since the rule took effect.

The Florida Legislature unanimously approved the expansion of KidCare, the state's Children's Health Insurance Program, in March of 2023 – raising the household income threshold from 200 percent to 300 percent of the U.S. federal poverty level, which would make an estimated 42,000 new children eligible for coverage at lower premiums.

New payment tiers for the program were supposed to take effect at the first of this year, the same time a new federal law took effect that requires states to provide 12 months of continuous eligibility to children under 19 who are enrolled in Medicaid or CHIP, without exception. Non-payment of premiums was not an exception to the new continuous eligibility rule, the federal agency said.

Florida became the only state to sue over the rule, claiming that the new continuous eligibility requirement would create a "free for all" that "unlawfully undermines" the expansion of Florida's Children's Health Insurance Program.

State health officials claimed the state would have to give up $27.5 million a year in lost premiums under the current plan, and $48.5 million under the expanded plan. They also claimed that complying with the rule would cost the state $12 million a year to provide benefits to "participants who should have been disenrolled."

The lawsuit was dismissed by a federal judge in Tampa. AHCA has appealed that ruling, which is pending before the 11th Circuit Court of Appeal in Atlanta.