1. Health reform in Florida and the impact on
its children
Thursday, December 6 11:45 am to 12:30 pm
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2.  Introduction
 Children’s coverage and the ACA – Joan Alker,
Georgetown University Center for Children and
Families
 2012-2013 Opportunities and Goals for Child
Health Advocacy– Diana Ragbeer, The Children’s
Trust of Miami Dade
 Q&A
Today’s program

3. How is Florida doing in covering kids?
Joan Alker

4. Uninsured Children in Florida
Percent of 2011 State Number of 2011 State
Uninsured Ranking in Uninsured Ranking in
Children Percent of Children Number of
Uninsured Uninsured
Children Children
Florida 11.9% 48th 475,112 49th
National 7.5% -- 5,527,657 --

5. Florida – 3rd in Percentage Point
Change of Uninsured Children
2009-2011 Percentage Rank 2009-2011
Point Change Percentage Point
Change
United States -1.1 -
Florida -2.9 3
Source: “Uninsured Children 2009-2011: Charting the Nation’s Progress” Georgetown Center for Children
and Families, October 2012.

6. Florida vs. Neighboring states:
Rate of uninsured children in 2011
Florida 11.9%
Alabama 5.3%
Georgia 9.5%
Louisiana 5.8%
South Carolina 8.4%

7. What are the key issues for kids in the
ACA?
Joan Alker

8. Children’s Coverage in Florida,
2014

9. Key ACA issues for children
•Maintenance of effort which prohibits states from
rolling back eligibility for adults until 2014; children
2019.
•This includes proposals to make it harder for
people to enroll such as premiums or other ways in
which a state might add “red tape.”

10. Key ACA issues for children
•Alignment of eligibility for children below 133%
FPL i.e. “stairstep kids”.
•Intersection between Exchange and
Medicaid/Healthy Kids with respect to enrollment
practices
•Extending Medicaid coverage for parents and
other adults
•Moving to family based coverage

11. Policy and Procedural Changes
Under ACA
•No wrong door – coverage is coordinated regardless of
point of entry
•Multiple paths to enrollment, renewal, reporting
changes – online, phone, in-person, mail
•Eligibility – data-driven, technology-enabled, real-time
•Automated renewals using available data
•Navigators and enhanced consumer assistance

12. Current Eligibility Levels

13. How many Floridians would gain
coverage?
•We estimate that 815,000 to 1,270,000 adults
and children would gain coverage if the state
extended Medicaid to parents and other adults
below 133% FPL
Joan Alker

14. Why would children get coverage?
•Coverage is being extended for parents
and adults – the “newly eligible”
•But we know that more current eligibles
will get enrolled as a result of the “welcome
mat” effect. Most of these “eligible but
unenrolled” will be children.

15. Different federal matching rates
apply
•“Newly eligible” are funded at 100% federal cost
for FY2014-2016; tapers down to 90% over the
next seven years;
•Current eligibles get regular Medicaid match rate
(58%) or CHIP match rate (71%)
•Participation rates are likely to go up even without
Medicaid extension because of new “culture of
coverage”

16. Who Will remain uncovered w/o
broader Medicaid coverage?

17. New Medicaid enrollment if
changes occur
Adults Adults Children
newly currently currently
Total
eligible for eligible for eligible for
Medicaid Medicaid Medicaid
Total uninsured 1,295,000 257,000 500,000 2,052,000
Projected take-up rate
57% 10% 10%
(low assumption)
Number projected to
gain Medicaid
740,000 25,000 50,000 815,000
coverage
(low assumption)
Projected take-up rate
75% 40% 40%
(high assumption)
Number projected to
gain Medicaid
970,000 100,000 200,000 1,270,000
coverage
(high assumption)

18. Bottom line
•Florida incurs few costs for adults newly
eligible for Medicaid, slightly higher costs for
new enrollment by those already eligible.
•But savings due to more coverage should
more than offset costs.
•New coverage has positive effects for health
and quality of life

19. 2012-2013
Opportunities and Goals for Child
Health Advocacy
Diana Ragbeer

20. Alignment with
CHIPRA/Continuation
Opportunities
•Extend coverage to all children who are eligible
and qualify for the enhanced federal match under
provisions of the Children’s Health Insurance
Program Reauthorization Act (CHIPRA).
• Reinstate and implement presumptive eligibility
for all Florida KidCare program components.

21. Alignment with
CHIPRA/Continuation
Opportunities
•Implement 12-month continuous eligibility to
promote health outcomes and quality of care for
children enrolled in all Florida KidCare program
components. (Currently, children ages 6-19 with
incomes below the poverty level are excluded while
more moderate-income children of the same age
qualify).

22. Administrative Efforts
•Implement “express lane eligibility” in KidCare to
expedite enrollment by using information from
other public programs (such as school district free
and reduced lunch data)

23. Affordable Care Act
• Ensure that all adults who are newly eligible for
Medicaid under the Patient Protection and Affordable
Care Act (up to 138% of the federal poverty level) are
extended coverage under Florida law. (When parents
gain coverage, children gain coverage, and economic
security for the entire family is improved)
Diana Ragbeer

24. Affordable Care Act
Alignment with Changes
in Federal Law
Florida must revise state statue and/or regulations to ensure
compliance with federal law in these areas:
•Align Medicaid coverage to 138% of the federal poverty
level for children of all ages. Shifting children from
Healthy Kids to Medicaid will keep children in the same
family in the same program, thereby improving
administrative efficiency
•Increase Medicaid reimbursement rates for primary
care providers to assure access to care, drawing down
100% federal funding to boost rates to Medicare levels

25. Affordable Care Act
Alignment with Changes
in Federal Law
Florida must revise state statue and/or regulations to ensure
compliance with federal law in these areas:
•Ensure that federal funds are appropriated to
implement the “no wrong door” state law that requires
Florida to upgrade, coordinate and increase the
efficiency of enrollment and eligibility systems.

26. More information
Joan Alker
jca25@georgetown.edu
ccf.georgetown.edu
www.theccfblog.org/
Diana Ragbeer
diana@thechildrenstrust.org
www.thechildrenstrust.org

27. Thanks for joining us!
www.kidswellflorida.org
info@kidswellflorida.org