Florida is among the top 10 states to see declines in children's Medicaid enrollment, according to real-time data measured by Georgetown University Center for Children and Families.
Since 2025, the Sunshine State has been listed as having the fourth largest decline, 5%, behind Indiana, Texas and California.
Why? Some experts, such as Joan Alker, director of the Center for Children and Families, think it is the result of President Donald Trump's aggressive illegal immigration policies.
"They're having a chilling effect," Alker said.
According to Georgetown research, immigrant parents aren't seeking their children's Medicaid even though they legally qualify.
"So they're faced with this horrible choice of not accessing the healthcare their child is entitled to because they fear deportation," she said.
The real-time Georgetown tracker reached 2 million fewer children in Medicaid since Trump took office in January 2025.
What concerns Alker more is where these kids are getting — or not getting — insurance now. With changes to the Affordable Health Care marketplace, options outside of Medicaid are few.
Last year, the Trump administration didn't renew the "enhanced premium tax credit," which kept monthly premiums "affordable." In Florida, about 97% of customers used the tax credit, KFF research shows.
"Unfortunately, I think we can feel pretty confident that the uninsured rate for children is going up," Alker said.
According to Georgetown research, the past decade has shown an inverse relationship between a shrinking Medicaid rate and a growing uninsured rate.
"Typically, when Medicaid enrollment of children goes down, the uninsured rate for children goes up," Alker said. "And Florida's was already going up due to its poor performance during the Medicaid unwinding."
Medicaid unwinding
Between 2022 and 2024, Florida reported a jump in its children's uninsured rate from 7.4% to 8.5%, according to U.S. census data.
That period was during Medicaid unwinding, in which states were allowed to review eligibility and terminate coverage for those on the federal-state insurance program.
In 2020, Trump signed into law the continuous enrollment provision, which meant states could not remove people from Medicaid coverage during the COVID-19 public health emergency. Once the emergency ended, states could review eligibility.
In 2023, Florida, like other states, began removing people from Medicaid. By the end of the unwinding period, it had removed about 500,000 kids.
At the time, about 80,000 children migrated over to Florida's Children's Health Insurance Program (CHIP), but it was not known what happened to the vast majority of other children, as the state did not track that information. The newly released census data paints a better picture, revealing that about 67,000 kids became uninsured between 2022 and 2024.
The Legislature did create a solution to help families who cannot afford insurance for their children, but the state has yet to implement it.
Now the state is preparing to explain to a judge why it can't implement that solution.
Delayed KidCare
In 2023, the Legislature unanimously passed an expansion to Florida KidCare – the state's subsidized children's health insurance. The expansion allows families who make an income within 300% of the federal poverty level (FPL) to qualify for subsidized insurance. Previously, only families whose income was within 200% of the FPL qualified.
The state Agency for Health Care Administration has yet to follow through on the law, arguing the federal government is preventing Florida from doing so.
AHCA has argued that a Biden administration rule is preventing the state from expanding.
In 2024, the federal Centers for Medicare and Medicaid Services issued rules requiring states to provide 12 months of continuous coverage for children in Medicaid and CHIP, even if the family misses a monthly premium. The idea was to protect children's healthcare or treatments from being interrupted by temporarily missed payments.
AHCA sued in federal court to eliminate the 12-month requirement. The state argued that it would cost the state too much money to uphold the requirement. The complaint was dismissed.
At a meeting in October, state senators asked AHCA Deputy Secretary for Medicaid Brian Meyer why the expansion hadn't started yet.
"We are certainly proponents of the legislation we would have implemented long ago if we could," Meyer said, referring to the lawsuit as the reason.
Alker isn't convinced the 12-month rule is holding the state back.
"I just have to conclude that (Gov. Ron DeSantis) really wants to not do the expansion. I think he's going to try everything he can to leave office without expanding KidCare, which was the bipartisan will of the Legislature," Alker said.
In March, the Florida Health Justice Project and the National Health Law Program filed a lawsuit in a Leon County Circuit Court against AHCA and Florida Kidcare.
Earlier this month, a motion for a hearing was granted. A court is expected to take up the issue with the state in late July.
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