Many Working Parents and Families in Florida Would Benefit from Closing the Coverage Gap by Georgetown University Center for Children and Families and Kids Well Florida Key Points Introduction 1. The Florida legislature is currently debating a bill to The U.S. has made significant progress expand Medicaid to over one million low-income in decreasing rates of uninsurance for Floridians. In Florida, uninsured parents with children parents and adults.2 However, many low- present in the home account for 28 percent of the income families in Florida still struggle to population potentially eligible for health coverage obtain health coverage. In 2013 (prior to if the state expands Medicaid.1 A significant the Affordable Care Act’s major coverage coverage gap exists for parents whose income provisions), there were over 3.9 million exceeds Florida’s extremely low eligibility threshold people living without health insurance for Medicaid but don’t earn enough to receive tax coverage in Florida, accounting for 8.5 credits for coverage through the federal health percent (1 in 12) of all uninsured individuals insurance marketplace. A parent in a family of three in the United States. working more than 18 hours a week in a minimum The Affordable Care Act (ACA) created new wage job would earn too much to get Medicaid opportunities for low-income adults to enroll coverage under Florida’s stringent guidelines. in coverage through two principal means. 2. Of those parents that could benefit from extended First the ACA expands Medicaid eligibility to Medicaid eligibility, 63 percent are employed and low-income adults under 138 percent of the many of them are in jobs supporting Florida’s Federal Poverty Level (FPL), with the intent service based, tourist-dependent economy. of raising the Medicaid eligibility level in all Uninsured parents potentially eligible for Medicaid states.3 The ACA also established health expansion are most likely to be white, between the insurance marketplaces where consumers ages of 26 to 49 years old and have one or two can shop for private health insurance as children. well as qualify for tax premium subsidies 3. Florida has some of the highest rates and numbers and cost-sharing reductions. States now of uninsured children and parents in the nation. have flexible options for providing Medicaid Providing health coverage to Florida’s parents coverage to parents and childless adults would reduce children’s uninsured rate and with incomes up to 138 percent of the FPL. enhance families’ financial security. Experience Today, twenty-eight states and the District of from other states shows that an extremely Columbia have taken the option to expand effective way to reduce the uninsured rate for Medicaid coverage.4 children is to extend coverage to parents so the whole family can get covered. April 2015 CCF.GEORGETOWN.EDU and KIDSWELLFLORIDA.ORG FLORIDA MEDICAID EXPANSION 1 Figure 1. Parents Will Remain Uninsured Without Broader Medicaid Coverage* 400% of the FPL ($80,360/year) Exchange Subsidies (Premiums based on sliding scale ranging from 2% - 9.5% of income) 215% of the FPL ($43,194/year) 138% of the FPL ($27,724/year) 100% of the FPL ($20,090/year) Medicaid/ Coverage Gap: Florida Exchange Subsidies KidCare Unavailable 34% of the FPL ($6,831/year) Children Parents Childless Adults * FPL is for a family of 3 in 2015. Florida is one of 22 states that has elected not are uninsured in Florida, 37 percent currently to accept federal funding under the ACA to have a path to coverage, but this number would extend Medicaid coverage to parents and other increase to 68 percent if Florida expanded low-income adults. Consequently, parents in Medicaid.7 Research based on the experience Research based on Florida are not eligible for Medicaid or premium of other states shows that insurance rates for the experience of tax credits if their incomes exceed 34 percent children improve when coverage is available to other states shows of the poverty line ($6,831 annually, or $569 per the whole family. month, for a family of three in 2015) but remain that insurance rates Florida saw robust enrollment in its Federally below 100 percent of the poverty line ($20,090 for children improve annually, or $1,674 per month for a family of Facilitated