Florida is unlikely to expand Medicaid this year, as North Carolina and other Republican states have done recently, but lawmakers are pushing measures they say will expand health care for more children from low-income families.
About $76 million has been set aside in the House’s proposed budget to incentivize more pediatricians to treat children on Medicaid. And a bill progressing through the Legislature will expand the number of families eligible for subsidized child health insurance programs.
But the measures fall short of what health care advocates warn is needed as Florida next month begins to purge its Medicaid rolls, which swelled by 1.8 million people during the pandemic when additional federal money was given to states to keep people insured. At least 900,000 Floridians, including many children, covered by the program could lose medical coverage, according to state data.
Advocates would rather see Florida emulate North Carolina, where Gov. Roy Cooper on Monday signed legislation expanding Medicaid coverage to an estimated 600,000 residents. The bill was passed by the Republican-controlled state Legislature, reversing years of opposition to expanding the federal program.
“Those North Carolina legislators really did the brave and correct and right thing,” said Holly Bullard, chief strategy and development officer at the nonpartisan nonprofit Florida Policy Institute. “There’s no reason why Florida can’t too.”
Florida lawmakers say they don’t want to increase dependence on benefit programs.
“The better way to go is to try to bring down the cost of care, private insurance and other insurance to increase access while still maintaining quality,” House Speaker Paul Renner said during a news conference Friday when asked about Medicaid expansion.
In the proposed House budget, about $31 million in general revenue and about $45 million from the Medical Care Trust Fund have been set aside to raise reimbursement rates above what Medicaid gives doctors who treat children.
Republican lawmakers are also pushing a bill that would make more families eligible for health coverage subsidies through KidCare, a series of child health insurance programs. Currently, only children from families that earn less than 200% of the federal poverty level qualify. For a family of three, that limit is just under $50,000, according to a Senate analysis. If the bill is approved, families earning up to three times the federal poverty level would be eligible.
The subsidies reduce monthly premiums to as little as $15 a month for each child. Without it, KidCare costs up to $259 a month per child.
The bill would make an additional 42,000 children eligible for KidCare, according to a House analysis based on 2021 data. It’s unclear how many more children would fall into the KidCare qualification after the Medicaid unwinding begins. Roughly 327,000 Florida children had no health insurance in 2021.
“Our goal is not to perpetuate or increase the amount of social benefits, but it is to help people ascend above them and to achieve economic self-sufficiency,” said Sen. Alexis Calatayud, R-Miami, the Senate’s bill sponsor.
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Calatayud said the goal is to create a path for adults so they can continue their upward climb. She said the idea wasn’t inspired by the upcoming purge of Medicaid rolls, but rather has been a long-standing effort driven by Renner.
Lawmakers have argued that even a slight increase in income, like a raise of $1 an hour, can mean a family loses eligibility, causing them to either turn down the raise or to drop coverage for their children.
The expansion of KidCare is welcomed by the Florida Policy Institute but the Orlando nonprofit warns that some new enrollees often must navigate a difficult two-month delay before their care is covered, Bullard said.
Her group and others have also raised the alarm about how many Floridians could be kicked off Medicaid this year.
Typically, each year, KidCare grows by about 3%, according to a House analysis. But for the 2023-24 fiscal year, a growth of about 77% is expected because of the number of families that will lose coverage.
An estimated 900,000 more Floridians — roughly 4% of the state’s population — would be eligible for Medicaid if Florida expanded eligibility as allowed under the Affordable Care Act, according to the Florida Policy Institute.
It would cost the state about $500,000 but would save more than $200 million a year as it would qualify for more federal reimbursements, according to an analysis by the institute. A study by the Commonwealth Fund conducted by the conservative-leaning Leavitt Partners found that expansion of the federal program would save the state $300 million over five years.
Florida is also missing out on federal incentives that would give the state $3.5 billion over the first two years following expansion, Bullard said.
Research suggests that health outcomes for children are better when their parents also have access to care, she said.
“Because we’re a nonexpansion state, they don’t have that pathway,” she said. “If they were living in North Carolina, they would have that opportunity.”