HB 135 2022
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
A bill to be entitled 1
An act relating to Florida Kidcare program 2
eligibility; amending s. 409.8132, F.S.; conforming a 3
provision to changes made by the act; amending s. 4
409.814, F.S.; increasing the income eligibility 5
threshold for coverage under the Florida Kidcare 6
program; requiring an applicant seeking coverage under 7
the program to provide certain documentation if 8
eligibility cannot be verified using reliable data 9
sources; creating s. 409.8141, F.S.; requiring the 10
Agency for Health Care Administration to examine 11
graduated family contribution rates for newly 12
qualifying families under the program; providing 13
guidelines for such rates; providing applicability; 14
requiring the agency to inc rease the income 15
eligibility threshold for coverage under the program 16
each fiscal year until meeting a specified income 17
threshold; authorizing the agency to seek federal 18
waiver approval or submit state plan amendments as 19
necessary; amending s. 624.91, F.S. ; conforming a 20
provision to changes made by the act; providing an 21
effective date. 22
23
Be It Enacted by the Legislature of the State of Florida: 24
25
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
Section 1. Paragraph (a) of subsection (6) of section 26
409.8132, Florida Statutes, is amended to read: 27
409.8132 Medikids program component. — 28
(6) ELIGIBILITY.— 29
(a) A child who has attained the age of 1 year but who is 30
under the age of 5 years is eligible to enroll in the Medikids 31
program component of the Florida Kidcare program, if the child 32
is a member of a family that has a family income which exceeds 33
the Medicaid applicable income level as specified in s. 409.903, 34
but which is equal to or below 250 200 percent of the current 35
federal poverty level. In determining the eligibility of such a 36
child, an assets test is not required. A child who is eligible 37
for Medikids may elect to enroll in Florida Healthy Kids 38
coverage or employer -sponsored group coverage. However, a child 39
who is eligible for Medikids may participate in the Florida 40
Healthy Kids program only if the child has a sibling 41
participating in the Florida Healthy Kids program and the 42
child's county of residence permits such enrollment. 43
Section 2. Section 409.814, Florida Statutes, is amended 44
to read: 45
409.814 Eligibility. —A child who has not reached 19 years 46
of age whose family income is equal to or below 250 200 percent 47
of the federal poverty level is eligible for the Florida Kidcare 48
program as provided in this section. If an enrolled individual 49
is determined to be ineligible for coverage, he or she must be 50
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immediately disenrolled from the respective Florida Kidcare 51
program component. 52
(1) A child who is eligible for Medicaid coverage under s. 53
409.903 or s. 409.904 must be enrolled in Medicaid and is not 54
eligible to receive health benefits under any other health 55
benefits coverage authorized under the Florida Kidcare program. 56
(2) A child who is not eligible for Medicaid, but who is 57
eligible for the Florida Kidcare program, may obtain health 58
benefits coverage under any of the other components listed in s. 59
409.813 if such coverage is approved and available in the county 60
in which the child resides. 61
(3) A Title XXI-funded child who is eligible for the 62
Florida Kidcare program who is a child with special health care 63
needs, as determined through a medical or behavioral screening 64
instrument, is eligible for health benefits coverage from and 65
shall be assigned to and may opt out of the Children's Medical 66
Services Network. 67
(4) The following children are not eligible to receive 68
Title XXI-funded premium assist ance for health benefits coverage 69
under the Florida Kidcare program, except under Medicaid if the 70
child would have been eligible for Medicaid under s. 409.903 or 71
s. 409.904 as of June 1, 1997: 72
(a) A child who is covered under a family member's group 73
health benefit plan or under other private or employer health 74
insurance coverage, if the cost of the child's participation is 75
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
not greater than 5 percent of the family's income. If a child is 76
otherwise eligible for a subsidy under the Florida Kidcare 77
program and the cost of the child's participation in the family 78
member's health insurance benefit plan is greater than 5 percent 79
of the family's income, the child may enroll in the appropriate 80
subsidized Kidcare program. 81
(b) A child who is seeking premium assistan ce for the 82
Florida Kidcare program through employer -sponsored group 83
coverage, if the child has been covered by the same employer's 84
group coverage during the 60 days before the family submitted an 85
application for determination of eligibility under the progr am. 86
(c) A child who is an alien but who does not meet the 87
definition of a lawfully residing child. This paragraph does not 88
extend eligibility for the Florida Kidcare program to an 89
undocumented immigrant. 90
(d) A child who is an inmate of a public institution or a 91