Marketplace (FFM), yet a large when coverage is three).5 coverage gap remains.8 During the second open enrollment season (October of 2014 through available to the As a result, there are an estimated 764,000 February of 2015), nearly 1.5 million adults ages whole family. Floridians (including childless adults) who fall 18 to 64 signed up for coverage through the into this coverage gap and a total of 1.2 million exchange—the highest number of enrollees in adults excluded from coverage due to Florida’s any state.9 decision not to expand Medicaid.6 Of those that 2 FLORIDA MEDICAID EXPANSION CCF.GEORGETOWN.EDU and KIDSWELLFLORIDA.ORG April 2015 In Florida, many more individuals with Who are the Uninsured in incomes between 35 and 100 percent of FPL would likely sign up for coverage through Florida? the exchange if they were not excluded from Data reported here is from 2013 and does not receiving tax subsidies. Adults with incomes reflect the impact of the ACA’s major provisions between 100 and 138 percent of FPL, while that took effect on January 1, 2014. Full eligible for tax credits through the marketplace, implementation of the ACA will likely improve may forego coverage if the cost proves to coverage rates and will be reflected in 2014 be prohibitive. If Florida decides to extend data when it becomes available.12 Medicaid, many adults in the coverage gap Florida has some of the highest rates and would become eligible for Medicaid, which has numbers of uninsured children and parents in strong cost-sharing protections for low-income the nation. parents. zz Florida ranks 47th among all states and Should Florida choose to extend Medicaid the District of Columbia in percent coverage to adults with incomes up to 138 of uninsured children (11 percent or percent of FPL, federal funding will be available about 445,000 of Florida’s children are to cover 100 percent of the costs for this uninsured). new coverage through 2016. A conservative zz In the U.S., there are 13.9 million uninsured estimate, based on the state’s Estimating parents. Florida has the 49th highest rate of Conference data, finds that in 2015 Florida is uninsurance for parents in the nation, with losing $10 million in federal funds every day 28 percent (1.1 million) of Florida’s parents because lawmakers have not accepted the remaining uninsured. money to extend Medicaid coverage.10 In 2014 the state gave up over $3.6 billion in federal funding. The Federal Medical Assistance Figure 2. Rates of Uninsurance in Percentage (FMAP) for this population Florida and the U.S., 2013 decreases to 95 percent in 2017 and eventually 30.0% declines to 90 percent in 2020. Even then, the 28.1% FMAP for the expansion population is much 25.0% Florida ranks higher than the regular Medicaid matching 47th rate, which is just below 60 percent, making 20.0% 19.8% for highest rate of Medicaid expansion a good deal for Florida. uninsured Florida would likely accrue savings in other 15.0% children areas of the state’s budget if expansion were and 11.1% enacted.11 49th 10.0% for highest 7.1% rate of uninsured 5.0% parents 0.0% Children Parents (under 18 years old) (18-64 years old) Florida U.S. April 2015 CCF.GEORGETOWN.EDU and KIDSWELLFLORIDA.ORG FLORIDA MEDICAID EXPANSION 3 Who are the potentially poor. More than half (57 percent) of potentially eligible uninsured parents live eligible parents in Florida? below the poverty line (35 to 100 percent The population of low-income uninsured FPL). In Florida, minimum wage workers parents most likely to be helped by Medicaid make $8.05 per hour.13 This means that About half (47 expansion in Florida are white, employed, and minimum wage workers in a family of have one to two children. three who work more than 18 hours per percent) of all week have incomes too high to qualify potentially eligible Employment for Medicaid (34 percent of the FPL is uninsured parents zz Of those potentially eligible uninsured $142 per week). Employees earning the work in retail, parents, working parents are most likely to minimum wage who work more than gain coverage through Medicaid expansion 18 hours per week but earn less than restaurants, and in Florida. Nearly two-thirds (63 percent) $419 per week have incomes too high professional services. of the uninsured