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State Weighs Cost of Covering More Kids

Children’s health care programs in Florida could attract millions more in federal dollars with a few changes aimed at easing enrollment.

But a new report warns that the cost to state taxpayers of revamping the existing Florida KidCare network could outstrip the amount of federal cash drawn into the programs.

The analysis by the state’s Office of Program Policy Analysis and Government Accountability could undermine a lingering fight pitting legislative Democrats who demand more coverage against Republicans struggling to balance a recession-ripped state budget.

In Florida, even with KidCare, one-in-six children are uninsured, according to the national advocacy group Families USA.

“We’re really in a position like that pop psychology game, `Lifeboat,’” said Sen. Don Gaetz, R-Niceville, a member of the Health and Human Services budget committee. “In this case, we don’t have enough money to go around for everyone. So we have to choose who gets to stay on. It’s a cruel game.”

Gaetz said that steering state dollars toward a KidCare expansion would likely detract from efforts to maintain other health and social welfare programs, with the state facing a $2.6 billion shortfall in next year’s budget.

But Sen. Nan Rich, a Weston Democrat who last spring got legislation approved that eased some eligibility requirements for KidCare, said there are still modest steps that could be taken to strengthen the number of children receiving state-backed health coverage.

Although 259,258 children are currently enrolled in KidCare, making them eligible for state-paid doctor visits, critics say that level falls far short of what it could be with 1 million Floridians out-of-work and unemployment at a 34-year high.

“It’s going to cost us some money, there’s no question,” Rich said. “But the bigger question is whether you pay up front or at the back end for medical problems. These uninsured kids and their families are going to wind up in emergency rooms costing the state even more money.”

Rich said she planned to reach out to potential allies, the Florida Hospital Association and the Florida Safety Net Hospital Alliance, which represents mostly large, teaching hospitals, to bulk-up the drive next spring for expanding KidCare.

“If people are eligible for the program, in this economy, it’s needed,” Rich said.

Bruce Rueben, president of the Florida Hospital Association, agreed.

“Our position is that it’s always better to have access to health coverage than not,” Rueben said. “Typically, when people don’t have health insurance, they wait and the outcome is worse and the costs are higher.”

OPPAGA, however, cautioned that Florida officials are uncertain about how much federal money the state could draw through the so-called “bonus payments” made to states that implement at least five of eight specific strategies to boost children’s health insurance enrollment.

State officials, however, were quick to put a price tag on the cost to the state for some of the proposed changes that Rich has advocated.

Presumptive eligibility, which would allow children to begin receiving services while their eligibility is determined, could cost $63 million in state funding; another $21 million in state cash would be needed to double to 12 months the time frame children aged 5 to 19 could receive Medicaid health coverage, state analysts found.

In the most modest upgrade of the program, $165,000 would be needed to draw federal dollars for so-called express-lane eligibility. Such streamlining allows states to use information from one public program to determine eligibility for other state-backed services.

While warning about the upfront costs of seeking more federal money, OPPAGA also said that bringing more families to Florida KidCare would likely result in the state finding more children eligible for Medicaid. Unlike KidCare, Medicaid is an entitlement program that can’t be limited by available dollars.

The state is currently facing a $1.7 billion projected deficit in the Medicaid program heading into next year.

Indeed, the health care overhaul making its way through Congress could have a profound effect on Florida’s health and human services programs. Similarly, KidCare has drawn new political shading, with Gov. Charlie Crist earlier this year appearing to distancing himself from the program’s success in criticizing federal efforts backing government-paid health care.

Crist has defended KidCare as a “limited” health insurance plan. And supporting efforts to expand the program could hurt the Republican governor in his duel with former House Speaker Marco Rubio for their party’s U.S. Senate nomination.

“We believe you should get as many kids enrolled as we can,” said Tony Carvalho, who lobbies for the Safety Net Hospital Alliance. “But there’s a bunch of things going on right now in health care that really confuse things.”

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