Broward County

Reports: Fewer uninsured children in Florida, but challenges ahead for public program

Reina Lobo, 40, holds her grandson, Julio, 3, while meeting with Nadine Gousse, of the Human Services Coalition, a group working to enroll low-income Hispanic children in Florida KidCare.
Reina Lobo, 40, holds her grandson, Julio, 3, while meeting with Nadine Gousse, of the Human Services Coalition, a group working to enroll low-income Hispanic children in Florida KidCare. El Nuevo Herald

In Florida, as in the rest of the nation, the number of children without healthcare coverage has declined during the last five years — but the Sunshine State still has one of the country’s highest rates of uninsured children, a challenge that could be met or missed depending on policy decisions on the state and federal levels, according to a brief published this week by the Georgetown University Center for Children and Families.

While the number of uninsured children aged 18 and younger in the state has decreased from about 668,000 in 2008 to 445,000 in 2013, according to the report, Florida has the highest rate in the South and fifth highest in the nation.

The Affordable Care Act is expected to help further reduce the numbers of uninsured children in Florida and the nation, according to the brief authored by Joan Alker, executive director of the Georgetown University center.

Part of the reason is that more parents are expected to find affordable coverage through the health law, leading to increased coverage for children, an impact known as the “welcome mat” effect.

But other policies within the ACA also are expected to reduce the numbers of uninsured children in Florida, Alker noted, such as a provision that children ages 6 to 18 in eligible low-income families transition to coverage that no longer requires monthly premiums.

“Since premiums are known to depress enrollment in families with low and moderate incomes,” Alker wrote, “the … provision is likely to cause more eligible families to enroll and fewer children to lose coverage in Florida because their families can’t afford to pay the premiums.”

Alker reported that Medicaid enrollment among children has been growing this year, by about 3.9 percent between March and August.

But a number of health policy changes on the horizon could affect the number of uninsured children in Florida.

Chief among them is whether Congress renews funding for the Children’s Health Insurance Program, or CHIP, which in Florida is called KidCare/Healthy Kids. Barring congressional action, funding for the program will expire on Sept.30.

A report published Thursday by the nonprofit Pew Charitable Trusts also highlighted the uncertainty created by Congress’s inaction.

“It is still not clear when or whether funding for the federal-state, low-income children’s health plan known as CHIP will be authorized beyond Sept. 30,” reported Christine Vestal, a senior writer for Pew. “At issue is whether the subsidized health plans offered on the state and federal health insurance exchanges created under the ACA are an adequate alternative to CHIP.”

Vestal noted that a bipartisan group of 39 governors have advocated for Congress to reauthorize funding to avoid a gap in the program, which costs $13billion to fund and serves more than 8 million children and their families.

All of the governors who have written in response to requests for input from the House Energy and Commerce Committee and the Senate Finance Committee have supported extending funding for CHIP.

Florida’s Agency for Health Care Administration is finalizing the state’s response, which will be similar to those of the other governors who have supported extending funding for CHIP, said Shelisha Coleman, an agency spokeswoman.

Coleman noted that AHCA worked with the federal government to require private insurers in the statewide Medicaid Managed Care program to provide well child check-ups; and maintain a network of primary care physicians and specialists in adolescent medicine and pediatrics.

Alker, author of the Georgetown University report, painted a potentially disastrous picture for Florida should Congress not renew the program: About 400,000 children could lose coverage over the course of a year, costing the state about $495million to $560 million in federal funds.

Medicaid expansion also could impact the numbers of uninsured children in Florida, one of 23 states that has so far declined to make the state-federal healthcare program available to more residents.

But Alker’s report also noted that Florida officials have a lot of flexibility to make policy changes that could increase enrollment in Healthy Kids, including extending eligibility to lawfully residing immigrant children; eliminating waiting periods for the program, and doing away with premiums for some or all families.

Uninsured children

Below are the 10 counties in Florida with the largest number of uninsured children

Rank

County

Uninsured children

1.

Miami-Dade

64,806

2.

Broward

48,217

3.

Orange

35,429

4.

Palm Beach

33,233

5.

Hillsborough

26,639

6.

Duval

17,138

7.

Polk

17,061

8.

Lee

16,560

9.

Pinellas

14,628

10.

Osceola

12,447

Source: Georgetown University Center for Children and Families

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