Thousands of children in Florida will have greater access to health care now that legislators have steered more money to a program that reduces the cost of health insurance plans for low- and middle-income families.
The action takes aim at the problem of uninsured children, whose numbers at last count have grown to an estimated 325,000 in Florida, the second-largest total in the nation. The funding will go to the Florida Healthy Kids Corp., a public-private organization that offers health insurance to children up to 18 whose families earn too much income to qualify for Medicaid.
As of June 2018, the program covered 190,713 children across the state through two health plans — one subsidized and the other a "full-pay" plan for families who can pay more.
About four years ago, the full-pay plan became too expensive for many families after federal regulations caused administrators to add benefits, which increased deductibles.
The families of about 9,600 children were forced to pay the higher rates or seek other options.
"Our numbers for the full-pay program dropped dramatically at that time," said Dr. Stephanie Haridopolos, a family medicine physician and the chair of the board of directors for Florida Healthy Kids.
The newly approved funding will restore the less expensive coverage for families who rely on the full-pay plan. For this initial round, the federal government will contribute $5.8 million to the program, and the state will add $1.1 million.
As a result, full-pay deductibles that now stand at $3,000 for medical costs and $1,500 for pharmacy costs will be eliminated, along with a 25 percent coinsurance requirement. The new terms will take effect Jan. 1.
"We're getting some of those patients back," Haridopolos said, referring to the families that left after costs rose in 2015. "But we believe we'll reach so many more families now that those deductibles and coinsurance have been removed, making it much more affordable."
The full-pay plan covers those with household incomes above 200 percent of the federal poverty limit, or $51,500 for a family of four.
U.S. Sen. Marco Rubio and U.S. Rep. Gus Bilirakis, R-Palm Harbor, worked with the U.S. Department of Health & Human Services to come up with regulatory changes to give more options to the large population of uninsured children and their families in Florida. The lawmakers were able to add provisions through an extension of the federal Children's Health Insurance Program, known as CHIP, which works with state governments to cover families with children. President Trump signed the extension into law last year.
Kyle Matthews' son, Charley, is one of 800 children in Hillsborough County who are currently enrolled in the full-pay plan. Hillsborough also is one of five counties with the largest uninsured populations in the state.
Charley, 9, has cerebral palsy and wears leg braces. He requires regular physical, speech and occupational therapies. Under the previous full-pay plan, he was getting the care he needed and seeing therapists three days a week to help him walk and speak.
But when the plan changed, the Matthews family struggled to find an alternative that would cover the therapy their son needed. They faced significantly higher costs over the next two and a half years.
"The new plan would only cover 30 therapy sessions a year, and Charley would go through that in a month," said Matthews, who runs a health care nonprofit. "Everything became so much more expensive out of pocket for us."
They found a solution at the Shriners Hospital for Children in Tampa, which continued on with Charley's therapy at no extra cost to the family.
"They don't charge at Shiners, which was a huge help for us. But that doesn't work for every family," Matthews said. "Shriners is very specific in their work with orthopedics."
Because of his regular care, Charley is down to needing just one day of therapy a week. And Matthews plans to continue with the Florida Healthy Kids full-pay plan in January.
"This plan will lower the out-of-pocket costs by the thousands for each family," he said. "Most of the kids on these plans are medically needy like Charley. They need more than just the regular check up. They spend more time in the hospital than a typical kid, and that's why this plan really helps."
The added funding affects nearly 15,000 children currently enrolled in the full-pay plan, and, according to Florida Healthy Kids, offers a more affordable insurance option to thousands more.
Most of the children covered under Florida Healthy Kids are eligible for government-subsidized coverage, which costs nothing at all or around $15 to $20 a month to cover all children in the household. Families who make more can buy the full-pay coverage for a monthly premium of $230 per child, and in the past, that also included paying deductibles, coinsurance and copays.
"There's this misconception out there that if you're working you don't qualify, and that's just not true," Haridopolos said. "There's no cap on income for the full-pay program."
A report released in November by the Georgetown University Center for Children and Families found that Florida, after years of declines in the number of children without health insurance, saw an increase of 37,000 uninsured kids in 2017.
It was one of the largest percentage increases in the nation. Florida was second only to Texas in the number of uninsured children in the state, the report found.
At the time, health officials blamed Florida's refusal to expand Medicaid as a leading reason for the trend.
Florida Healthy Kids is part of a larger network of programs that offer health insurance to children in Florida. Florida Kidcare is the umbrella organization over Medicaid for children, Medikids, Florida Healthy Kids and Children's Medical Services.
Florida Healthy Kids has struggled in recent years. In 2015, plan administrators had to make changes because of new insurance regulations associated with the Affordable Care Act.
The new rules required that plans cover more benefits, including emergency-room visits and preventative screenings and vaccines. They also prevented plans from limiting spending on essential health benefits for children.
The new regulations improved coverage, but the added cost made premiums double for families in the full-pay program. The additional funding from the latest legislative session hopes to ease some of that burden.
Contact Justine Griffin at email@example.com or (727) 893-8467. Follow @SunBizGriffin.