parents that could benefit for Medicaid and too low for premium from expanded Medicaid eligibility are assistance through the exchanges. employed outside of the home. One zz Reflecting the nature of Florida’s service quarter (24 percent) of these parents are based, tourist-dependent economy, not in the labor force, meaning they are about half (47 percent) of all potentially most likely students, homemakers, or eligible uninsured parents work in retail, otherwise retired workers. Only 13 percent restaurants, and professional services.14 of these parents are unemployed. Top professions for these parents zz One-fifth (22 percent) of potentially eligible include restaurant and other food service uninsured parents are from families with occupations, construction, department two working parents in the home. and grocery store clerks, and landscaping. zz Florida’s Medicaid expansion would lead to greater health coverage for the working Figure 3. Top 10 Industry Sectors for Potentially Eligible Uninsured Parents 25.0% 20.0% 15.0% 10.0% 5.0% 0.0% 4 FLORIDA MEDICAID EXPANSION CCF.GEORGETOWN.EDU and KIDSWELLFLORIDA.ORG April 2015 Family Demographics Figure 4: Uninsured Florida Parents zz The majority of potentially eligible Potentially Eligible for Medicaid uninsured parents are in young to middle by Race and Ethnicity adulthood, between ages 26 and 49 years of age (64 percent). The vast majority By Race of families (78 percent) have one or two children. More than half of families (54 percent) have school-aged children (those ages 6 to 17 years old). White Black zz Of the potentially eligible uninsured 67% 25% parent population, two-thirds are white (67 percent). The remaining third of this population self-identifies as Black (25 percent), American Indian/Alaska Native (6 percent), and Asian/Native Hawaiian/ Pacific Islander (2 percent).15 Asian/ American Indian/ Hawaiian/API Alaska Native zz Florida has a large Hispanic population 2% 6% (24 percent of the population) and they experience a high rate of uninsurance. Nearly one in every three Hispanic By Ethnicity individuals (31 percent) are uninsured. Florida also has one of the highest rates of uninsurance for Hispanic children with 14.4 percent of all Hispanic children lacking Hispanic health coverage (168,000 uninsured 37% White children) compared to the national average (non-Hispanic) Non- 63% of 11.5 percent.16 Hispanic zz Medicaid expansion would significantly 63% help Hispanic families gain coverage. Just over one-third (37 percent) of eligible parents are Hispanic (who may be of any race).17 April 2015 CCF.GEORGETOWN.EDU and KIDSWELLFLORIDA.ORG FLORIDA MEDICAID EXPANSION 5 Children Benefit When Their Parents Have Coverage Covering parents increases the likelihood of and parents reduces hospitalizations and leads to children being enrolled in health coverage. This is fewer emergency department visits later in life.24 particularly important in Florida, which has one of Not only does Medicaid expansion for parents the highest rates of uninsured children in the nation and Medicaid coverage for children lead to better (11 percent). A number of studies find that when health outcomes in the short-term, but it also leads parents are insured, children are more likely to have to better long-term outcomes including lower rates health coverage.18 This is because most uninsured of mortality, improved educational attainment, children are already eligible for Medicaid or CHIP and government savings. One study found that but not enrolled. For example, a recently published Medicaid eligible children were more likely to study in Oregon showed the odds of eligible children attend college and had lower rates of mortality receiving Medicaid or CHIP coverage doubled if their than their non-Medicaid eligible counterparts.25 parents enrolled in Medicaid.19 In Massachusetts, Expanding Medicaid eligibility improved the health coverage expansions for parents helped cut economic outcomes for low-income children the uninsurance rate for children in half.20 who experienced positive economic mobility In Florida, an estimated 305,000 children are in adulthood.26 In addition, children enrolled eligible for Medicaid/CHIP but are not enrolled. The in Medicaid had higher wages and, because average