A Florida circuit court judge listened to arguments Tuesday regarding the state's reluctance to expand Florida KidCare – a subsidized children's health insurance program. Meanwhile, the demand for KidCare increased earlier this year.
In March, the Florida Health Justice Project and the National Health Law Program filed a suit against the state on behalf of three Florida families, arguing that state healthcare leaders are breaking the law by not expanding Florida KidCare.
"Respondents are not complying with their clear ministerial duty to implement a change to state law, to the great injury of the petitioners as well as the other tens of thousands of children in Florida for whose benefit the law was enacted," said Lynn Hearn, the lead attorney for the FHJP.
In 2023, the Legislature unanimously passed a bill that would expand Florida KidCare, making more families eligible for the subsidized insurance. The law broadens the eligibility requirement from families making a household income within 200% of the federal poverty line to 300%. For a family of four, that's a household income of $64,300.
The expansion legally went into effect in January 2024. However, the Florida Agency for Health Care Administration, which oversees Florida KidCare, did not implement the expansion. AHCA leaders have repeatedly said over the years that it couldn't implement the expansion until it settled a lawsuit with the Centers for Medicare and Medicaid Services (CMS) regarding a rule in place that would require the state to cover families for 12 months if a family missed a monthly premium.
The state has challenged the rule in court several times over the last two years and has not found a legal victory. After dropping a lawsuit in February, it refiled another case against CMS later that same month and is currently in litigation.
Hearn argued that the lawsuit, or any previous lawsuit, shouldn't tie AHCA's hands from enacting the expansion.
"Respondents are free to pursue their dispute with the federal government over whether the continuous eligibility requirement is a valid condition of Florida's waiver," Hearn argued. "What respondents cannot do is use that dispute as a basis to block the program in its entirety, even after it has received the necessary approvals from the federal government to proceed."
CMS granted approval for the expansion in 2024. After approval was made, AHCA should have begun the procedure to implement the law, Hearn said.
However, the state's attorney, Nick Cavallaro, argued that's not the case.
"The approval does not automatically force the agency to immediately implement the program, regardless of what the federal approval says," Cavallaro said. "Once federal approval is obtained, respondents must still ensure the statute is legally implemented ... including making sure they are not implementing a statute in a way that would conflict with other statutes they are required to follow."
Cavallaro also argued that the plaintiffs should be thrown out of court because the families involved did not exhaust other available options to receive healthcare, and instead are relying on an "extraordinary remedy," or legal action, rather than exhausting other administrative services.
Addressing that argument, Hearn said there is no administrative remedy to the state's refusal to follow the law.
Judge Joshua Hawke concluded the hearing and said he would issue a ruling, but did not state when.
The families waiting
There are 68,000 uninsured children in Florida households with income between 200% and 300% of the federal poverty level, according to court documents.
Among them is 10-year-old Landon Booth, an Orlando resident and cancer survivor. Five years ago, he battled the disease and won, but it left his body in need of many post-chemo therapies, like speech, occupational, and physical therapy.
Landon is on a Full Pay coverage plan offered by the Florida Healthy Kids Corp., which is an insurance program under Florida KidCare that offers both subsidized and full-pay premium options. The plan doesn't cover extensive therapies kids like Landon require. Without more therapy, Landon is behind his peers and faces physical and mental developmental challenges.
However, if AHCA expanded KidCare, his parents would qualify for the income threshold, and he could get the therapies he needs, said Erin Booth, Landon's mom.
"My son really needs the right plan made for him," Booth said after Tuesday's hearing. "I hope the state decides to just drop the case because they are wasting tax dollars on a law that was already passed."
More Families in need of KidCare
During the first quarter of the year, the Florida KidCare program experienced a 6% increase in overall enrollment.
Seeing an increase in KidCare (which is known in most states as the Children's Health Insurance Program or CHIP) is a surprise considering the national trend has seen enrollment shrink, said Joan Alker, executive director of the Center for Children and Families at Georgetown University, which tracks Medicaid and CHIP around the country.
"It was good news to see CHIP enrollment heading in the other direction," Alker said. "These increases in CHIP, which are not huge, but they're turnarounds, show that kids need healthcare in Florida."
The numbers were discussed Wednesday during a Social Services Estimating Conference meeting in Tallahassee. The group meets to address next year's projections for KidCare ahead of advising workers planning the next fiscal budget year. The group is made up of members of the Florida Legislature, representatives of the Governor's Office, and state economists with the Office of Economic & Demographic Research.
The Florida Healthy Kids Corp. insurance has both government-subsidized plans and a full-pay plan, where families pay $276 a month for coverage.
Both programs saw a combined jump of over 10,000 children between December and April, a 6% increase, according to Florida Healthy Kids data.
That's an unusual jump and defied last year's projection of 2026, said Antonio Murphy, the chief financial officer at Florida Healthy Kids.
"The 12-month rolling trend coming out of the November caseload conference -- we were trending everything down based on some of the drastic disenrollment we were seeing back in the fall -- and then we get to the top of the year in January, and we start to see enrollment increase drastically, completely contradicting what we've seen coming out of the fall," Murphy said.
The board said they were unsure of why such a big increase occurred.
"By the time we get here for the January conference, we may have some more data to support... whether that trend needs to go up or down," Murphy said.
Meanwhile, there are thousands of kids like Landon Booth who aren't getting the right kind of insurance. If KidCare expanded, Landon would qualify for another KidCare insurance program, Children's Medical Services, that would cover all of his therapies and get him on track to heal.
But his parents, and many others, have an income beyond 200% of the FPL.
"You tend to see children in that part of (KidCare) who are pretty sick a lot of the time. These are children who may have cancer or autism and other serious conditions, and they really need healthcare," Alker said. "I really hope that the courts are going to intervene here and help kids out. I mean, this is just an absolutely terrible situation where you have children."
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