Florida's Child Health Care Law Leaves Thousands in Limbo

The second in a two-part series, this article was published originally by New America Media.

When three of Khorshadul Kabil’s children came home from school with high fevers, dread set in for the 42-year-old immigrant from Bangladesh and his wife.  Three of their four kids have severe asthma. In a few hours, the children — ages 3 to 14 — were heavily wheezing and coughing. Their father rushed them to a nearby hospital.

Kabil knows all too well that those symptoms can quickly escalate to a dire situation. The couple’s 14-year-old daughter has had convulsions. The 3- and 7-year-old boys have shortness of breath and chest pains at least twice a month.

“Our situation [is] not good,” said Kabil, who lives in Florida. “My job [doesn’t pay enough for me to buy] health insurance,” he said in broken English.

He works part-time at a small grocery store a few blocks from their rented house in Fort Lauderdale, Fla. His wife is a stay-at-home mom. There are times, he said, when they can’t afford to pay for their kids’ medicines.

The state has a nearly free, low-income health insurance program for children called KidCare, but the Kabils don’t qualify to take advantage of it. That’s because that program, like Medicaid, has a five-year residency requirement. The family emigrated from Bangladesh to the area just two years ago.

Kabil and his wife could enroll their children in KidCare, but they would have to pay much higher fees for each child -- almost $200 per child as compared to $20 per month for all his children.

Five-year ban slapped on new immigrants

When the Welfare Reform Act  passed in 1996,  the five-year ban was slapped on immigrants.  

But in 2009, when Congress passed the Children’s Health Insurance Program Reauthorization Act (CHIPRA), states were given the option of extending eligibility  to even newly minted immigrant children. CHIPRA even offered to pick up 70 percent of the costs if Florida did away with the waiting period. 

Momentum had been building in the state to do away with the five-year ban. Two state bills, introduced last year and sponsored by Republican Sen. Rene Garcia (SB 704) and Republican Rep. Jose Felix Diaz (HR 4023), would have eliminated the five-year waiting period for lawfully residing children.

Both bills failed to pass last week. Given the fact that Florida is in the midst of preparing for the onset of health care reform, including Medicaid expansion for low-income people, "there was only so much energy and time, and the Medicaid expansion -- rightfully so -- took a lot of that energy," lamented Linda Merrell, the convener for Florida Child Healthcare Coalition. The Medicaid expansion program became a higher priority for lawmakers, she said.

The five-year waiting period impacts somewhere between 20,000 and 40,000 immigrant children across the state, according to a Florida Center for Fiscal and Economic Policy (FCFEC) report. According to Merrell, Florida has the second highest number of uninsured children in the nation.

Karen Woodall, executive director of FCFEP, said that unless the bill is reintroduced and is passed next year, these children would remain uninsured.

“The Affordable Care Act…does not remove the five-year wait,” she said. “These kids will continue to use a more expensive emergency-room treatment, and the government will pay more for these services.”

Misinformation

There was also misinformation and confusion about the costs of eliminating the five-year waiting period and expanding Medicaid to include those children.

A fiscal analysis by Florida Agency for Health Care Administration (AHCA) reported that expanding healthcare to lawfully residing immigrant children would dramatically increase the healthcare costs for the state. Even though AHCA  retracted its analysis later on, advocates said, the damage twas done.

The Florida Center for Fiscal and Economic Policy contends that the maximum cost to the state to extend coverage to these children would be $17.6 million per year, an amount that could already be covered by unspent state funds already earmarked for children’s health coverage as well as funds freed up as a result of increased federal-match rates.

Florida currently receives about $39 million from the federal government, but that amount would increase to slightly more than $63 million if the state eliminated the five-year waiting period for legal immigrant children.

A strong anti-immigrant sentiment in the state also played a role in defeating the measures, advocates say.

“There’s still a very strong anti-immigrant sentiment among legislators,” Woodall explained. “It does not matter whether these children are lawful-residing immigrants.”

Sponsors of SB 704/HB 4023 pledge to reintroduce the bills again at the first state legislative session in 2014 or even earlier at a special session.

Life-changing Accident

Palm trees and white beaches were part of the American Dream for Kabil and his family when they first came to Fort Lauderdale.

“We love it here. The weather [is] like Bangladesh; it’s comfortable,” he said.

But, just a year after they arrived, things took a bad turn. Kabil had a hit-and-run accident that left him nearly crippled. The driver has not been found.

“I was walking to my work and the car came [from behind me]. I did not see it,” he recounted. “I was on the ground, but the driver did not stop.”

Although he can still walk, the accident has affected his mobility. He gets tired easily, he says, particularly if he works for a long time in a day.

“I need a doctor. My kids need a doctor,” Kabil said. “Every day we have health problems, but we have no access to health care.”