Florida’s KidCare ToolBox

November 2, 2012


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Executive Summary

Florida has made significant progress in the effort to ensure that all of its children can get and keep the affordable, quality health coverage that is pivotal to their growth and development. Much of this progress is the result of sustained efforts by elected leaders, child health advocates, and health care providers to develop and strengthen the Florida KidCare program.

Formally launched in 1998, Florida KidCare consists of an interconnected group of components (Medicaid for children, Florida Healthy Kids, Medikids, and Children’s Medicaid Services) that primarily provide subsidized coverage to low-income children. The components of KidCare are administered by several different state entities and funded through a state-federal partnership under two federal programs: the Medicaid program and the Children’s Health Insurance Program (CHIP).

Working in tandem with private health insurance coverage, KidCare reduced the percentage of Florida children who are uninsured to an estimated 13.8% in 2011, the lowest rate since the statistic was first formally published.

Florida has achieved these reductions in child uninsurance in large part through the acquisition and use of what are described in this report as “tools”. These tools are in fact policies or practices intended to facilitate enrollment and retention in KidCare coverage.  Some are implemented at the state level, while others are federal changes. Some are accomplished through legislative action and others through initiatives at the administrative level.

Despite this addition of a number of new tools to what this report refers to as Florida’s “KidCare Toolbox” in recent years, an estimated 579,000 Florida children remained uninsured in 2011, including 358,000 low-income children who were income-eligible for coverage through some component of KidCare. In order to finish the job of covering children in the Sunshine State, however, Florida needs more tools in its Toolbox.

The good news is that a number of such tools are already available to Florida now, and more will become available in 2014. In particular, two new federal laws, the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) and the Patient Protection and Affordable Care Act (ACA), make important new resources available.

Expounding on the Toolbox metaphor, this report reviews six different types of tools that Florida needs in order to better enroll and retain its children in KidCare coverage, including:

  • “Blueprints”, which are different from the other types of tools described in the report, in that they do not pertain directly to enroll or remain in coverage. Rather, they provide background explaining who Florida’s uninsured children are and why it is critical that they gain coverage. For example:
    • In 2011, Florida had the fourth highest child uninsurance rate of any state.
    • Not surprisingly, the six largest Florida counties accounted for more than half of the state’s uninsured children in 2010. That said, uninsured children are distributed throughout the state and are even found in disproportionate amounts in some rural areas.
    • Since 1998, Florida has lost $400 million in federal CHIP funds that were unused when its authority to spend the money expired. By 2014, an additional $290 million is projected to be diverted from Florida because of the state’s inability to use the funding already allotted.
  • “Sledgehammers” are named for the power they have to open up new KidCare coverage opportunities that do not currently exist. In short, they are potential expansions of coverage. First, CHIPRA allowed for KidCare coverage to be made available to children of low-income state workers (now in effect in Florida) as well as lawfully present immigrant children. The following year, the ACA created several additional coverage opportunities for children, both direct and indirect. Indirectly, Florida has the option of extending coverage to hundreds of thousands of low-income parents in 2014 by raising the income limit for Medicaid eligibility to 138 percent of the federal poverty level (currently $26,344 for a family of three) for adults and by creating the Basic Health Program to serve adults who are above the Medicaid limit but still low-income. Such actions taken to cover parents would help increase coverage rates for children (with little additional state spending). More directly, the ACA also raises the income limit for Medicaid for school-age children from 100 to 138 percent of the poverty level, while providing moderate-income families with Advance Premium Tax Credits they can use to purchase affordable, quality coverage through the new Health Insurance Exchange. Finally, two other small but important opportunities warrant mention: the extension of KidCare “full-pay” coverage to infants and the alignment of the Medicaid income limits for pregnant women with KidCare.
  • “Crowbars” are useful for “prying” open barriers that can prevent or delay children from obtaining coverage. For example, Express Lane eligibility would use data that is already collected from other public assistance programs to expedite the eligibility determination process and streamline administration. Presumptive eligibility would provide children who likely meet eligibility criteria with coverage starting at the time of application while the formal eligibility process is completed.
  • “Clamps” help children remain in coverage once enrolled. Providing children in all components of the KidCare program with 12-month continuous eligibility (i.e., no requirement to provide proof of eligibility in the interim) would help significantly in that regard, as would verifying the information needed for renewal of eligibility through electronic means whenever possible.
  • “Sealants” are needed to fill in gaps in a system that is fragmented, uncoordinated and unnecessarily complex. A “No Wrong Door” system of coordinated eligibility and enrollment will reduce the likelihood that coverage through the KidCare component for which they are eligible can be delayed or denied simply because they apply for a different component. Standardization of the processes and tools used to determine eligibility would help prevent falling through the cracks. Children’s Medical Services is the KidCare component covering children with special or complex health care needs, but fragmentation within the program itself could be fixed. Finally, making KidCare income limits consistent for all children (except infants) will eliminate the confusion that often results from having siblings in the same family enrolled in different KidCare components with different rules.
  • “Funnels” steer children into coverage, and in particular, an effective outreach program would be even more effective if outreach workers had sustained, real-time access to eligibility information.

Regardless of how one assesses progress in reducing the extent to which Florida children lack the health coverage they need (this report uses three such methods), Florida has made great strides. With these additional tools in the Toolbox, the stage would be set for completion of the task so critical to Florida’s future.

Click here to access the entire report

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