Just last week we released a report commending Florida
for making significant progress in reducing the number of uninsured children
between 2008 and 2010. Today, we
are releasing a report that shows Florida will unravel much of that
progress if allowed to go forward with proposed changes to its Medicaid program
that include the imposition of a $10 premium on all Medicaid beneficiaries
enrolled in managed care. Since another central feature of the Section 1115
waiver request is to enroll the vast majority of Florida’s Medicaid enrollees
in managed care, this new premium would apply to virtually all children in
Florida’s Medicaid program. The
proposal was
approved by the Legislature and Governor but cannot go into effect without
federal CMS approval.
Thanks to the Jessie Ball DuPont Fund and Winter Park
Health Foundation, my colleague Jack Hoadley and I were able to take an
in-depth look at proposed changes to Florida’s Medicaid program and how they
would impact children and families.
So let’s take a look at the facts. Despite the recent progress we
reported, Florida still has one of the highest rates and largest number of
uninsured children in the nation.
Using a model developed by researchers at the Urban Institute based on
the experience of other states, we assessed the impact of charging these
premiums on families in Florida’s Medicaid program. We found that if the
premiums were instituted, 807,000 children and parents would drop their
Medicaid coverage because they couldn’t afford it. The vast majority of these families – 98% have incomes below
the poverty line. It is possible that some families would find other sources of
coverage but the declining availability of affordable employer-sponsored
coverage, especially for families with low incomes, makes it likely that many
of the children and their parents would become uninsured.
My colleague and co-author Jack Hoadley also points out
that the disenrollment of children and families from Medicaid would not only
impact the health and well-being of children and families, it would have ripple
effects throughout the state.
Those who disenroll are more likely to end up using emergency rooms and
delay primary and preventive care –increasing costs throughout the health care
system and safety net programs.
Medicaid has proven itself to be a cost-effective
approach to meeting the health care needs of uninsured children and families in
Florida and elsewhere. We found
that in Florida, Medicaid has shown a 4.8% decline in per person costs over the
past five years, while per person costs nationally for employer-sponsored
coverage have increased more than 31%.
While some states charge premiums in their Medicaid or
CHIP programs, it is typically at higher income levels. No state currently charges premiums to
Medicaid children with family incomes below the poverty line. Florida’s proposed premium requirement
is likely the most far-reaching to date because the state seeks to apply a
relatively high charge to everyone in the program regardless of income or age.