State, Advocates Struggle With KidCare Money Debate

Published: Aug 1, 2007

TALLAHASSEE - "If you're healthy and you know it, then your face will surely show it; if you're healthy and you know it, clap your hands."

Beaming girls and boys take turns singing new lyrics to the old tune in a television ad, now playing on cable news channels.

"It makes my heart sink," said Alex Sink, Florida's chief financial officer. "Every time I see one of those ads, I keep thinking about all this potential extra money that's going to be made available that, at this point and time, other states will soak up because those other states have good public health policy."

The ad, bankrolled by the pharmaceutical lobby, urges Congress to reauthorize the State Children's Health Insurance Program, or S-CHIP, a federal program that provides matching funds for health insurance that states provide to low-income children. S-CHIP will expire this year unless Congress renews it.

Most stakeholders and politicians agree on continuing S-CHIP, but debate over how to do it is in full swing on Capitol Hill. The Senate took up a bill this week that would pour an additional $35 billion into the $25 billion program. The House continues to fine-tune its version, which would add $50 billion. Meanwhile, President Bush is proposing $5 billion more and threatening to veto any attempt at significant expansion.

In Florida, it's not the veto threat that frustrates Sink most. Instead, she's dismayed that the debate seems to mean so little here, in light of millions in S-CHIP matching dollars that Florida has forfeited. This year, Florida will lose $20 million in S-CHIP money the state failed to spend in 2005 on KidCare, the state's health insurance program for low-income children.

Advocates and bureaucrats disagree over Florida's risk of losing future S-CHIP funds, but most agree the relationship between S-CHIP and KidCare has been a roller coaster since the beginning in 1998.

Sink, a Democrat who as CFO presides over much of KidCare, said the Legislature is unlikely to improve the program this year. She is looking for new ways to end paperwork headaches for parents and solve other problems that keep out eligible children.

"We drop thousands of kids off the program every month, because of some of these administrative hassles," Sink said. "Time's a-wasting."

Federal-State Partners

The federal S-CHIP program provides a 2-to-1 federal match for states to cover the health care costs of low-income children who do not qualify for Medicaid. In Florida, S-CHIP dollars cover about two-thirds of the cost of KidCare enrollment for about 224,000 children, with Medicaid covering enrollment for 1.1 million of those with the lowest incomes.

Democrats in Congress are confident efforts to authorize and expand S-CHIP will gain significant majorities in both chambers. But battles are expected to get intense.

In the House, Republican Adam Putnam of Bartow sees S-CHIP expansion as a move toward covering all Americans through Medicare, Medicaid or S-CHIP and "a bureaucracy that makes decisions about people's health care and remove patient choices."

Democratic Rep. Kathy Castor of Tampa, meanwhile, is an ardent proponent of expansion, calling it "the best thing going for not just kids and parents, but for state government itself" because the federal government provides 71 cents for every 29 cents the state provides.

Still, Florida controls much of its own destiny when it comes to insuring its poor children, and reforming KidCare has steadily slid down the list of legislative priorities in Tallahassee this year.

Florida's Uninsured Children

According to a revised 2005 U.S. Census report on health insurance, about 488,000 of the state's more than 700,000 uninsured children live in families with incomes low enough to qualify for KidCare, including those with incomes low enough for enrollment through Medicaid.

Strict payment, documentation and eligibility requirements "that might not be viewed as consumer friendly have been dogging the program since the beginning," said Les Beitsch, director of the Florida State University Center on Medicine and Public Health and former deputy secretary at the state Department of Health.

A bipartisan coalition of state lawmakers tried this spring to expand eligibility and simplify KidCare, which stretches across four state agencies. But Senate leaders refused, citing a lack of consensus among agencies and other stakeholders.

Since then, lawmakers and advocates have repeatedly raised the prospect of fixing KidCare during a special session. But as leaders have announced one session after the next, they have left KidCare out. House Speaker Marco Rubio and Senate President Ken Pruitt have called for limiting the session Sept. 18 to state budget cutting only.

"It's going to be very difficult in a budget-cutting session to get more for this program," said Rep. Bill Galvano, R-Bradenton, chairman of the House Healthy Families Committee. "The discussion sort of ended when the Senate made clear they were not going to put any more money towards KidCare in a special session."

On Monday, Galvano joined a committee created by Sink to find nonlegislative ways to improve Healthy Kids, the non-Medicaid part of KidCare that Sink oversees. The committee is recommending several fixes, such as billing families during the first month of coverage, rather than requiring advance payment before enrolling a child, and offering payroll deduction as a payment option.

Such changes should help, said Chris Card, a social worker who heads Sink's committee and sits on the Healthy Kids board. But he expressed frustration that state lawmakers have lost their appetite to address KidCare this year, even as federal lawmakers hammer out new S-CHIP rules and funding formulas.

"We need to position ourselves to best take care of our kids in Florida," he said. "How can we, at this point, even inform our congressional delegation as to what is in our best interest?"

Like Card, state leaders and advocates generally agree that increasing S-CHIP funding gives Florida KidCare the best chance at expanding in the future. But they disagree as to which of the S-CHIP proposals would serve the state best.

Two Versions Of The Story

Healthy Kids Director Rose Naff said Florida would benefit under the U.S. Senate's funding plan. Longtime child advocate Karen Woodall argued that only the House version would provide crucial flexibility, particularly regarding eligibility. Naff also sides with the White House on stopping a handful of other states from spending S-CHIP dollars on insurance for low-income parents and other adults, arguing that stopping the practice will free up more money to cover the nation's children in Florida and elsewhere.

Woodall disagreed. "What other states do with their allocation of dollars doesn't affect us."

Naff and Woodall offered different views of the state's loss of S-CHIP funds over the years. Woodall noted that the state has lost $139.7 million in unspent funds since 1998, the result of low state spending and underenrollment. Every dollar Florida has given up deprived a child of KidCare coverage, she said.

That's true, said Naff, but Florida has also spent enough in other years to reap extra funding, ultimately bringing the state's net gain to $29.6 million. The $20 million loss of funds this year, Naff added, results partly from a change in how federal officials redistribute unspent dollars.

State Rep. Galvano, who plans another attempt at reforming KidCare next year, said he has heard both versions of the story. It still boils down to 500,000 uninsured children who could be enrolled in KidCare today, he said.

"As long as those eligible kids are not in the program, we are missing an opportunity," he said. "We are leaving federal dollars on the table."

Reporters Billy House and Carol Gentry contributed to this report. Reporter Catherine Dolinski can be reached at (850) 222-8382 or