Medicaid/CHIP participation rate in the they contributed more taxes later in life, led the United States for children is 87 percent and Florida’s government to recoup most of the dollars spent on Medicaid/CHIP participation rate is well below that Medicaid for children.27 Untreated maternal at 83 percent. Vermont, on the other hand, has the depression can be highest rate of participation with 97 percent of all When parents are covered, their health status improves along with the well-being of their damaging to a eligible children enrolled.21 If Florida increased its children. Uninsured parents have more difficulty child’s cognitive, participation rate to the level achieved in Vermont, accessing needed care, potentially compromising about 49,000 children would gain health insurance. social and emotional their ability to work, support their families, and care development. Extending Medicaid coverage for parents and other for their children.28 Medicaid coverage improves low-income adults has proven to be an effective access to necessary health care and decreases strategy to boost children’s enrollment rates. out-of-pocket spending for low-income adults, Arkansas enrolled significant numbers of already improving financial stability for the whole family. eligible children when the state expanded coverage For example, more than half of all infants living in to their parents. In just one month, Arkansas’s poverty have a mother suffering from depression.29 enrollment effort resulted in 58,000 new enrollees, Untreated maternal depression can be damaging including 2,500 children.22 to a child’s cognitive, social and emotional development. While depression is treatable, many Recent research shows that children with poor mothers do not receive care. In Oregon, rates Medicaid coverage and Medicaid-eligible parents of depression decreased by 30 percent as a result have improved physical well-being, earning of new Medicaid coverage.30 potential, and educational attainment. Children enrolled in Medicaid are more likely to receive States choosing to extend Medicaid coverage well-child care and are significantly less likely to to parents directly help children by reducing the have unmet or delayed needs for medical care, number of uninsured children, boosting a family’s dental care, and prescription drug use due to financial security, and enabling children to get cost.23 Expanding Medicaid eligibility to children better care from healthier parents. 6 FLORIDA MEDICAID EXPANSION CCF.GEORGETOWN.EDU and KIDSWELLFLORIDA.ORG April 2015 Appendix: Profile of Uninsured Parents in Florida Potentially Eligible for Medicaid Age Age of Children 18-25 26% Presence of young children (under 6 years only) 19% 26-34 25% Presence of school-aged children 35-49 39% (6-17 years only) 54% 50-64 10% Presence of both young and school-aged children (under 6 and 6-17 years) 26% Federal Poverty Level 35-100% of FPL 57% Employment Status Employed (Civilian) 63% 101-138% of FPL 43% Unemployed 13% Race Not in Labor Force 24% White 67% Top 10 Industry Sectors Black 25% Retail 19% American Indian/Alaska Native 6% Restaurants/Food Services 15% Asian/Hawaiian/API 2% Professional Services (accounting, Ethnicity architecture business support, etc.) 13% Hispanic 37% Medical (hospitals, dentist, outpatient care) 10% White, non-Hispanic 63% Construction 10% Service (beauty, car wash, maintenance, Number of Children other) 8% 1 44% Transportation 4% 2 35% Financial (banking, insurance, real estate) 4% 3 15% Entertainment (arts, recreation 4% 4 to 7 7% Manufacturing 3% Note: Due to rounding, percentages may not add to 100 percent. April 2015 CCF.GEORGETOWN.EDU and KIDSWELLFLORIDA.ORG FLORIDA MEDICAID EXPANSION 7 Methodology Data Source the ACS provides one-year health insurance This brief analyzes 2013 Public Use Microdata coverage estimates. The U.S. Census Bureau Sample (PUMS) from the U.S. Census Bureau recognizes and reports race and Hispanic origin American Community Survey (ACS) and applies (i.e., ethnicity) as separate and distinct concepts. the PUMS person weight. The U.S. Census Bureau To report on an individual’s race, we merge the publishes PUMS data on Data Ferrett. data for “Asian alone” and “Native Hawaiian or Parents other Pacific Islander alone.” In addition, we