Florida’s Delayed Children’s Health Insurance Expansion Leaves Thousands Uninsured Despite Federal Approval

Like many parents, Tatiana Lafortune wants her children to receive a quality education, nutritious meals, and access to medical care when they’re sick. Public schools and her church’s food pantry help her meet the first two needs. Securing health insurance, however, has been the most persistent challenge.

Lafortune and her husband work as nursing assistants at a traumatic brain injury rehab center near Tampa, Florida. Their employer offers health insurance benefits, but the couple cannot afford the premiums. Their daughters also earn too much to qualify for subsidized coverage through Florida KidCare, the state’s safety net health insurance program for children in low-income families. The full monthly premium for enrolling her two daughters in KidCare is $525, an expense the family cannot cover. Instead, Lafortune purchased a family plan on the Affordable Care Act marketplace for $500 per month, though this plan lacks dental coverage and includes higher out-of-pocket costs.

“KidCare is better for children,” she said. “But at least I have something for them.”

In 2023, Florida lawmakers unanimously approved an expansion of KidCare to close coverage gaps for families like Lafortune’s. The expansion would raise the eligibility threshold, extending coverage to more than 40,000 children. Despite federal approval following a lawsuit, the changes have not taken effect. The administration of Florida Governor Ron DeSantis, a Republican, has not implemented the expansion, leaving the program mired in legal disputes and ongoing negotiations between state and federal regulators.

“I don’t know what they’re waiting for,” Lafortune said. “They should see people in Florida have needs.”

When asked for comment, DeSantis’ office directed KFF Health News to a March 31 press conference video, during which the governor referred questions to the state’s Agency for Health Care Administration, which oversees KidCare. The agency did not respond to repeated requests for an interview or information about the delayed expansion.

Federal Rule vs. State Policy: The Core Dispute

The delay stems from a federal rule adopted under the Biden administration. The rule requires all states to provide 12 months of continuous coverage for children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP), known as KidCare in Florida. This means coverage would not lapse even if parents miss a monthly premium payment. Florida is the only state to challenge this rule in court, suing the federal government for the right to disenroll children from KidCare for unpaid premiums and delaying the planned expansion.

“We’ve had to do a lot of back and forth with CMS on various things,” DeSantis said during the March press conference, referring to the Centers for Medicare & Medicaid Services (CMS), which regulates public health insurance programs.

In December, Texas also expressed opposition to the rule. Cecile Erwin Young, then the executive commissioner of Texas Health and Human Services, wrote to CMS Administrator Mehmet Oz, requesting the rescission of CHIP rules that require states to provide continuous coverage for children.