patient in an institution for mental diseases. 92
(e) A child who is otherwise eligible for premium 93
assistance for the Florida Kidcare program and has had his or 94
her coverage in an employer -sponsored or private health benefit 95
plan voluntarily canceled in the last 60 days, except those 96
children whose coverage was voluntarily canceled for good cause, 97
including, but not limited to, the following circumstances: 98
1. The cost of participation in an employer -sponsored 99
health benefit plan is greate r than 5 percent of the family's 100
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income; 101
2. The parent lost a job that provided an employer -102
sponsored health benefit plan for children; 103
3. The parent who had health benefits coverage for the 104
child is deceased; 105
4. The child has a medical condition tha t, without medical 106
care, would cause serious disability, loss of function, or 107
death; 108
5. The employer of the parent canceled health benefits 109
coverage for children; 110
6. The child's health benefits coverage ended because the 111
child reached the maximum lifet ime coverage amount; 112
7. The child has exhausted coverage under a COBRA 113
continuation provision; 114
8. The health benefits coverage does not cover the child's 115
health care needs; or 116
9. Domestic violence led to loss of coverage. 117
(5) A child who is otherwi se eligible for the Florida 118
Kidcare program and who has a preexisting condition that 119
prevents coverage under another insurance plan as described in 120
paragraph (4)(a) which would have disqualified the child for the 121
Florida Kidcare program if the child were a ble to enroll in the 122
plan is eligible for Florida Kidcare coverage when enrollment is 123
possible. 124
(6) A child whose family income is above 250 200 percent 125
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of the federal poverty level or a child who is excluded under 126
the provisions of subsection (4) may pa rticipate in the Florida 127
Kidcare program as provided in s. 409.8132 or, if the child is 128
ineligible for Medikids by reason of age, in the Florida Healthy 129
Kids program, subject to the following: 130
(a) The family is not eligible for premium assistance 131
payments and must pay the full cost of the premium, including 132
any administrative costs. 133
(b) The board of directors of the Florida Healthy Kids 134
Corporation may offer a reduced benefit package to these 135
children in order to limit program costs for such families. 136
(7) Once a child is enrolled in the Florida Kidcare 137
program, the child is eligible for coverage for 12 months 138
without a redetermination or reverification of eligibility, if 139
the family continues to pay the applicable premium. Eligibility 140
for program components funded through Title XXI of the Social 141
Security Act terminates when a child attains the age of 19. A 142
child who has not attained the age of 5 and who has been 143
determined eligible for the Medicaid program is eligible for 144
coverage for 12 months without a redetermination or 145
reverification of eligibility. 146
(8) When determining or reviewing a child's eligibility 147
under the Florida Kidcare program, the applicant shall be 148
provided with reasonable notice of changes in eligibility which 149
may affect enrollment in one or more of the program components. 150
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If a transition from one program component to another is 151
authorized, there shall be cooperation between the program 152
components and the affected family which promotes continuity of 153
health care coverage. Any authorized transfers must be managed 154
within the program's overall appropriated or authorized levels 155
of funding. Each component of the program shall establish a 156
reserve to ensure that transfers between components will be 157
accomplished within current year appropriations . These reserves 158
shall be reviewed by each convening of the Social Services 159
Estimating Conference to determine the adequacy of such reserves 160
to meet actual experience. 161
(9) In determining the eligibility of a child, an assets 162
test is not required. If eligibility for the Florida Kidcare 163
program cannot be verified using reliable data sources in 164
accordance with federal requirements, each applicant shall 165
provide documentation during the application process and the 166
redetermination process, including, but not li mited to, the 167
following: 168
(a) Proof of family income, which must be verified 169
electronically to determine financial eligibility for the 170
Florida Kidcare program. Written documentation, which may 171
include wages and earnings statements or pay stubs, W -2 forms, 172
or a copy of the applicant's most recent federal income tax 173
return, is required only if the electronic verification is not 174
available or does not substantiate the applicant's income. 175
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(b) A statement from all applicable, employed family 176
members that: 177
1. Their employers do not sponsor health benefit plans for 178
employees; 179
2. The potential enrollee is not covered by an employer -180
sponsored health benefit plan; or 181
