Florida ‘callously’ strips healthcare from thousands of children despite new law

Florida is continuing to “callously” strip healthcare coverage from thousands of children in lower-income households in defiance of a new federal law intended to protect them.

Since 1 January, more than 22,500 children have been disenrolled from Florida KidCare, its version of the Children’s Health Insurance Program (Chip) that is jointly subsidized by states and the US government for families with earnings just above the threshold for Medicaid.

Florida healthcare officials admit at least some were removed for non-payment of premiums, an action prohibited by the “continuous eligibility” clause of the 2023 Consolidated Appropriations Act that took effect at the beginning of this year. The clause secures 12 months of cover if at least one premium payment is made.

Last week, the administration of the Republican governor, Ron DeSantis, challenged the rule in federal court in Tampa, arguing it makes Chip an entitlement program that illegally overrides a state law requiring monthly payment of premiums.

But it has chosen not to wait for a ruling before continuing to separate children from coverage. Figures from the Florida Health Justice Project show there were 5,552 removals in the month to 1 April, following 5,097 in March, 5,147 in February, and 6,780 in January.

Florida argues the numbers include children ageing out or moving into other coverage, and that “disenrollment has been consistent at this level for years”. Notably, the monthly average so far this year is more than 1,500 higher than the whole of 2023.

“It’s just enormously cruel and a crisis of callousness by our governor and state of Florida who are willing to sacrifice sick children for their political aims,” said the Democratic US congresswoman Kathy Castor, who said she had been contacted by several families booted from KidCare, or “unwinded” from Medicaid as Covid-19 protections expired.

“It’s an important reform for parents because once you qualify you can stay on for a year, your child will get the care they need, consistent visits to the doctor’s office, and if they have a complex medical condition they know it will be handled.

“In the end, it saves everyone money, and saves families’ heartache when young children can stay healthy and well. But Ron DeSantis loves a lawsuit. Florida is the only state in the country that is so upset that children are going to get healthcare that he’s suing in federal court.”

Castor said one family she had spoken with had a two-and-a-half-year-old toddler who was born three months prematurely.

“She is fed exclusively through a tube. She has extreme developmental delays and requires 24-hour nursing care,” she said.

“They said since birth she has faced challenges including five months in neonatal intensive care, hernia surgery, air tube surgeries and seizures, and ongoing treatment. So the state now has ended her coverage. It’s heartbreaking, it’s cruel and it’s unnecessary.”

Independent experts also question the purge.

“While Florida is not alone in rapidly disenrolling children from Medicaid during the unwinding process – many of whom likely remain eligible – families should know that Florida is distinguishing itself in an apparent violation of federal law by kicking children off Chip as well,” Joan Alker, executive director of the non-partisan Center for Children and Families and a research professor at the Georgetown McCourt school of public policy, said in an analysis published last week.

“Florida is one of just nine states that charges premiums to children below 150% of the poverty line. Seven states have dropped all premiums in Chip at any income level in recognition of the barriers they pose for low and moderate income families.

“With the litigation, [Florida’s] efforts to block children from retaining affordable health coverage are not stopping at its borders. Depending on how it is framed, a ruling in Florida’s favor could give all states the green light to terminate the coverage of Chip kids if their parents miss a premium payment.”

Florida’s agency for healthcare administration did not return a request for comment. In a statement published on 19 April, the agency called previous media coverage of the issue “misleading”, but did not dispute the accuracy of the disenrollment figures.

“Allowing disenrollment for nonpayment of premiums is crucial to maintaining the integrity and long-term sustainability of the program and helps Florida continue to maintain its high level of quality service for KidCare participants,” it said.

The agency also noted that, in 2023, DeSantis signed legislation that increased income eligibility to 300% of the federal poverty level. They claim that the legislation, which has not yet been enacted, would open Chip to a further 68,000 children. Overall, the agency said 182,000 Florida children were covered by KidCare – 66% more than in May 2023.

Castor, however, says the state’s illegal dropping of enrolled children, and other recent developments – namely Florida’s six-week abortion ban that will take effect on Wednesday – prove the state is more determined to restrict healthcare than expand it.

“Hypocrisy abounds,” she said. “On the ability of women to control when they have kids, and if they have kids, the state of Florida and Ron DeSantis says: ‘You have to have children, you have to.’

“Then if you have a child, it says: ‘OK, you’re on your own,’ even in the face of a new federal law. All of the research shows that if children get the care they need, especially in their early years, they’re going to be more successful in school, have higher reading scores, higher graduation rates, they’ll be more productive in life.

“This is a self-inflicted wound on the ability to have a healthy, functioning state of Florida.”