Just a few hours ago, the Florida legislature passed its final bills of the session and included an extension of Medicaid and CHIP coverage to lawfully residing immigrant children who are currently excluded for five years. Known to many as the “ICHIA option”, this was a huge victory for kids in Florida (and their advocates who have worked for many years to pass this bill).
Florida’s decision is a fascinating political development in a state where a bitter fight last session between the Republican-controlled Senate and the Republican-controlled House over Medicaid expansion saw the Speaker of the House, Steve Crisafulli, lead the opposition. This year, Speaker Crisafulli threw his full weight behind passage of coverage for lawfully-residing immigrant kids saying: “Our country is a place where, if you are a legal citizen or resident, you should have the same opportunities as everyone else.” Approximately 17,000 children are expected to benefit.
And in more good news for kids, earlier this week approximately 1,000 lawfully-residing children in Utah were also extended Medicaid and CHIP coverage as the legislature passed a bill directing the Governor to adopt the ICHIA state option.
So at the beginning of the week, we had 29 states who had said “yes” to welcoming lawfully-residing immigrant children in the door to affordable health coverage and now we have 31. This is a significant step forward for kids on an issue where not a lot of movement has happened in recent years – and it happened in states in which all legislative branches are Republican-controlled. What accounts for this change?
Well there may be various political calculations here, but ultimately I think the main driving factor in breaking the logjam was the adoption of an enhanced CHIP matching rate (known as the “CHIP bump”) last year when the Medicare Access and CHIP Reauthorization Act (MACRA) was enacted. As a result, Utah’s CHIP program is now 100% federally financed and Florida’s match rate for these new kids is 95% federal. Given that there are some savings in existing Medicaid emergency spending, Florida budget projections estimated virtually no cost to this change.
In fact, when the Florida Senate Appropriations Subcommittee moved the legislation forward at the end of January, Committee Chair Matt Hudson, who had long opposed the bill, noted that the cost of the provision had dropped significantly (because of the CHIP bump) and this helped to explain his change of heart.
In Utah there was virtually no public discussion of the provision, but Executive Director of Utah Voices for Children Lincoln Nehring, whose organization had pushed for the change, said to me that Utah would not have made this change if not for the bump.
And as regular readers of SayAhhh! know, the state of Arizona has been debating reopening its CHIP program with the House recently passing this change with a strong vote of 47-12. Arizona is the only state in the country without an active CHIP program. We will have to see where this one ends up – but as a result of the CHIP bump, the cost of reopening CHIP would now be 100% federal. It is clear to me as a longtime observer of the Arizona debate that the bump has moved the debate from a low simmer to a boil.
Given the state of national dysfunction, this good news may seem surprising. It is terrific news because it means more children will get the health coverage they need to succeed. It’s also great news for taxpayers as research shows that investing in health coverage for children provides a strong long-term return as children grow up to be healthier, better educated and more economically successful adults. This is also a hopeful sign for our political system as state legislators who were unable to find consensus on covering more adults proved that they can put aside their differences and unite to help children. And it is clear from these results that even conservative states will respond to positive fiscal incentives from the federal government to cover more kids. It’s more important than ever to keep Medicaid and CHIP strong for kids. The strong bipartisan support for reauthorizing CHIP we witnessed when Congress passed MACRA last year shows that elected leaders at the federal level can also find common ground when it comes to helping children.