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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 income 2
eligibility; creating s. 409.8141, F.S.; establishing 3
a tiered system of family premiums for Title -XXI 4
coverage under the Florida Kidcare program beginning 5
with a specified fiscal year; prohibiting the total 6
monthly aggregate family premium from exceeding a 7
specified amount; authorizing the Agency for Health 8
Care Administration to seek federal waiver approval or 9
submit any state plan amendments as necessary; 10
providing for future expiration; amending ss. 11
409.8132, 409.814, and 624.91, F.S.; increasing the 12
income eligibility threshold for coverage under the 13
program to conform to changes made by the act; 14
providing applicability; providing for reversion of 15
certain provisions; requiring the agency to notify the 16
Division of Law Revision within a specified timeframe 17
after receiving federal approval through a waiver or 18
state plan amendment; providing an effective date. 19
20
Be It Enacted by the Legislature of the State of Florida: 21
22
Section 1. Section 409.8141, Florida Statutes, is created 23
to read: 24
409.8141 Tiered system of family premiums for Title -XXI 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
coverage under the Florida Kidcare program. — 26
(1) Beginning with th e 2022-2023 fiscal year and subject 27
to federal approval through a waiver or a state plan amendment, 28
the following tiered system of family premiums for Title -XXI 29
coverage under the Florida Kidcare program shall apply: 30
(a) For a child whose family has an i ncome from 201 31
through 250 percent of the federal poverty level, a family 32
premium of $50 per month per child. 33
(b) For a child whose family has an income from 251 34
through 300 percent of the federal poverty level, a family 35
premium of $100 per month per chi ld. 36
(c) For a child whose family has an income from 301 37
through 350 percent of the federal poverty level, a family 38
premium of $150 per month per child. 39
(d) For a child whose family has an income from 351 40
through 400 percent of the federal poverty level , a family 41
premium of $200 per month per child. 42
(2) For the coverage specified in subsection (1), the 43
total monthly aggregate family premium for all children in a 44
family may not exceed $800 per month. 45
(3) The agency may seek federal waiver approval or submit 46
any state plan amendments necessary to implement this section. 47
(4) This section expires July 1, 2025. 48
Section 2. Paragraph (a) of subsection (6) of section 49
409.8132, Florida Statutes, is amended to read: 50
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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
409.8132 Medikids program component. — 51
(6) ELIGIBILITY.— 52
(a) A child who has attained the age of 1 year but who is 53
under the age of 5 years is eligible to enroll in the Medikids 54
program component of the Florida Kidcare program, if the child 55
is a member of a family that has a family income which exceeds 56
the Medicaid applicable income level as specified in s. 409.903, 57
but which is equal to or below 400 200 percent of the current 58
federal poverty level. In determining the eligibility of such a 59
child, an assets test is not required. A child who is eligible 60
for Medikids may elect to enroll in Florida Healthy Kids 61
coverage or employer -sponsored group coverage. However, a child 62
who is eligible for Medikids may participate in the Florida 63
Healthy Kids program only if the child has a sibling 64
participating in the Florida Healthy Kids program and the 65
child's county of residence permits such enrollment. 66
Section 3. Section 409.814, Florida Statutes, is amended 67
to read: 68
409.814 Eligibility. —A child who has not reached 19 years 69
of age whose family incom e is equal to or below 400 200 percent 70
of the federal poverty level is eligible for the Florida Kidcare 71
program as provided in this section. If an enrolled individual 72
is determined to be ineligible for coverage, he or she must be 73
immediately disenrolled fr om the respective Florida Kidcare 74
program component. 75
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(1) A child who is eligible for Medicaid coverage under s. 76
409.903 or s. 409.904 must be enrolled in Medicaid and is not 77
eligible to receive health benefits under any other health 78
benefits coverage aut horized under the Florida Kidcare program. 79
(2) A child who is not eligible for Medicaid, but who is 80
eligible for the Florida Kidcare program, may obtain health 81
benefits coverage under any of the other components listed in s. 82
409.813 if such coverage is a pproved and available in the county 83
in which the child resides. 84
(3) A Title XXI-funded child who is eligible for the 85
Florida Kidcare program who is a child with special health care 86
needs, as determined through a medical or behavioral screening 87
instrument, is eligible for health benefits coverage from and 88
shall be assigned to and may opt out of the Children's Medical 89
Services Network. 90
(4) The following children are not eligible to receive 91
Title XXI-funded premium assistance for health benefits coverage 92
