That divergence represents more than just two states taking their own path. It showcases a broader breakthrough moment, Alker said, as the nation rethinks how government works for families following the covid-19 pandemic. \u00a0The divide also underscores the policies at stake in the 2024 presidential election.<\/p>\n
Republican-led legislatures in Florida and Arizona worked across party lines in 2023 to pass bills to expand their states\u2019 Children\u2019s Health Insurance Program \u2014 widely known as CHIP \u2014 which covers anyone younger than 19 in families earning too much to be eligible for Medicaid.<\/p>\n
Florida Republican Gov. Ron DeSantis and Arizona Democratic Gov. Katie Hobbs then signed bills into law last year that increased the amount of money a family can make and still be eligible for their states\u2019 CHIP programs. That\u2019s where the similarities end.<\/p>\n
Arizona began to enroll newly eligible children in March. That state has adopted policies that align with the Biden administration\u2019s efforts<\/a> to apply Affordable Care Act-style protections to CHIP, such as eliminating annual and lifetime limits on coverage and lockouts if families don\u2019t pay premiums.<\/p>\n Arizona\u2019s CHIP plan, called KidsCare<\/a>, suspended its monthly premiums in 2020 and has yet to reinstate them. State officials are considering whether it\u2019s worth the expense to manage and collect the payments given that new federal rules forbid the state from disenrolling children for nonpayment, said Marcus Johnson<\/a>, a deputy director for the state\u2019s Medicaid agency.<\/p>\n \u201cWe\u2019re trying to understand if the juice is worth the squeeze,\u201d he said.<\/p>\n By contrast, Florida has yet to begin its expanded enrollment and is the only state to file a federal lawsuit challenging a Biden administration rule requiring states to keep kids enrolled for 12 months<\/a> even if their families don\u2019t pay their premiums.<\/p>\n A judge dismissed Florida\u2019s lawsuit on May 31, saying the state could appeal to federal regulators. The state\u2019s CHIP expansion now awaits federal regulatory approval before newly eligible children can be enrolled.<\/p>\n \u201cNo eligible child should face barriers to enrolling in CHIP or be at risk of losing the coverage they rely on,\u201d said Sara Lonardo, a spokesperson for the federal Department of Health and Human Services.<\/p>\n Florida\u2019s CHIP expansion calls for significantly raising premiums and then boosting them by 3% annually. The state estimates expansion will cost an additional $90 million in its first full year and expects to collect about $23 million in new premiums to help fund the expansion of what it calls Florida KidCare<\/a>.<\/p>\n But Florida officials have said that complying with a provision that bars children from being disenrolled for unpaid premiums would cause the state to lose $1 million a month. The state\u2019s 2024 budget<\/a> allocates $46.5 billion to health care and projects a $14.6 billion surplus<\/a>.<\/p>\n Florida officials have flouted federal regulations and removed at least 22,000 children<\/a> from CHIP for unpaid premiums since the rule banning such disenrollments took effect on Jan. 1, according to public records obtained by the Florida Health Justice Project, a nonprofit advocacy group.<\/p>\n DeSantis\u2019 office and Florida\u2019s Medicaid administration did not respond to KFF Health News\u2019 repeated requests for comment about CHIP. But in legal filings, Florida said its CHIP plan is a \u201cpersonal responsibility program.\u201d It is \u201ca bridge from Medicaid to private insurance,\u201d the administration said on social media<\/a>, to get families used to premiums, cost sharing, and the risk of losing coverage when missing a payment.<\/p>\n For some Floridians, like Emily Dent in Cape Coral, the higher premiums proposed in the state\u2019s expansion plan would create a financial burden, not open a path to self-sufficiency.<\/p>\n Dent, 32, said her 8-year-old son, James, was disenrolled from Medicaid in April because the family\u2019s income was too high. Although James would qualify for CHIP under Florida\u2019s proposed expansion, Dent said the $195 monthly premium would be a financial struggle for her family.<\/p>\n Leaving James uninsured is not an option, Dent said. He is severely disabled due to a rare genetic disorder, Pallister-Killian syndrome, and requires round-the-clock nursing.<\/p>\n \u201cHe has to have health insurance,\u201d she said. \u201cBut it\u2019s going to drain my savings, which was going to be for a house one day.\u201d<\/p>\n Research shows the cost of premiums can block many families<\/a> from obtaining and maintaining CHIP coverage even when premiums are low.<\/p>\n And premiums don\u2019t offset much of a state\u2019s costs to operate the program, said Matt Jewett<\/a>, director of health policy for the Children\u2019s Action Alliance of Arizona, a nonprofit that promotes health insurance coverage for kids in the Grand Canyon State.<\/p>\n He noted that the federal government pays 70% of Florida\u2019s program costs and 75% of Arizona\u2019s \u2014 after deducting all premiums collected.<\/p>\n \u201cPremiums are more about an ideological belief that families need to have skin in the game,\u201d he said, \u201crather than any practical means of paying money to support the program.\u201d<\/p>\n Republican-leaning states are not alone in implementing monthly or quarterly premiums for CHIP. Twenty-two states<\/a>, including Democratic-leaning states such as New York and Massachusetts, charge premiums.<\/p>\n States have had wide discretion in how they run CHIP since the program became law in 1997, including the ability to charge such premiums and cut people\u2019s access if they failed to pay. That\u2019s been part of its success, said Jennifer Tolbert<\/a>, deputy director of the Program on Medicaid and the Uninsured at KFF.<\/p>\n \u201cEspecially in more conservative states, the ability to create CHIP as a separate program \u2014 independent from Medicaid \u2014 enabled and fostered that bipartisan support,\u201d Tolbert said.<\/p>\n But in the decades since CHIP was enacted, government\u2019s role in health insurance has evolved, most significantly after President Barack Obama in 2010 signed the Affordable Care Act, which introduced coverage protections and expanded assistance for low-income Americans.<\/p>\n Former President Donald Trump didn\u2019t prioritize those things while in office, Tolbert said. He has suggested that he is open<\/a> to cutting federal assistance programs if reelected, while the Biden administration has adopted policies to make it easier for low-income Americans to enroll and keep their health coverage.<\/p>\n Just as for Dent, the question of CHIP premiums in this debate isn\u2019t abstract for Erin Booth, a Florida mom who submitted a public comment to federal regulators<\/a> about Florida\u2019s proposed CHIP expansion. She said she would have to pay a high premium, plus copayments for doctor visits, to keep her 8-year-old son covered.<\/p>\n \u201cI am faced with the impossible decision of whether to pay my mortgage or to pay for health insurance for my son,\u201d she wrote.<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n![](\"https:\/\/esportslegendary.com\/wp-content\/uploads\/2024\/06\/James_Dent.jpg\")
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