report The estimates presented here focus on parents the ACS category “some other race alone” and defined as civilian non-institutionalized adults age “two or more races” as “Other.” Except for “Other,” 18 to 64 living with a biological, adoptive, or step all other racial categories refer to respondents who child under the age of 18 (“own” children). Note indicated belonging to only one race. that the definition of “own” children excludes We report “Hispanic or Latino,” as “Hispanic.” As foster children since they are not related to the this refers to a person’s ethnicity, these individuals householder. We did not adjust the family unit may be of any race. We report data for both “white” definition to analyze health insurance units (HIUs), parents and “white non-Hispanic parents.” The most likely resulting in an undercount of the total former refers to all parents whose race is reported number of individuals. as white, without regard to their ethnicity; the Health Coverage latter category refers to parents who reported their Data on health insurance coverage are point-in- race as white and do not report their ethnicity as time estimates that convey whether a person does Hispanic. For more detail on how the ACS defines not have coverage at the time of the survey. The racial and ethnic groups see “American Community estimates are not adjusted to address the Medicaid Survey and Puerto Rico Community Survey 2013 undercount often found in surveys, which may be Subject Definitions.” accentuated by the absence of state-specific health Employment insurance program names in the ACS. This brief reports those who are employed as Medicaid Eligibility Under Current Rules those who had a job or business and those who Data on poverty levels includes only those are unemployed as those who do not work or individuals for whom the poverty status can are actively looking for work. The labor force is be determined for the last year. Therefore, this everyone classified as employed or unemployed. population is lightly smaller than the total non- People who are not in the labor force are mostly institutionalized population of the U.S. We include students, homemakers, retired workers, seasonal only those parents whose income-to-poverty status workers, institutionalized people, and people doing is determined to be 35 percent to 138 percent of unpaid family work. Federal Poverty Level ($7,032 to $27,724 for a As defined by the U.S. Department of Labor family of three in 2015). Bureau of Labor Statistics, working part-time is The ACS does not contain sufficient information to working between 1 and 34 hours per week and full determine whether an individual is an authorized time work is 35 hours or more per week. immigrant and therefore potentially eligible for Limitations of Data Medicaid coverage, thus we only include those who Data provided in this brief should be noted as an are classified as citizens (those who are born in the estimate. Variables presented are defined using U.S.; Born in Puerto Rico, Guam, the U.S. Virgin only the information provided on the PUMS and do Islands, or the Northern Marina; Born abroad of not include adjustments for possible measurement American parent(s); U.S. citizen by naturalization). problems. We did not use statistical models to Demographic and Socio-economic impute for various socio-demographic factors (e.g., Characteristics authorized immigration status and health insurance In this brief we report data for all seven race unit). categories and two ethnicity categories for which 8 FLORIDA MEDICAID EXPANSION CCF.GEORGETOWN.EDU and KIDSWELLFLORIDA.ORG April 2015 Endnotes 1 Based on a Georgetown CCF and Urban 7 M. Buettgens, et al., “Eligibility for Assistance and Institute analysis of U.S. Census Bureau American Projected Changes in Coverage Under the ACA: Community Survey (ACS) data, 2013 single year Variation Across States,” Urban Institute (October estimates. Georgetown CCF estimated that there are 2013). about 243,000 uninsured parents potentially eligible for Medicaid if Florida expands eligibility, accounting 8 A core component of the ACA is the creation of for 28 percent of the total newly eligible adult state-based health insurance exchanges designed to population. We believe this likely underestimates