The Florida Legislature often cites children’s health and well-being as a priority. Although laws are passed to expand or improve child health, they often stall when it comes to their implementation. Proponents who create and pass these laws do little to follow through once these laws go into effect. In turn, this lack of accountability contributes to a system of continued inadequate care, especially for the children in Florida. Furthermore, the state has resisted adopting federal guidelines and best practices for these programs that could help improve health care and health outcomes for children.
Medicaid In Schools
Forty percent of children enrolled in Florida’s school districts receive Medicaid services. Nationwide, individuals in rural communities rely more on Medicaid services due to having lower income and less access to higher-paying jobs. In Florida, rural counties, like Hamilton, have a much higher share of children enrolled in Medicaid (69.9 percent), as opposed to non-rural counties like St. Johns (14.2 percent). (See Figure 1.)
In 2020, the Florida Legislature passed CS/HB 81, a measure to help schools draw down at least $51 million annually in additional federal Medicaid dollars for school-based health services, including mental health screenings, diagnoses, and treatment. This bill was drafted to align Florida law with federal law. In 2014, the Centers for Medicare and Medicaid Services (CMS) issued guidance that eliminated the requirement that Medicaid recipients receiving services through the Florida Medicaid Certified School Match Program (1) qualify for certain provisions of the Individuals with Disabilities Education Act (IDEA), (2) qualify for exceptional student services, or (3) have an Individualized Education Plan (IEP) or Individualized Family Service Plan (IFSP). The 2014 guidance allowed states to pay for medically necessary services for any Medicaid-eligible student, regardless of whether those services were identified in an IEP/IFSP. Florida submitted a State Plan Amendment (SPA) to enact these changes; however, CMS determined that Florida’s school-based reimbursement methodology was not in compliance with federal financing rules. It remains out of compliance, and that has caused the state to miss out on over $2 billion ($200 million annually) that could have gone towards school-based Medicaid services since 2014.
Since the passage of CS/HB 81 in 2020, the state’s Agency for Healthcare Administration (AHCA) has continued to drag its feet on implementation. As of 2025, AHCA has not submitted an implementation guide or policy to enact these changes. The agency’s website for the program still outlines the pre-2020 qualifications for School Based Medicaid Services.
Furthermore, it has been noted that Florida’s schools are not being reimbursed for some of the Medicaid services they offer under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services benefit. This is a benefit that provides a comprehensive array of prevention, diagnostic, and treatment services for low-income infants, children, and adolescents under age 21, as specified in the Social Security Act.[1] As the state seeks to be in compliance with the federal guidelines, including these services within a new implementation guide would bring more health care services to children in school. (See Table 1.)
While this plays out, Florida’s school districts will continue to face challenges providing care for students who need nurses and treatment on-site throughout the school day. The deadline for the implementation of these federal requirements is July 1, 2026.
KidCare
In 2023, the Florida Legislature passed HB 121, a measure to expand eligibility for the state’s Child Health Care Insurance Program (CHIP), also known as KidCare. The measure was broadly designed to increase the number of children who are eligible for subsidized health insurance by increasing the income limits and enabling more families to qualify. The program covers children in families with incomes that are too high to qualify for Medicaid, and children in families with employer-sponsored insurance that may not cover those children. The changes to Florida’s CHIP program would have provided lower premium payments to an additional 42,000 currently uninsured children with household incomes between 200 and 300 percent of the Federal Poverty Level (FPL).
To date, KidCare has not been expanded due to initial administrative errors by AHCA. The agency failed to submit the application, called a 1115 waiver, on time. It has since been submitted with an updated structure of premiums that is different from those originally passed under HB 121 in 2023. Ultimately, these premiums are still costly to families. The waiver also fails to align with the federal CMS and Department of Health and Human Services’ (HHS) federal guidance that requires states to provide 12 months of continuous eligibility for children under age 19 who are enrolled in Medicaid and CHIP, with no exceptions. The new guidance sets the precedent that families and children cannot be disenrolled for missing a monthly premium payment.
In response to the new guidance, on February 1, 2024, the DeSantis administration filed a lawsuit against CMS claiming that a new requirement “unlawfully undermines” the recent expansion of CHIP, delaying the KidCare expansion. Florida is the only state that has challenged this rule. These rules are now being challenged under the Trump administration, and both the DeSantis and Trump administrations have agreed to hold the lawsuit until September 12, 2025, at which point a federal judge will review the case.
In the meantime, families that could potentially benefit from KidCare expansion will continue to wait or pay higher costs for their children’s health care.
Action Needed
Without further delay, Florida’s state agencies should drop the lawsuit for KidCare and expand the program with the federal requirements for 12-month eligibility. Along with the KidCare expansion, the state should implement Medicaid in Schools by submitting a State Plan Amendment by the July 1, 2026 deadline that includes all of the services covered by the (EPSDT) Benefit.
