1. Health

Florida lets federal health care dollars for children slip away

Published Jan. 16, 2012

Florida is losing out on millions of federal dollars by failing to help more low-income families get health insurance for their children.

The federal government recently awarded nearly $300 million in bonuses to 23 states that have increased enrollment and improved access to children's health programs. Among Florida's neighbors, Alabama received $19 million, Georgia nearly $5 million and Louisiana almost $2 million.

But Florida, which has more than 380,000 children whose families' incomes should make them eligible for coverage, didn't get a dime of the bonus dollars.

Only California and Texas have more children from low-income families who don't have public health coverage.

What's the problem? To get the funding, states must meet specific criteria governing how the money is distributed, and Florida has failed to enact the legislation and policies needed to meet those requirements.

"It's a tremendous loss to Florida," said state Sen. Nan Rich, D-Weston, who has pushed unsuccessfully for legislation that would improve access to Medicaid, the state-federal health program for the poorest residents, and KidCare, the program aimed at children of the working poor. "Each and every year we are in a group of states that leaves money on the table, and that money ends up going to other states."

And that's not the only health care money Florida is forgoing. The state also stands to lose a further $22 million in federal funds because the KidCare program enrolls fewer children than it is budgeted for. That fact alone, advocates say, shows that Florida isn't working hard enough to let families know that help may be available.

More than 1.6 million Florida children receive health insurance through Medicaid, which covers the poorest families. Another 250,000 are enrolled in KidCare, available to children whose families earn up to 200 percent of the federal poverty level, or $44,700 a year for a family of four. But the program has money for another 20,000 children.

All this comes at a time when the lingering effects of the recession have left more young Floridians than ever without insurance coverage.

To qualify for the bonus money, states need to adopt at least five of eight measures that the federal government says make it easier for families to apply for and renew coverage. Florida has just two in place, including no longer requiring a face-to-face interview to get into the program.

But Florida hasn't done as much as other states to help families enroll in programs that many people either don't know about at all, or don't understand fully.

For instance, Florida still requires families to fill out separate applications for Medicaid and KidCare — even though just a few dollars' difference in income can mean people who cannot get help through Medicaid could get aid through KidCare.

Nor do program employees use information from other assistance programs, such as food stamps or free and reduced-price school lunch, to figure out whether a family might also qualify for medical coverage. That system, called "express lane eligibility," helped Georgia and South Carolina earn bonuses.

"Other states are finding ways," said Jodi Ray, who directs a program at the University of South Florida that coordinates outreach efforts around the state.

She said while groups such as hers are getting more families into the insurance programs, a bigger challenge is keeping them in — and that will take more than just outreach.

In 2010, Rich introduced a bill that would have adopted at least two more measures needed to get a federal bonus. Her legislation would have provided enrollees with 12 months of continuous coverage, even if the families' financial situations improved during the year. Advocates say that's important because people might, for instance, pick up temporary work that gets them bumped out of the program, but then they lose that new job, forcing them to go through the entire bureaucracy again to reapply. End result: inconsistent care for their children.

The other measure, called presumptive eligibility, would have allowed children to receive coverage immediately after their parents apply, rather than wait until they've made a premium payment. Officials say this can help children receive needed care more quickly.

But the bill died in committee, and Rich said it would be "very difficult" to get such measures passed this year with the current economic and political climate.

She said the legislative leadership is too focused on cutting current programs, rather than looking to the future. "It's about less taxes, less government," she said. "Unfortunately, they don't look at the other side, the investment you make when you enroll more children early and make sure they're healthy."

Despite losing out on the bonuses, Rich Robleto, executive director of the Florida Healthy Kids Corp., which administers KidCare, noted that the programs have made improvements.

The state increased the percentage of eligible children enrolled in Medicaid and KidCare from 70 percent in 2008 to 77 percent in 2009. Enrollment in both programs went up by 70,859 kids between October 2010 and October 2011.

But that alone isn't enough to qualify for the bonus. Federal officials also want states to simplify the application process.

Even without legislative action, Robleto expects the state to meet a third bonus criteria this year. For the first time, it will require families who are going through the annual program renewal process only to update information that has changed, rather than starting all over again with a new application.

In August, the state received two small federal grants to beef up outreach. USF got $1 million to help school districts reach out to potentially eligible families. Sacred Heart Health Systems Inc. received $754,200 to help boost enrollment in six northwest Florida counties.

But Rich said her South Florida district includes several high-poverty, high-minority areas, and she often hears from families struggling with the Medicaid/KidCare process.

"They call about the barriers to getting their kids enrolled, or keeping their kids enrolled," she said. "I tell them we're still working on it."

Richard Martin can be reached at or (813) 226-3322.