TALLAHASSEE — Nearly 600,000 Florida children lost their government-provided health insurance last year after the federal government ended the national COVID-related health emergency, more than any other state except Texas, according to a newly released report by the Georgetown Center for Children and Families .

The report, a national study of how states shed children from Medicaid after the federal government lifted a hold that blocked them from dropping these patients during the pandemic, found that Florida lost 589,671 children in state-run government health insurance programs from April to December.

Total enrollment for children in April 2023 was 3,093,191. By December, it had dropped to 2,503,520.

How many of those children found health insurance elsewhere is unknown, according to the authors of the report, which questioned Florida’s efforts to prevent children from going uninsured unnecessarily.

“We don’t know how many of these children are now uninsured or have a gap in coverage but there are many, many reasons to worry,” said Joan Alker, the report’s lead author and executive director of the Georgetown University Center for Children and Families, on a media call Thursday.

On Friday, Florida’s Department of Children and Families pushed back hard against the findings, saying that the state has diligently reviewed eligibility, processing nearly 5 million cases and getting responses from 9 out of every 10 patients. Mallory McManus, deputy chief of staff to the state’s Department of Children and Families, also said that new enrollment in Affordable Care Act marketplace plans and in KidCare, the umbrella term for the state’s health programs for kids, swelled over the last year.

“Any notion that Florida has failed in this process is false,” McManus said. “States that have been found to be in non-compliance have been required by (the federal Centers for Medicare & Medicaid Services) to pause their processes until issues are remediated. Florida has never been one of those states.”

Although the state disputes the report’s conclusion, the study found a massive shedding of patients nationally from government health programs.

Overall, there were 4.16 million fewer children enrolled around the country in the government-subsidized health insurance programs Medicaid and the Children’s Health Insurance Program, or CHIP, over that period of time, the report states. Together, Florida and Texas accounted for 38% of that decline, the report states.

During the COVID-19 pandemic, the federal government barred states from dropping people already enrolled in Medicaid. Since the mandate ended last April, Florida and states around the country have been reassessing whether patients on Medicaid were still eligible. (Because Florida is one of 10 states that has declined to expand Medicaid to its working poor, it covers mostly pregnant women and children.)

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But this reassessment, known as the “Medicaid unwinding,” has generally been fraught with problems, according to the nonprofit health policy group KFF, which estimates that, across the country, 70% of the Medicaid patients who have lost coverage since the unwinding began were dropped due to procedural or red-tape reasons.

Alker said that federal researchers estimated that “three-quarters of the children who will or have lost Medicaid during the windfall” are eligible for health insurance through the program but “are losing coverage for procedural or red-tape reasons.” These reasons could include not getting their renewal paperwork in on time.

“This means that the renewal process has been broken down in some way,” Alker said.

A matter of effort

Since the federal government allowed states to begin reassessing eligibility last year and require recipients to renew their coverage, it created a set of optional tools states could use to make the process smoother. Those tools included ways to increase automatic renewal of coverage, update contact information of enrollees, and give insurance companies that run Medicaid greater latitude in helping patients through the process. A separate report released by the Urban Institute on Thursday showed a “particularly striking association” between how many of the tools states implemented and how many children they retained in their government health insurance programs after the unwinding began.

Florida is the only state in the country that has declined to implement any of these tools, according to the federal program Centers for Medicare & Medicaid Services.

On Dec. 18, US Health and Human Services Secretary Xavier Becerra sent a letter to Gov. Ron DeSantis stated that Florida “is among the nine states with the largest number or highest percentage of children who have lost Medicaid or CHIP coverage since full eligibility renewals for these programs restarted this spring.”

Becerra laid out “several strategies” DeSantis’ administration could adopt to ensure Florida children were not dropped from coverage “due to ‘red tape’ or other avoidable reasons.” Those strategies included implementing some optional tools discussed above, as well as removing barriers to enrolling children in the Children’s Health Insurance Program and expanding Medicaid coverage to the working poor.

But McManus, the deputy chief of staff for the state’s Department of Children and Families, disputed that Florida allowed kids to slip through the cracks.

“For those who were ‘procedurally disenrolled,’ meaning they were unresponsive, the Department of Children and Families went above and beyond contacting them up to 13 times via phone, mail, email, and text before processing the disenrollment,” McManus wrote. “Florida has one of the lowest procedural disenrollment rates in the nation and is well below the national average.”

McManus said 93% of families with children with “medically complex conditions” were successfully contacted, and said the state created a dedicated Medicaid line for recipients that has an average wait time of less than five minutes.

“We haven’t just complied with all federal requirements; we have exceeded them,” McManus said. “It is difficult to determine what additional measures the State could even take beyond the exhaustive measures that are already in place to support these individuals through the process.”

The Florida Health Justice Project is suing the secretaries for the Florida Department of Children and Families and Agency for Health Care Administration in federal court over the state’s redetermination process, claiming it violated patients’ due process. There is a bench trial scheduled for May 13 in Jacksonville.

Where did dropped patients go for health coverage?

McManus told the Times/Herald that, since the federal government lifted the federal health emergency, 182,000 children have been enrolled in Florida KidCare, an increase of 66%, as of last month. She also said the number of children enrolled in plans through the Affordable Care Act marketplace increased by 50%.

Alker, however, said that enrollment in the Affordable Care Act marketplace, where low-income families can buy coverage using government subsidies, only offset the decline in Medicaid and Children’s Health Insurance Program enrollment for children nationally by 14%.

She said enrollment in a separate Children’s Health Insurance Program for families with slightly higher incomes only offset the decline for children by 10% nationally. In Florida, that number was slightly higher, with 12% of children who lost coverage under Medicaid and the Children’s Health Insurance Program enrolling in the separate program, according to data as of March, said Alker.

“So, these are the reasons to worry that children in states with high numbers or rates of Medicaid decline are going uninsured for at least some period of time,” Alker said. “These states should make efforts to reach out to families with trusted community-based partners and resources to re-enroll eligible children and consider systems reforms to make the process go more smoothly.”

Alker laid blame for children potentially going uninsured after the unwinding began primarily on state governors because their administrations ran these government health insurance programs. But McManus said an objective reading of the state’s efforts would come to the opposite conclusion.

“The fact is Florida has been fighting to provide more children access to coverage under (the Children’s Health Insurance Program),” McManus wrote. “In June of 2023 Governor Ron DeSantis signed bipartisan legislation that expanded the Florida KidCare program’s income eligibility requirements from 200% to 300% of the federal poverty level giving Florida the ability to serve an additional 68,000 uninsured children. Yet, to date, the Biden Administration is yet to approve Florida’s CHIP expansion.”

Nearly 600,000 Florida kids shed from government health care, study says

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