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Florida vs. federal government: Gov. DeSantis’ battle against health insurance guidelines for kids hits roadblock


Florida – In a significant legal decision last Friday, a U.S. district judge dismissed a lawsuit brought by the state of Florida against new federal guidelines concerning the Children’s Health Insurance Program (CHIP), which provides subsidized health insurance to children. The court’s decision underscores a pivotal moment in the ongoing discussion about health insurance policies for lower-income families in the United States.

Florida vs. federal government: Gov. DeSantis' battle against health insurance guidelines for kids hits roadblock

Judge William Jung of Tampa issued a 16-page ruling that has pivotal implications for how states interact with federal guidelines regarding subsidized health insurance. The lawsuit, initiated by Florida in February, targeted the new federal stipulations that prevent states from discontinuing coverage for children once they have been deemed eligible for the program, even if premiums are not paid.

Florida’s challenge was rooted in concerns that the new guidelines would allow coverage to continue for months without the payment of premiums, potentially destabilizing the financial underpinnings of the program. According to the state, family payments are crucial for “maintaining the long-term stability” of the KidCare program, as it is known in Florida, where families typically pay $15 or $20 a month for coverage.

However, Judge Jung, appointed by former President Donald Trump, concluded that Florida should have first sought an administrative resolution with the Centers for Medicare & Medicaid Services (CMS) before approaching the courts. The judge emphasized that the CMS had issued the new guidelines through a “frequently asked questions” document in the fall of 2023 and had asked states to amend their CHIP plans accordingly.

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“Rather than submitting an amended plan or risking an adverse determination, Florida filed this action in federal court seeking a preliminary injunction. This Florida cannot do,” Jung wrote, dismissing the lawsuit and the request for a preliminary injunction.

The judge’s decision highlighted the complex legal framework governing federal and state interactions over health policy, particularly under the Administrative Procedure Act (APA). Judge Jung noted that interpreting the Medicaid and CHIP statutes “falls squarely within CMS’ realm of expertise,” acknowledging the complexities involved in managing these programs.

This legal outcome aligns with the arguments presented by U.S. Department of Justice attorneys, who defended the new guidelines as a proper implementation of the Consolidated Appropriations Act, 2023. These changes aim to reduce the administrative burdens and coverage lapses caused by frequent cycles of termination and re-enrollment, commonly referred to as ‘churn,’ which can disrupt continuous care for vulnerable children.

Future of Florida’s CHIP and Potential Expansion

Florida’s children’s health insurance program, dating back to the 1990s, currently offers subsidized insurance to families with incomes up to 210 percent of the federal poverty level. In an effort to expand these benefits, the Florida Legislature and Governor Ron DeSantis last year passed legislation to increase eligibility to 300 percent of the poverty level, albeit with higher premiums.

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However, the state’s plans hinge on federal approval, which now appears contingent on Florida adhering to the newly established federal guidelines regarding continuous eligibility. The CMS has explicitly indicated that it would not approve Florida’s proposed program expansion without modifications that prevent the disenrollment of eligible children for nonpayment of premiums during the eligibility period.

The recent court decision not only reaffirms the federal government’s authority over state-administered health programs but also sets a precedent for how disputes over such guidelines are to be resolved, emphasizing the necessity for states to engage with federal agencies through established administrative channels before resorting to litigation. As the legal and policy landscapes continue to evolve, the implications of this ruling will likely influence the administration of children’s health insurance programs across the nation.

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