Like many parents, Tatiana Lafortune wants her children to get a good education, eat nutritious food, and see a doctor when they\u2019re not feeling well.<\/p>\n
Public schools and her church\u2019s pantry help Lafortune accomplish the first two goals. But insurance to cover doctor visits has been the most difficult to secure.<\/p>\n
As nursing assistants at a traumatic brain injury rehab center near Tampa, Florida, Lafortune and her husband cannot afford the health insurance benefits offered by their employer. And they earn too much for their daughters to qualify for subsidized coverage through Florida KidCare<\/a>, the state\u2019s safety net health insurance program for children in low-income families.<\/p>\n Her family also can\u2019t afford the $525 monthly cost to enroll her two daughters in KidCare at full price, so she purchased a family plan for $500 a month on the Affordable Care Act marketplace with no dental coverage and higher out-of-pocket costs.<\/p>\n \u201cKidCare is better for children,\u201d she said. \u201cBut at least I have something for them.\u201d<\/p>\n In 2023, Florida lawmakers unanimously approved expanding KidCare to close the gaps for families like Lafortune\u2019s, raising the eligibility threshold so that coverage would extend to more than 40,000 children. But the expanded coverage has not taken effect \u2014 even after it was approved by federal regulators following a federal lawsuit \u2014 because the administration of Florida Gov. Ron DeSantis, a Republican, has not implemented the changes.<\/p>\n Instead, Florida\u2019s KidCare expansion has been mired in lawsuits and ongoing negotiations between the state and federal regulators. While the delay continues, Florida could be violating the law.<\/p>\n \u201cI don\u2019t know what they\u2019re waiting for,\u201d Lafortune said. \u201cThey should see people in Florida have needs.\u201d<\/p>\n Asked to comment on the delay, DeSantis\u2019 office referred KFF Health News to a video of a press conference<\/a> on March 31, during which the governor directed questions to the state\u2019s Agency for Health Care Administration, which oversees KidCare. The state agency did not respond to KFF Health News\u2019 repeated requests for an interview or information on the delayed expansion.<\/p>\n Entitlement vs. Personal Responsibility<\/strong><\/p>\n At issue is a federal rule<\/a>, adopted under the Biden administration, that requires all states to continue to provide 12 months of coverage for children in Medicaid and in the Children\u2019s Health Insurance Program, known as KidCare in Florida. That means insurance coverage would not lapse even if parents miss a monthly premium payment.<\/p>\n But only Florida has challenged the rule in court, suing the federal government for the right to disenroll children from KidCare for unpaid premiums and delaying the planned expansion.<\/p>\n \u201cWe\u2019ve had to do a lot of back and forth with CMS on various things,\u201d DeSantis said during the March press conference, referring to the Centers for Medicare & Medicaid Services, which regulates public health insurance programs.<\/p>\n In December, Texas also said it opposed the rule. Cecile Erwin Young, who was then the executive commissioner of Texas Health and Human Services, wrote to Mehmet Oz, the CMS administrator, asking him to rescind CHIP rules that require states to keep children enrolled for 12 months at a time, prohibit waiting periods for coverage, and prevent states from imposing financial benefit limits.<\/p>\n \u201cThese policy changes effectively redefine CHIP to be more like an entitlement program \u2014 a strategy not supported by law and which conflicts with the core program design adopted by Texas,\u201d Young wrote.<\/p>\n Like Texas, Florida views KidCare as a \u201cpersonal responsibility program\u201d designed to help families by \u201csupporting independence and a ladder towards economic self sufficiency,\u201d according to legal filings and presentations to Florida lawmakers<\/a>.<\/p>\n \u201cIt\u2019s something that goes back to this mentality of people needing to pull themselves up by their bootstraps,\u201d said Melanie Andrade Williams<\/a>, policy director for the Florida Health Justice Project. The nonprofit legal aid group, together with the National Health Law Program, sued Florida\u2019s Medicaid and KidCare agencies<\/a> on March 9, asking a judge to order the state to implement the approved expansion.<\/p>\n The state agencies had not filed a response to that lawsuit as of April 22. The court ordered the state to explain by mid-May why the expansion should not be implemented.<\/p>\n Williams called the state\u2019s tactic \u201clargely political theater.\u201d<\/p>\n Health policy researchers and advocates also noted that Florida\u2019s refusal to implement the KidCare expansion goes against the Trump administration\u2019s strategy to \u201cMake Our Children Healthy Again<\/a>.\u201d Last year, a commission appointed by President Donald Trump recommended a series of policy changes, including a collaboration between CMS and state CHIP programs, to promote \u201cevidence-based prevention and wellness initiatives for children at the local level.\u201d<\/p>\n Numerous studies have found that CHIP coverage can improve children\u2019s health by increasing access to care<\/a>, improving long-term health<\/a>, and reducing poverty<\/a>.<\/p>\n \u201cThis should go without saying, but you can\u2019t make children healthy again by taking away their health coverage,\u201d said Holly Bullard<\/a>, chief strategy and development officer for Florida Policy Institute, a nonprofit that has advocated for the state to implement the KidCare expansion.