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Florida appeals judge’s ruling on federal children’s health insurance guidelines

TALLAHASSEE — After a U.S. district judge rejected her arguments, Florida is sending her case to an appeals court in a dispute over new federal guidelines for a program that provides subsidized health insurance to children.

Attorney General Ashley Moody’s office and attorneys for the state Agency for Health Care Administration on Monday filed notice of appeal of the May 31 ruling by District Judge William Jung to the 11th U.S. Circuit Court of Appeals.

As is typical, the notice did not provide details of the arguments the state will present in the Atlanta appeals court.

The lawsuit, which Florida filed in Tampa in February, challenges coverage guidelines for the federal children’s health insurance program, which Florida calls KidCare. The program provides low-cost health insurance to children whose families earn too much to qualify for Medicaid. In Florida, that meant families paid $15 or $20 a month for coverage.

The new guidelines would prevent states from cutting off coverage for nonpayment of premiums after children have been deemed eligible for the program. Eligibility is determined annually, so the state says the guidelines could lead to coverage being provided for months without paying premiums.

Because KidCare is funded by the state, the federal government and premiums, the lawsuit said family payments play an important role in “maintaining the long-term stability” of the program. The state argued that federal officials violated a law known as the Administrative Procedure Act and sought a preliminary injunction to block the guidelines.

Jung, however, denied the request for a preliminary injunction and dismissed the lawsuit against the federal Centers for Medicare and Medicaid Services and the U.S. Department of Health and Human Services.

Jung ruled that Florida should file an administrative complaint with the Centers for Medicare & Medicaid Services rather than sue in district court. The federal agency will issue guidance in the fall of 2023 through a document that Jung’s ruling described as a “frequently asked questions,” or FAQ.

“(The Centers for Medicare & Medicaid Services) has issued FAQs and requested amended (Children’s Health Insurance Program) plans from states that were treating nonpayment of premiums as an exception to continued eligibility,” Jung wrote. “Rather than file an amended plan or risk an adverse ruling, Florida has filed this lawsuit in federal court seeking a preliminary injunction. Florida cannot do that.”

He also wrote that “it is clear that any analysis of Florida’s (Administrative Procedure Act) claims will rely in large part on a proper interpretation of the Medicaid and (Children’s Health Insurance Program) statutes. Interpreting these statutes is within the (Centers for Medicare & Medicaid Services)’s area of ​​expertise, especially given the recognized complexities of Medicaid and (Children’s Health Insurance Program).”

U.S. Justice Department lawyers argued that the guidance properly implements a federal law known as the Consolidated Appropriations Act of 2023, which made changes to the Children’s Health Insurance Program. In a February court filing, Justice Department lawyers said the law requires the children’s program to meet a “continuing eligibility requirement” in Medicaid that does not allow people to drop out of coverage because of nonpayment of premiums.

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Florida’s program dates back to the 1990s, and subsidized coverage is available to families with incomes up to 210 percent of the federal poverty level. For example, a family of four with an income of 200 percent of the poverty level this year would have an income of $62,400, according to federal calculations.

The Legislature and Gov. Ron DeSantis approved legislation last year that would expand eligibility for the program to 300% of the poverty level with higher premiums than those charged in the past. The expansion requires federal approval, and court documents say the state will have to comply with the new guidelines to get approval.

Author: Jim Saunders, News Service of Florida