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

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

TALLAHASSEE — After a U.S. district judge rejected its arguments, Florida will take a 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 filed a notice Monday that they are appealing U.S. District Judge William Jung’s May 31 decision to the 11th U.S. Circuit Court of Appeals.

As is often the case, the opinion does not detail the arguments the state will present before the Atlanta-based appeals court.

The lawsuit, filed in February in Tampa by Florida, challenges coverage guidelines for the federal Children’s Health Insurance Program, which operates in Florida as KidCare. The program provides low-cost health insurance to children whose families earn too much money to qualify for Medicaid. In Florida, that means families must pay $15 or $20 a month for coverage.

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

Because KidCare is funded by the state, the federal government and premiums, the complaint claims that payments to families 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.

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

Judge Jung ruled that Florida should file an administrative action with the Centers for Medicare & Medicaid Services, rather than filing a complaint in district court. The federal agency issued the guidance in fall 2023 through what Judge Jung’s decision describes as a “frequently asked questions,” or FAQ, document.

“(The Centers for Medicare & Medicaid Services) issued the FAQs and asked states that considered nonpayment of premiums an exception to continued eligibility to amend their (children’s health insurance) plans,” Jung wrote. “Rather than submit an amended plan or risk an adverse decision, Florida filed this action in federal court seeking a preliminary injunction. Florida cannot do that.”

He also wrote that “it is undeniable that any analysis of Florida’s (Administrative Procedure Act) claims will depend in large part on the proper interpretation of the Medicaid and (Children’s Health Insurance Program) statutes. The interpretation of those statutes is clearly within the expertise of (the Centers for Medicare & Medicaid Services), particularly given the recognized complexities of Medicaid and the (Children’s Health Insurance Program).”

U.S. Justice Department lawyers argued that the guidance properly implemented a federal law known as the Consolidated Appropriations Act of 2023, which made changes to the children’s health insurance program. In a court filing in February, Justice Department lawyers said the law required the children’s program to meet a “continued eligibility requirement” of Medicaid that does not allow coverage to be dropped for nonpayment of premiums.

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

Last year, the House and Gov. Ron DeSantis approved a bill that would expand eligibility for the program to 300% of the poverty level, with higher premiums than had been charged in the past. The expansion requires federal approval, and court documents say the state would have to meet the new guidelines to get approval.

By Jim Saunders, Florida News Service