Florida’s children are more likely to go without health insurance than children in most other states. In a rare display of bipartisan unity, the Florida Legislature recognized the need to address the high cost of health insurance for families with children and took action by unanimously approving a bill to expand the state’s Healthy Kids program to cover children in families earning up to 300% of the federal poverty line (FPL) or about $80,000 for a family of 3. Healthy Kids is the state’s Children’s Health Insurance Program (CHIP), supported with matching federal dollars, and currently covers children in families earning up to 215% FPL or about $60,000 for a family of 3 (which is below the national median of 255% FPL).
Governor Ron DeSantis signed the bill into law on June 22, 2023, but his Administration has failed to implement the unanimously approved expansion of a successful program more than two years later. During that time, Florida’s child uninsured rate has gotten worse and remains one of the highest in the nation with more than 400,000 Florida children going without health insurance. (Only one other state – Texas – has more uninsured children.) Florida is also the only state in the country that I am aware of that is flouting federal law ensuring 12 months of continuous coverage for children covered by Medicaid and CHIP.
It’s not that families in Florida don’t need the help. Quite the contrary. Many desperate families in Florida are anxiously awaiting the DeSantis Administration to finally implement this bipartisan plan to help their children access the health care they need to thrive. Listen to Naomi, and Nova both single moms caring for their autistic sons while working and earning over the current low income eligibility levels. Or listen to Erin whose 8-year-old son is already a cancer survivor. These are just a few of the families who have been harmed because of the state’s refusal to implement the bipartisan plan to help families afford health coverage for their children.
I’ve been chronicling the saga for a while . The DeSantis Administration sued the Biden Administration because they object to federal law guaranteeing children in Medicaid and CHIP 12 months of continuous coverage and sued to preserve the ability to kick children off if their parents failed to pay the premiums. A very detailed timeline of this sad saga is available from the Florida Health Justice Project here.
A Trump-appointed judge dismissed the suit entirely, but the state appealed the decision, raising the question of how much money is Governor DeSantis willing to spend on lawyers to prevent children from getting the health care they need. According to a contract search done by the Florida Health Justice Project, the state has already spent over $837,000 on outside counsel.
The latest action on the litigation occurred on September 12, 2025 when the court provided an update stating that “leadership at the Department of Health and Human Services are still determining how they wish to proceed. The parties are also exploring other avenues that may obviate the need for further litigation.”
Desperate families continue to wait. The expansion is not yet up and running.
In fact, we know that the state of Florida is disenrolling children every month for failure to pay premiums, which is in violation of federal law, and thousands of children are losing coverage – children whose family income falls below 215% FPL making the math of paying monthly premiums in the face of high costs for food and housing even tougher. Over 43,000 children have lost their health insurance this way this year as of August. This has nothing to do with the expansion but has everything to do with the state violating federal law for children currently enrolled in CHIP whose families earn below 215% FPL.
The state needs a Section 1115 waiver to move forward; as any state does. Arizona passed a CHIP expansion during the same time period and quickly obtained approval for the waiver as this excellent story on a “Tale of Two States” details – children are benefitting from the state’s alacrity. But the DeSantis Administration refused to comply with the terms and conditions offered by the Biden Administration when it approved the waiver in December 2024 because these conditions incorporate federal law protecting children’s 12 months of continuous coverage. This law is intended to prevent harmful gaps in children’s health care and protect families from large medical bills by ensuring that small income fluctuations don’t lead to health coverage loss for children.
The Trump Administration is nowhere to be found either in enforcing 12 months continuous coverage or new protections for children in separate CHIP programs that have gone into effect as a consequence of the passage of H.R. 1 as my colleague Tricia Brooks and I explained here. As a consequence of H.R. 1, Florida needs to remove its waiting period for its CHIP program and ensure smooth transitions from Medicaid to CHIP but state officials openly stated that they did not believe they had to.
Following the recent election results, President Trump has announced his intent to focus more on “affordability.” He need not look any further than the dysfunction in his home state of Florida for an easy win. And the task at hand does not require negotiating with Democrats as the state legislature has already unanimously passed a bipartisan plan to bring Florida’s CHIP more in line with other states, making health insurance more affordable for children. All President Trump needs to do is nudge the DeSantis Administration to follow through in implementing the CHIP expansion bill the Governor signed into law more than two years ago and enforce federal law requiring 12 months of continuous coverage for eligible children and the elimination of the CHIP waiting period requirement. Now that would be a meaningful step toward health care affordability for Florida’s families.