Florida and six other states accounted for 70 percent of the enrollment decline in the U.S. between 2017 and 2018
TALLAHASSEE, Fla. – A decline in child enrollment in Medicaid and the Children’s Health Insurance Program (CHIP) — known as KidCare in Florida — is part of an alarming national trend, according to a new report by the Georgetown University Center for Children and Families (CCF). Between 2017 and 2018, found CCF, Florida saw one of the nation’s largest declines, with almost 70,000 fewer children covered by Medicaid and KidCare.
The report found little evidence to support claims that the improving economy was responsible for the decline in child Medicaid and CHIP enrollment.
Most low-income children rely on Medicaid and CHIP-funded programs, such as Florida KidCare, to meet their health needs, explained Tricia Brooks, author of the report and a senior fellow at CCF. She added that it’s unlikely that all of the children who lost public coverage were enrolled in private health insurance plans.
“Florida experienced important gains in the share of insured residents after provisions of the Affordable Care Act first went into effect in 2014,” said Sadaf Knight, CEO of the nonpartisan Florida Policy Institute. “We have not seen the same commitment to coverage under the current federal Administration. Florida already has a growing number of children becoming uninsured, and these declining enrollments in children’s Medicaid and KidCare is a sign that it is getting worse.”
“When kids lose health coverage, they lose critical access to health care,” said Alison Yager, director of policy advocacy for Florida Health Justice Project. “Yet health care is an essential ingredient in a child’s ability to thrive. We know from the research that Medicaid and CHIP coverage contribute to long-term positive outcomes not just in health, but also in school performance, educational attainment, and economic success.”
While data is not yet available on the number of uninsured children in Florida for 2018, Florida was among the states that saw an increase in 2017, the first time in nearly a decade that the uninsured rate for children increased nationwide. Florida saw a statistically significant increase with about 37,000 more children lacking insurance in 2017 than in 2016.
“There are clearly many factors at play that are putting children at risk,” said Brooks. “The Trump Administration took several steps that undermined enrollment including cutting outreach and consumer assistance funding. Proposed immigration policies also have kept many eligible families from seeking or renewing coverage for their children.”
The report found that the enrollment decline was uneven across the states. Combined enrollment in Medicaid and CHIP dropped in 38 states by 912,000 children in 2018. Enrollment declines were concentrated in seven states – California, Florida, Illinois, Missouri, Ohio, Tennessee, and Texas – which account for nearly 70 percent of the losses.
State-specific policy and practices also likely influenced the declines in child Medicaid and CHIP enrollment including cumbersome processes for enrollment and renewal, and stricter rules or more frequent reviews of eligibility, according to the report authors. In Florida, for instance, lack of 12-month continuous eligibility for children on Medicaid can result in breaks in health coverage, known as “churn,” which can disrupt care and exacerbate the seriousness of existing health conditions.
Required monthly premiums also contribute to program churn. Research shows that during 2017, more than 60,000 children were denied eligibility for non-payment. Florida is one of a handful of states that charges premiums for families with income below 150 percent of the poverty level– just $31,170 per year for a three-person household. In addition, Florida’s income eligibility for its CHIP program — Florida Healthy Kids — is low compared to the national average and other southern states.
“The fact that so many children lost Medicaid and CHIP coverage is very alarming,” said Joan Alker, executive director of CCF. “This report puts policymakers on notice that the success the U.S. has achieved on children’s health coverage is in jeopardy. Federal and state leaders must acknowledge the problem, investigate its causes, and take immediate action to ensure children have the health coverage they need to succeed.”
The CCF is an independent, nonpartisan policy and research center founded in 2005 with a mission to expand and improve high-quality, affordable coverage for America’s children and families. CCF is based at the McCourt School of Public Policy.
Florida Policy Institute is an independent, nonpartisan and nonprofit organization dedicated to advancing state policies and budgets that improve the economic mobility and quality of life for all Floridians.
Florida Health Justice Project, a nonprofit advocacy organization, seeks to improve access to affordable healthcare for Floridians, with a focus on vulnerable low-income populations.