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Rates of uninsured children in Florida and around the nation decreased in the COVID-19 pandemic, but gains could be short-lived

Eden, Janine and Jim via Flickr creative commons

A new report finds that despite significant job losses at the beginning of the COVID-19 pandemic, rates of children without health insurance in Florida and around the nation actually improved. While this marks a positive trend, health policy experts warn, these gains could be short-lived.

The report, from the Center for Children and Families at Georgetown University, a nonpartisan policy and research center, finds the rate of uninsured children nationally improved from 5.7% to 5.4% between 2019 and 2021, according to an analysis of U.S. Census Bureau data.

Those percentages translate to about 200,000 more children having health coverage. Although Florida’s rate of uninsured children is higher than the national rate, the Sunshine State mirrored that trend, as the rate of uninsured children in Florida dropped from 7.6% to 7.3%.

Joan Alker is Executive Director and co-founder of Georgetown’s Center for Children and Families, a Research Professor at Georgetown’s McCourt School of Public Policy and the report’s lead author. She said these gains are largely due to federal protections put in place through a federal COVID-19 relief package, known as the Families First Coronavirus Response Act (FFCRA).

“So, what happened essentially was that states have been given more money during the pandemic for their Medicaid program, and in exchange for accepting those additional federal dollars, states agreed not to disenroll anybody from the program.”

Alker warns, however, that these gains will likely end when the federal public health emergency expires, which could happen as soon as April, although that date remains unknown at this time. “We don’t know for sure. That’s our best guess,” said Alker.

“The federal government released a study this summer that the vast majority of children, millions of children, (are) projected to lose Medicaid after these federal protections expire. An estimated three out of four of those children will remain eligible. So, this is not about children being on the program,” said Alker.

“For a state like Florida that hasn’t expanded Medicaid to other adults, children are the majority of your Medicaid enrollees, and they’re going to remain eligible, but they’re going to fall through the cracks due to these bureaucratic lapses, due to problems going through the renewal process.”

When federal protections preventing states from disenrolling Medicaid recipients ends, it will trigger all states to embark on a massive re-evaluation of Medicaid eligibility. Alker said Florida’s complex public coverage system means kids in the Sunshine State are especially vulnerable to losing access to medical care.

“We, in our report earlier this year, identified six states that have red flags. That means children are most at risk in these states and Florida was one of those six states. So, there’s just a lot of hurdles and barriers here to make this process go well. That’s what state leaders need to commit to: simplifying that process and protecting children along the way,” said Alker.

Nationally, the Center for Children and Families predicts that at least 6.7 million children are likely to lose Medicaid coverage for some period of time when the federally declared health emergency ends. Alker said this latest report, “finds there were 4.1 million uninsured children in 2021, so that would more than double if our projections are accurate. And to be honest, we thought our projections were kind of conservative.”

The Families First Coronavirus Response Act has been a boon for Florida’s Medicaid program, providing the state with more than $2 million in excess of what the federal government typically provides in order to cover higher enrollment rates during the pandemic. Still, Florida’s rate of uninsured residents is high overall, when compared to the rest of the nation.

“Florida ranks behind, for example, its neighbors in Alabama and Louisiana who have done significantly better for children,” said Alker.

“So, this has been an ongoing problem for Florida and there are lots of reasons we think Florida is, unfortunately, in position to go backwards even further than other states.”

She said Florida is “behind the pack” when it comes to modernizing its eligibility system and having programs in place to help answer questions and assist low-income families in navigating the state’s “very complex coverage system.”

For decades, the national rate of uninsured children had been improving. “The CHIP program (Children’s Health Insurance Program) was created in 1997. And so for a few decades there, progress was being made to reduce the number of uninsured children in the country and the lowest level of uninsured children was reached in 2016,” said Alker.

“And then once the Trump administration came into office, the numbers started going in the wrong direction and that was the case really until the pandemic started.”

Making sure children have healthcare coverage has broad-ranging societal benefits. “We have a lot of research showing that when children have Medicaid when they’re growing up, they are healthier as adults, they actually pay more in taxes and use fewer benefits. They have better educational outcomes,” said Alker.

“As a society, its very pennywise and pound-foolish not to make sure children are covered.”

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