the provide a competitive marketplace where individuals, full number and should be used as an approximation families, and small businesses can comparison for the population profile of uninsured parents shop between private insurance plans. Individuals potentially eligible for Medicaid expansion. See with incomes between 100 and 400 percent of the Methodology section for complete methodological FPL are eligible to receive premium tax subsidies notes. and cost-sharing reductions that reduce the cost of coverage. For the 34 states that have chosen not to 2 S. Long, et al., “QuickTake: Taking Stock: establish their own marketplace, including Florida, Health Insurance Coverage Under the ACA as of the federal government runs the exchange. December 2014”, Urban Institute Health Reform Monitoring Survey (March 2015); M. Karpman, et al., 9 Office of The Assistant Secretary for Planning and “QuickTake: Health Insurance Coverage for Parents Evaluation (ASPE), “Health Insurance Marketplaces under the ACA as of September 2014,” Urban 2015 Open Enrollment Period: March Enrollment Institute Health Reform Monitoring Survey (March Report,” Department of Health and Human Services 2015). (March 10, 2015). 3 As originally written, the ACA operated under the 10 Defined as State Fiscal Year (SFY) 2014- assumption that all states would extend Medicaid 2015. Social Services Estimating Conference, coverage to all low-income adults under 133 percent “Estimates Related to Federal Affordable Care of the FPL, with a standard five percentage point Act: Title XIX (Medicaid) & Title XXI (CHIP) of FPL disregard, bringing the effective eligibility Programs,” (March 7, 2013), available at http:// level to 138 percent of the FPL. For higher income edr.state.fl.us/Content/conferences/medicaid/ adults, the ACA provided tax premium subsidies and FederalAffordableHealthCareActEstimates.pdf. cost-sharing reductions to individuals with incomes 11 For estimates of how Florida may save money between 100 and 400 percent of the FPL. However, if the state expanded Medicaid, see “Florida’s the Supreme Court later ruled on the constitutionality Medicaid Choice: Understanding Implications of of Medicaid expansion and effectively gave states a Supreme Court Ruling on Affordable Health Care choice as to whether to extend coverage to low- Act” by Georgetown University for Children and income adults, leaving a coverage gap for low- Families (November 2012) and “States Expanding income adults in non-expansion states. Medicaid See Significant Budget Savings and 4 Kaiser Family Foundation, “Status of State Action Revenue Gains” by Manatt Health Solutions (April on the Medicaid Expansion Decision,” (March 6, 2015). 2015), available at http://kff.org/health-reform/state- 12 For examples of preliminary data on uninsurance indicator/state-activity-around-expandingmedicaid- rates in 2014, see federal data from the CDC in under-the-affordable-care-act/. “Health Insurance Coverage: Early Release of 5 T. Brooks, et al., “Modern Era Medicaid: Findings Estimates From the National Health Interview Survey, from a 50-State Survey of Eligibility, Enrollment, January-September 2014”; policy briefs from the Renewal, and Cost-Sharing Policies in Medicaid and Urban Institute’s Health Reform Monitoring Survey CHIP as of January 2015,” Kaiser Commission on including “A First Look at Children’s Health Insurance Medicaid and the Uninsured (January 2015). Coverage under the ACA in 2014” and “Taking Stock: Health Insurance Coverage for Parents under 6 Kaiser Family Foundation, “How Will the Uninsured the ACA in 2014.” in Florida Fare Under the Affordable Care Act,” (January 2014), available at http://kff.org/health- 13 United States Department of Labor, “Wage and reform/fact-sheet/state-profiles-uninsured-under- Hour Division: Minimum Wage Laws in the States— aca-florida/. January 1, 2015,” (February, 24, 2015), available at http://www.dol.gov/whd/minwage/america.htm. April 2015 CCF.GEORGETOWN.EDU and KIDSWELLFLORIDA.ORG FLORIDA MEDICAID EXPANSION 9 14 Florida’s most common occupations in the 26 R. O’Brien, et al., “Medicaid and Intergenerational professional service sector include providing Economic Mobility,” University of Wisconsin- services for landscaping, buildings, employment, Madison Institute for Research on Poverty, No. 1428- business support, security, accounting, scientific, 15 (April 2015). and waste management. D. Brown, et al., “Medicaid as an Investment in 27 15 Not a significant percent of parents identify as Children: What is the Long-Term Impact on Tax “other/multiracial.” Receipts?,” National Bureau of Economic Research, Working Paper 20835 (January 2015). 