under the Florida Kidcare program, except under Medicaid if the 93
child would have been eligible for Medicaid under s. 409.903 or 94
s. 409.904 as of June 1, 1997: 95
(a) A child who is covered under a family member's group 96
health benefit plan or under other priv ate or employer health 97
insurance coverage, if the cost of the child's participation is 98
not greater than 5 percent of the family's income. If a child is 99
otherwise eligible for a subsidy under the Florida Kidcare 100
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program and the cost of the child's participa tion in the family 101
member's health insurance benefit plan is greater than 5 percent 102
of the family's income, the child may enroll in the appropriate 103
subsidized Kidcare program. 104
(b) A child who is seeking premium assistance for the 105
Florida Kidcare program through employer-sponsored group 106
coverage, if the child has been covered by the same employer's 107
group coverage during the 60 days before the family submitted an 108
application for determination of eligibility under the program. 109
(c) A child who is an alien b ut who does not meet the 110
definition of a lawfully residing child. This paragraph does not 111
extend eligibility for the Florida Kidcare program to an 112
undocumented immigrant. 113
(d) A child who is an inmate of a public institution or a 114
patient in an institution for mental diseases. 115
(e) A child who is otherwise eligible for premium 116
assistance for the Florida Kidcare program and has had his or 117
her coverage in an employer -sponsored or private health benefit 118
plan voluntarily canceled in the last 60 days, except th ose 119
children whose coverage was voluntarily canceled for good cause, 120
including, but not limited to, the following circumstances: 121
1. The cost of participation in an employer -sponsored 122
health benefit plan is greater than 5 percent of the family's 123
income; 124
2. The parent lost a job that provided an employer -125
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sponsored health benefit plan for children; 126
3. The parent who had health benefits coverage for the 127
child is deceased; 128
4. The child has a medical condition that, without medical 129
care, would cause serio us disability, loss of function, or 130
death; 131
5. The employer of the parent canceled health benefits 132
coverage for children; 133
6. The child's health benefits coverage ended because the 134
child reached the maximum lifetime coverage amount; 135
7. The child has ex hausted coverage under a COBRA 136
continuation provision; 137
8. The health benefits coverage does not cover the child's 138
health care needs; or 139
9. Domestic violence led to loss of coverage. 140
(5) A child who is otherwise eligible for the Florida 141
Kidcare program and who has a preexisting condition that 142
prevents coverage under another insurance plan as described in 143
paragraph (4)(a) which would have disqualified the child for the 144
Florida Kidcare program if the child were able to enroll in the 145
plan is eligible for Florida Kidcare coverage when enrollment is 146
possible. 147
(6) A child whose family income is above 400 200 percent 148
of the federal poverty level or a child who is excluded under 149
the provisions of subsection (4) may participate in the Florida 150
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Kidcare program as provided in s. 409.8132 or, if the child is 151
ineligible for Medikids by reason of age, in the Florida Healthy 152
Kids program, subject to the following: 153
(a) The family is not eligible for premium assistance 154
payments and must pay the full cost of the premiu m, including 155
any administrative costs. 156
(b) The board of directors of the Florida Healthy Kids 157
Corporation may offer a reduced benefit package to these 158
children in order to limit program costs for such families. 159
(7) Once a child is enrolled in the Flori da Kidcare 160
program, the child is eligible for coverage for 12 months 161
without a redetermination or reverification of eligibility, if 162
the family continues to pay the applicable premium. Eligibility 163
for program components funded through Title XXI of the Socia l 164
Security Act terminates when a child attains the age of 19. A 165
child who has not attained the age of 5 and who has been 166
determined eligible for the Medicaid program is eligible for 167
coverage for 12 months without a redetermination or 168
reverification of elig ibility. 169
(8) When determining or reviewing a child's eligibility 170
under the Florida Kidcare program, the applicant shall be 171
provided with reasonable notice of changes in eligibility which 172
may affect enrollment in one or more of the program components. 173
If a transition from one program component to another is 174
authorized, there shall be cooperation between the program 175
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components and the affected family which promotes continuity of 176
health care coverage. Any authorized transfers must be managed 177
within the program's overall appropriated or authorized levels 178
of funding. Each component of the program shall establish a 179
reserve to ensure that transfers between components will be 180