<\/p>\n The White House did not respond to a request for comment on Florida\u2019s and Texas\u2019 opposition to the rule requiring continuous enrollment in CHIP.<\/p>\n Those two states have among the highest numbers and rates of uninsured children<\/a>. In Texas, more than 1 million children, or 13.5%, have no health insurance, while in Florida more than 400,000 children, or 8.5%, are uninsured.<\/p>\n Texas has followed the federal rule on continuous coverage despite its opposition, but Florida has ignored the requirement and continues to disenroll children for unpaid premiums.<\/p>\n Choosing Between School Supplies and Health Insurance<\/strong><\/p>\n According to the Florida Healthy Kids Corp., the nonprofit contracted by the state to determine eligibility for and administer KidCare, about 250,000 children received subsidized coverage from Dec. 1, 2024, to Nov. 30, 2025. Of those, 43,000 children were disenrolled after their parents failed to pay the premium.<\/p>\n Joan Alker<\/a>, director of the Center for Children and Families at Georgetown University, said the Trump administration should act on the evidence that Florida is the only state defying the rule.<\/p>\n \u201cThousands and thousands of children are routinely losing their coverage in violation of federal law,\u201d she said, \u201cand the Trump administration has done nothing about that. At the same time, they\u2019re pulling money from states like Minnesota for alleged fraud violations<\/a> that haven\u2019t even been proven yet.\u201d<\/p>\n Families tend to miss premium payments in July and August, when it\u2019s time to buy back-to-school supplies, and again in December and January, around the holidays, Alker said.<\/p>\n \u201cThat is very, very sad,\u201d Alker said. \u201cYou have working parents here who are struggling and they have to choose between their child\u2019s school supplies and their health insurance.\u201d<\/p>\n This year, enrollment in KidCare has fallen below the state\u2019s projections, leading to a $32 million surplus in the program. On April 17, legislators voted to remove that amount<\/a> from the program and redirect it to the general fund, with some lawmakers expressing disappointment<\/a> that the expansion had not yet been implemented.<\/p>\n Lawmakers voted to expand KidCare eligibility to families earning up to 300% of the federal poverty level. The change would raise the income threshold for a family of four from about $5,500 a month to about $8,250 a month. Monthly premiums for subsidized coverage would also rise, from the current $15 to $20 a month to a maximum of $195 a month, regardless of the number of children a family enrolls.<\/p>\n The program provides more comprehensive and affordable<\/a> coverage than ACA marketplace plans. KidCare has no deductible or coinsurance, and maximum copayments of $15. It also includes dental and vision coverage.<\/p>\n With her ACA plan, Lafortune must pay a $35 copayment for doctor visits. Her family deductible is $1,600, and the coinsurance \u2014 or the share of covered services she must pay after meeting the deductible \u2014 is 20%. The plan\u2019s maximum out-of-pocket cost is $7,250.<\/p>\n \u201cI tried to get something cheaper, but it\u2019s not like I cannot have it,\u201d Lafortune said of the need for health insurance. \u201cI have to do something.\u201d<\/p>\n The state\u2019s initial lawsuit challenging the continuous eligibility rule was dismissed in May 2024, and a second lawsuit was withdrawn this February. The state and CMS told the judge they were \u201cworking to determine the most expeditious way to resolve the dispute\u201d and have yet to update the court on their discussions.<\/p>\n But three days after withdrawing the lawsuit, Florida sued CMS for a third time, accusing the federal agency of ignoring the state\u2019s public records request related to CMS\u2019 approval of the KidCare expansion.<\/p>\n As the legal wrangling continues, the cost of health insurance has skyrocketed.<\/p>\n For those with ACA marketplace coverage, the expiration of enhanced subsidies<\/a> has hit hard. About half of those who re-enrolled in ACA marketplace coverage for 2026 said their healthcare costs are \u201ca lot higher\u201d this year, according to a recent KFF survey<\/a>.<\/p>\n For Lafortune, Florida\u2019s KidCare expansion can\u2019t come soon enough.<\/p>\n \u201cChildren are the ones who are going to replace everyone here,\u201d she said. \u201cWhen you give them opportunities \u2014 for their health, for school, to eat \u2014 you make your country healthy and better.\u201d<\/p>\n Are you struggling to afford your health insurance? Have you decided to forgo coverage?\u00a0Click here<\/a>\u202fto contact KFF Health News and share your story.<\/em><\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/em><\/p>\n This <a target=”_blank” href=”https:\/\/kffhealthnews.org\/insurance\/chip-expansion-florida-delay-children-health-coverage-uninsured-rates\/”>article<\/a><\/a>; first appeared on <a target=”_blank” href=”https:\/\/kffhealthnews.org”>KFF<\/a> Health News<\/a> and is republished here under a <a target=”_blank” href=”https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/”>Creative<\/a> Commons Attribution-NonCommercial-NoDerivatives 4.0 International License<\/a>.<img src=”https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/8\/2023\/04\/kffhealthnews-icon.png?w=150"<\/a>; style=”width:1em;height:1em;margin-left:10px;”><\/p>\n
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