Earlier this week I released a brief and held a webinar with the Florida Philanthropic Network on Florida’s uninsured children. The brief provides an overview of the demographics of Florida’s kids and outlines some policy decisions that will impact Florida’s high uninsured rate in the future.

It will come as no surprise to regular Say Ahhh! readers that Florida continues to have one of the highest uninsured rates for children in the country. Despite some solid progress over the past five years, Florida’s child uninsured rate was 11.1% compared to a national average of 7.1% in 2013. Florida has the highest uninsured rate for children in the Southeast and the 5th highest in the nation.

And Florida is one of the states with the most at stake in the upcoming Congressional debate on whether or not to renew CHIP funding.

Who are Florida’s uninsured children?

About 67% of Florida’s uninsured children are white. School-aged and Hispanic children are disproportionately uninsured. Florida’s uninsured children can be found all across the state from rural to urban communities – check out the powerpoint slides for more info.

What can be done to connect more uninsured Florida kids with coverage?

There are several opportunities available to state policymakers to address Florida’s high child uninsured rate.

Expand Medicaid

Florida is one of 23 states that has not elected to accept federal funding under the Affordable Care Act to expand its Medicaid program to parents and childless adults below 138% of the poverty line. As a result, parents in Florida are not eligible for Medicaid or premium tax credits if their incomes exceed 35% of the poverty line ($6,927 annually for a family of three) but remain below 100% of the poverty line ($19,790 annually for a family of three). Research based on the experience of other states shows that offering Medicaid coverage to parents will help the whole family sign up for coverage and reduce the rate of uninsured kids.

Lower premiums in the Healthy Kids Program

Premiums that sound low remain unaffordable and suppress enrollment for low and moderate income families – particularly for families earning under 150% FPL who are extremely price sensitive. Prior to enactment of the ACA, Florida was one of only a handful of states (seven) that charged premiums to children in families earning under 133% FPL in the Healthy Kids Program. The ACA expanded Medicaid coverage to children in families at this level so their parents no longer have to pay premiums. Since premiums are known to depress enrollment in families with low and moderate incomes, the “stairstep” provision is likely to cause more eligible families to enroll and ensure fewer children lose coverage in Florida because their families can’t afford to pay the premiums.

At a congressional hearing on Wednesday, the Executive Director of the Medicaid And CHIP Payment and Access Commission (a Congressionally created body to provide recommendations to them on Medicaid and CHIP policy) recommended that premiums be discontinued for all children from families earning 150% FPL or below. MACPAC is charged with making policy recommendation to Congress on CHIP and Medicaid but it’s unclear whether or not Congress will follow this recommendation. The good news is that Florida doesn’t have to wait for Congress to act as it has the flexibility right now to lower premiums for these families..

Remove barriers to coverage

Florida is one of 25 states that has not elected to use CHIP funding to cover lawfully residing immigrant children. Picking up this option would extend eligibility to fewer than 20,000 legally residing children, a relatively small number, but would also create a more welcoming environment for families whose immigration status may be mixed.  This step would help reduce the disproportionately high number of Hispanic children who are uninsured.

Currently, Florida requires children to be uninsured for two months before they are eligible to enroll in Healthy Kids. This is called a “waiting period.” Waiting periods generally add a layer of administrative complexity and red-tape, and are rooted in pre-Affordable Care Act incentive structures that are no longer relevant. In a system that aspires to universal coverage, where families are subject to penalties for not having coverage, waiting periods no longer make sense.

Florida stands to take a giant step backwards if CHIP funding is not extended

There is one more policy decision that will have a huge impact on Florida’s children but it is not up to state leaders. Congress will decide whether or not to continue funding CHIP. If CHIP funding is not renewed, it would jeopardize coverage for about 400,000 Florida children over the course of a year. After Texas and New York, Florida has the most at stake in the debate over the future of CHIP.

Two members of the Florida delegation serve on the House Energy and Commerce Health Subcommittee that held a hearing today on the future of CHIP. The congressional subcommittee released letters from 39 Governors mainly supporting an extension of CHIP and making recommendations on how to change the program. Florida’s Governor has not yet weighed in on whether or not he supports continuing CHIP. It’s important for Florida leaders to examine the enormous impact CHIP funding has had in the state and convey to Congress how the elimination of funding would affect Florida’s children.

Florida has slowly been moving in the right direction for children. Consequential decisions lie ahead that will determine whether or not Florida’s children get the health coverage they need to succeed.

Thanks to the Florida Philanthropic Network, Jess Ball DuPont Fund and Winter Park Health Foundation for making this report and webinar possible. A recording of the webinar will be available soon.