accomplished within current year appropriations. These reserves 181
shall be reviewed by each convening of the Social Services 182
Estimating Conference to determine the adequacy of such reserves 183
to meet actual experience. 184
(9) In determining the eligibility of a child, an assets 185
test is not required. Each applicant shall provide documentation 186
during the application process and the redetermination process, 187
including, but not limited to, the following: 188
(a) Proof of family income, which must be verified 189
electronically to determine financial eligibility for the 190
Florida Kidcare program. Written document ation, which may 191
include wages and earnings statements or pay stubs, W -2 forms, 192
or a copy of the applicant's most recent federal income tax 193
return, is required only if the electronic verification is not 194
available or does not substantiate the applicant's in come. 195
(b) A statement from all applicable, employed family 196
members that: 197
1. Their employers do not sponsor health benefit plans for 198
employees; 199
2. The potential enrollee is not covered by an employer -200
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sponsored health benefit plan; or 201
3. The potential enrollee is covered by an employer -202
sponsored health benefit plan and the cost of the employer -203
sponsored health benefit plan is more than 5 percent of the 204
family's income. 205
(c) To enroll in the Children's Medical Services Network, 206
a completed application , including a clinical screening. 207
(10) Subject to paragraph (4)(a), the Florida Kidcare 208
program shall withhold benefits from an enrollee if the program 209
obtains evidence that the enrollee is no longer eligible, 210
submitted incorrect or fraudulent informatio n in order to 211
establish eligibility, or failed to provide verification of 212
eligibility. The applicant or enrollee shall be notified that 213
because of such evidence program benefits will be withheld 214
unless the applicant or enrollee contacts a designated 215
representative of the program by a specified date, which must be 216
within 10 working days after the date of notice, to discuss and 217
resolve the matter. The program shall make every effort to 218
resolve the matter within a timeframe that will not cause 219
benefits to be withheld from an eligible enrollee. 220
(11) The following individuals may be subject to 221
prosecution in accordance with s. 414.39: 222
(a) An applicant obtaining or attempting to obtain 223
benefits for a potential enrollee under the Florida Kidcare 224
program when the applicant knows or should have known the 225
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potential enrollee does not qualify for the Florida Kidcare 226
program. 227
(b) An individual who assists an applicant in obtaining or 228
attempting to obtain benefits for a potential enrollee under the 229
Florida Kidcare program when the individual knows or should have 230
known the potential enrollee does not qualify for the Florida 231
Kidcare program. 232
Section 4. Paragraph (b) of subsection (2) of section 233
624.91, Florida Statutes, is amended to read: 234
624.91 The Florida Healt hy Kids Corporation Act. — 235
(2) LEGISLATIVE INTENT. — 236
(b) It is the intent of the Legislature that the Florida 237
Healthy Kids Corporation serve as one of several providers of 238
services to children eligible for medical assistance under Title 239
XXI of the Social Security Act. Although the corporation may 240
serve other children, the Legislature intends the primary 241
recipients of services provided through the corporation be 242
school-age children with a family income equal to or below 400 243
200 percent of the federal pover ty level, who do not qualify for 244
Medicaid. It is also the intent of the Legislature that state 245
and local government Florida Healthy Kids funds be used to 246
continue coverage, subject to specific appropriations in the 247
General Appropriations Act, to children n ot eligible for federal 248
matching funds under Title XXI. 249
Section 5. (1) The amendments to ss. 409.8132, 409.814, 250
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and 624.91, Florida Statutes, made by this act are subject to 251
federal approval through a waiver or state plan amendment and 252
expire July 1, 2025. Upon expiration, the text of ss. 409.8132, 253
409.814, and 624.91, Florida Statutes, shall revert to that in 254
existence on June 30, 2022; however: 255
(a) This act shall remain in effect for any child enrolled 256
in the Title XXI-funded Florida Kidcare progra m on July 1, 2025, 257
until such time as the child ceases enrollment in the Title XXI -258
funded Florida Kidcare program. 259
(b) Any amendments to the text of ss. 409.8132, 409.814, 260
and 624.91, Florida Statutes, enacted other than by this act 261
shall be preserved an d continue to operate to the extent that 262
such amendments are not dependent upon the portions of text 263
which expire pursuant to this section. 264
(2) The Agency for Health Care Administration shall notify 265
the Division of Law Revision within 10 days after recei ving 266
federal approval through a waiver or state plan amendment. 267
Section 6. This act shall take effect July 1, 2022. 268