16 S. Schwartz, et al., “Hispanic Children’s Coverage: Steady Progress, But Disparities Remain,” 28 C. Lowenstein, et al., “Linking Depressed Georgetown Center for Children and Families and Mothers to Effective Services and Supports: A National Council of La Raza (November 2014). Policy and Systems Agenda to Enhance Children’s Development and Prevent Child Abuse and Neglect: 17 Note that Hispanic refers to a person’s ethnicity Summary of May 2013 Culminating Roundtable,” and is a separate and distinct concept from race; Urban Institute (October 2013). see Methodology for more information. 29 T. Vericker, et al., “Infants of Depressed Mothers 18 Georgetown Center for Children and Families, Living in Poverty: Opportunities to Identify and “Medicaid Expansion: Good for Parents and Service,” Urban Institute (August 2010). Children,” (January 2014), available at http://ccf. georgetown.edu/wp-content/uploads/2013/12/ 30 K. Baicker, et al., “The Oregon Health Insurance Expanding-Coverage-for-Parents-Helps- Experiment – Effects of Medicaid and on Clinical Children-2013.pdf. Outcomes,” New England Journal of Medicine 368:1713-1722 (May 2, 2013). 19 J. DeVoe, et al., “Effect of Expanding Medicaid for Parents on Children’s Health Insurance Coverage: Lessons From the Oregon Experiment,” JAMA Pediatrics 169 (January 2015). 20 L. Dubay and G. Kenney, “Expanding Public Health Insurance to Parents: Effects on Children’s Coverage under Medicaid,” HSR: Health Services Research, vol. 38: 1283-1302 (2003). 21 G. Kenney, N. Anderson, and V. Lynch, “Medicaid/ CHIP Participation Rates Among Children: An Update,” Robert Wood Johnson Foundation and Urban Institute (September 2013). 22 A. Strong, “Early Results in Arkansas Show ACA is Reaching Uninsured Children and Families,” Say Ahh! Blog (October 6, 2013), available at http://ccf. georgetown.edu/all/early-results-in-arkansas-show- aca-is-reaching-uninsured-children-and-families/. 23 J. Paradise and R. Garfield, “What is Medicaid’s Impact on Access to Care Outcomes, and Quality of Care? Setting the Record Straight on the Evidence,” Kaiser Commission on Medicaid and the Uninsured (August 2013). 24 L. Wherry, et al., “Childhood Medicaid Coverage and Later Life Health Care Utilizations,” National Bureau of Economic Research, Working Paper 20929 (February 2015). 25 S. Cohodes, et al., “The Effect of Child Health Insurance Access on Schooling: Evidence from Public Health Insurance Expansion,” National Bureau of Economic Research, Working Paper 20178 (May 2014). 10 FLORIDA MEDICAID EXPANSION CCF.GEORGETOWN.EDU and KIDSWELLFLORIDA.ORG April 2015 The Center for Children and Families (CCF) is an independent, nonpartisan policy and research center whose mission is to expand and improve health coverage for America’s children and families. CCF is based at Georgetown University’s Health Policy Institute. KidsWell Florida is a collaborative of many stakeholder groups who share a common vision: making sure children have affordable, quality health care coverage. It is a three-year project funded by The Atlantic Philanthropies and carried out by a team of key leaders from five statewide advocacy groups: Florida CHAIN, The Children’s Movement of Florida, the Florida Center for Fiscal and Economic Policy, The Children’s Trust of Miami-Dade, and Florida Children’s Healthcare Coalition. This report was written by Joan Alker and Alisa Chester, with input from members of the Kids Well Florida collaborative. Design and layout assistance provided by Nancy Magill. Center for Children and Families Health Policy Institute Georgetown University Box 571444 3300 Whitehaven Street, NW, Suite 5000 Washington, DC 20057-1485 Phone (202) 687-0880 Email childhealth@georgetown.edu ccf.georgetown.edu/blog/ facebook.com/georgetownccf twitter.com/georgetownccf April 2015 CCF.GEORGETOWN.EDU and KIDSWELLFLORIDA.ORG FLORIDA MEDICAID EXPANSION 11