Children’s Movement of Florida 2011 Legislative Agenda: Health Care Background Information

Health Care

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Florida has the nation's second-highest percentage of uninsured children, and one recent report places our state atop that list. More than 12 percent of our children – at least 548,000 of Florida's youngest, most vulnerable citizens – do not have health insurance. Children without health insurance do not receive adequate care, do not seek prompt treatment when they are ill, and when they enter a hospital in Florida, are 1.5 times as likely to die there as are insured children. Florida can provide health insurance to more than half of all uninsured children through outreach and a modest investment:

In Florida, KidCare has four parts:

• Medicaid: Covers children from birth through age 18. Age and income eligibility: 0-1 (185% FPL); 1-6 (133% FPL), 6-19 (100% FPL.)
• MediKids: Children from age 1 up to age 5 whose household income is between 133% and 200% of the Federal Poverty Level (FPL). The household is responsible to pay the monthly premium. (Note: the Federal Poverty Level for a family of 3 is $18,310; 133% FPL for a family of 3 is $23,803, and 200% FPL for a family of 3 is $36,620.)
• Florida Healthy Kids: Florida’s S-CHIP Program provides medical coverage for children ages 5 through 18 in households whose income is over the Medicaid limit and under 200% of the FPL. This household is responsible to pay the monthly premium.
• Children's Medical Services Network: Income-eligible children from birth through age 21 with chronic disease or mental health needs are covered for treatment and care coordination.

Outreach to eligible families to access KidCare including targeted enrollment efforts in schools: $6 million.

Community-based outreach efforts: $5 million

The University of Florida’s Florida Children’s Insurance Study 2007 shows an estimated 548,000 uninsured children in Florida - a conservative estimate. More than 400,000 of these are citizens or legal residents living at or near poverty and are eligible for KidCare. Families often do not know they are eligible for this coverage or how to access it. At its peak, Florida spent $10 million to increase and retain enrollment of children eligible to access Medicaid and KidCare. That outreach effort was associated with a significant increase in health insurance enrollment. Florida has employed highly effective grassroots and traditional marketing strategies to increase enrollment. When outreach allocations were discontinued, new enrollment fell. A 2010 OPPAGA study indicated that the Florida Healthy Kids Corporation, without allocated funds for outreach, spends only $46,000 for printing of materials for its “Back to School” Campaign, relying on the voluntary efforts of school districts to distribute postcards. The funding and effort is inadequate to reach all eligible families. OPPAGA recommends a more comprehensive effort and sufficient funding. A comprehensive community-based outreach budget developed by the Florida Covering Kids and Families Coalition estimated a cost of approximately $5 million for effective outreach efforts. These efforts would be supplemented by federal outreach grants of $1 million.

School-based outreach efforts: $1 million

The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) provides states with new tools and incentives to more effectively reach out to eligible but uninsured children. One of these new tools is Express Lane Eligibility (ELE), which allows states to enroll eligible children based on information they already have stored in their databases. Effectively, Medicaid and the Children’s Health Insurance Program (CHIP) are now allowed to borrow eligibility findings from other programs to determine eligibility and/or conduct renewals. This provides for cost-effective, targeted enrollment, particularly simplified, automated processes and school-based-efforts provided through the sharing of data from programs such as the free and reduced lunch program.

In a research memorandum dated March 1, 2010, OPPAGA discussed several options to improve Florida KidCare outreach and enrollment efforts through schools utilizing the free and reduced lunch program in which 53 percent of Florida public school students (1.4 of 2.6 million) were eligible in 2009-10. Because of similar income eligibility requirements of the two programs, school nutrition programs have information that could be used to identify children who are eligible for, but not currently participating in one or more KidCare program components.

School districts would incur minor staff time costs for modifying their file and data transfer system protocol to transmit additional data to the Department of Education (DOE), which would incur data handling costs. A one-time increase in legal expenses associated with the establishing of agreements for each entity that uses DOE’s data would also be incurred. While it is possible that some of these costs may be absorbed, $1 million has been set-aside to implement this option.

Increase number of children with health insurance: Provide more than 300,000 children with health insurance: $176.8 million (New federal funds generated: $271 million)

• To insure more than 200,000 Medicaid-eligible children, Florida would need to invest $121,697,633; the remaining cost of $151,450,856 would be covered through federal matching funds. Florida leaves this funding on the table each year because it does not produce the required 44.55% state match. The federal government would provide at least a 55.45% match for our state investment. In recent years the federal share has been even higher, lowering the state’s proportional cost; this trend is projected to continue. All children covered through Medicaid would be legal citizens or residents.
• Factoring in family premiums and the 68.5% federal share of costs, Florida can provide Healthy Kids coverage to nearly 100,000 eligible children for a state investment of $55,091,252; this would leverage $119,746,107 in federal funds. Like Medicaid, Florida leaves federal funds on the table each year because it does not produce the required state investment to cover all income-eligible children. All children covered through Healthy Kids would be legal citizens or residents.
• Using Express Lane Eligibility and the related practice of data-driven, automated renewal can help a state qualify for bonus payments:
  • States that exceed their enrollment target by 10 percent or less (“Tier I”) receive a performance bonus of 10 percent of the per capita cost of children’s Medicaid coverage in that state for each child enrolled above the target.
  • States that exceed their enrollment target by more than 10 percent (“Tier II”) receive a bonus of 62.5 percent of the per capita cost of children’s Medicaid coverage in the state for each child enrolled above Tier I.