3. The potential enrollee is covered by an employer -182
sponsored health benefit plan and the cost of the employer-183
sponsored health benefit plan is more than 5 percent of the 184
family's income. 185
(c) To enroll in the Children's Medical Services Network, 186
a completed application, including a clinical screening. 187
(10) Subject to paragraph (4)(a), the Flori da Kidcare 188
program shall withhold benefits from an enrollee if the program 189
obtains evidence that the enrollee is no longer eligible, 190
submitted incorrect or fraudulent information in order to 191
establish eligibility, or failed to provide verification of 192
eligibility. The applicant or enrollee shall be notified that 193
because of such evidence program benefits will be withheld 194
unless the applicant or enrollee contacts a designated 195
representative of the program by a specified date, which must be 196
within 10 working da ys after the date of notice, to discuss and 197
resolve the matter. The program shall make every effort to 198
resolve the matter within a timeframe that will not cause 199
benefits to be withheld from an eligible enrollee. 200
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
(11) The following individuals may be subj ect to 201
prosecution in accordance with s. 414.39: 202
(a) An applicant obtaining or attempting to obtain 203
benefits for a potential enrollee under the Florida Kidcare 204
program when the applicant knows or should have known the 205
potential enrollee does not qualify for the Florida Kidcare 206
program. 207
(b) An individual who assists an applicant in obtaining or 208
attempting to obtain benefits for a potential enrollee under the 209
Florida Kidcare program when the individual knows or should have 210
known the potential enrollee doe s not qualify for the Florida 211
Kidcare program. 212
Section 3. Section 409.8141, Florida Statutes, is created 213
to read: 214
409.8141 Graduated family contribution rates. — 215
(1) Subject to federal waiver approval and in accordance 216
with the cost containment goals for the Florida Kidcare program 217
and for the state, the agency shall examine graduated family 218
contribution rates for newly qualifying families under the 219
Florida Kidcare program which are consistent with the existing 220
standard established under the Chil dren's Health Insurance 221
Program (CHIP) as follows: 222
(a) For a child or children whose family has an income 223
between 200 and 225 percent of the federal poverty level, a 224
contribution rate of at least $30 per month per family. 225
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
(b) For a child or children wh ose family has an income 226
between 225 and 250 percent of the federal poverty level, a 227
contribution rate of at least $40 per month per family. 228
(2) The graduated family contribution rates in subsection 229
(1) are in addition to the existing contribution rates of $15 230
per month per family for a child or children whose family has an 231
income between 138 and 158 percent of the federal poverty level 232
and $20 per month per family for a child or children whose 233
family has an income between 158 and 215 percent of the feder al 234
poverty level, allowing the state to attain additional cost 235
savings for the expansion of the Florida Kidcare program and to 236
attain the federal Centers for Medicare and Medicaid Services' 237
stated goals for CHIP to expand coverage and healthcare access 238
for uninsured and underinsured children. 239
(3) Subject to federal waiver approval, the agency shall 240
increase the income eligibility threshold for coverage under the 241
Florida Kidcare program to 210 percent of the federal poverty 242
level for the 2022-2023 fiscal year, and shall increase the 243
income eligibility threshold by 10 percent each fiscal year 244
thereafter until meeting an income eligibility threshold of 250 245
percent of the federal poverty level. 246
(4) The agency may seek federal waiver approval or submit 247
any state plan amendments necessary to implement this section. 248
Section 4. Paragraph (b) of subsection (2) of section 249
624.91, Florida Statutes, is amended to read: 250
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F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
624.91 The Florida Healthy Kids Corporation Act. — 251
(2) LEGISLATIVE INTENT. — 252
(b) It is the intent of the Legislature that the Florida 253
Healthy Kids Corporation serve as one of several providers of 254
services to children eligible for medical assistance under Title 255
XXI of the Social Security Act. Although the corporation may 256
serve other children, the Legislature intends the primary 257
recipients of services provided through the corporation be 258
school-age children with a family income below 250 200 percent 259
of the federal poverty level, who do not qualify for Medicaid. 260
It is also the intent of the Legislatu re that state and local 261
government Florida Healthy Kids funds be used to continue 262
coverage, subject to specific appropriations in the General 263
Appropriations Act, to children not eligible for federal 264
matching funds under Title XXI. 265
Section 5. This act s hall take effect July 1, 2022. 266