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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 the Medicaid and Florida Kidcare 2
programs expansion; creating s. 402.723, F.S.; 3
requiring the Department of Children and Families to 4
publicly publish an online dashboard containing 5
certain data on the Medicaid and Florida Kidcare 6
programs; amending ss. 409.816 and 409.818, F.S.; 7
providing that certain enrollees in the Florida 8
Kidcare program and the Florida Healthy Kids program, 9
respectively, with family incomes at or below a 10
specified federal poverty level are not required to 11
pay any premiums; prohibiting certain charges from 12
being imposed on such enrollees under specified 13
circumstances; providing for future legislative review 14
and repeal; amending s. 409.904, F.S.; revising 15
eligibility for and length of time covered by Medicaid 16
optional payments; creating s. 409.91333, F.S.; 17
creating the Office of the Medicaid Ombudsman within 18
the Agency for Health Care Administration to provide 19
consumer protection and perform advocacy functions 20
related to Medicaid; providing a directive to the 21
Division of Law Revision; providing an effective date. 22
23
Be It Enacted by the Legislature of the State of Florida: 24
25
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Section 1. Section 402.723, Florida Stat utes, is created 26
to read: 27
402.723 Department of Children and Families; dashboard on 28
Medicaid and Florida Kidcare programs. —The Department of 29
Children and Families shall publicly publish each month an 30
online dashboard that presents data on the Medicaid an d Florida 31
Kidcare programs, including, but not limited to: 32
(1) The total number of enrollments and disenrollments and 33
the number of enrollments and disenrollments by county for each 34
program, including demographic data such as age, gender, race, 35
ethnicity, and language. 36
(2) The state application processing data, including the 37
number of applications processed, the number of applications 38
determined eligible and ineligible, the number of applications 39
pending, the number of ex parte renewals, and the number of 40
procedural terminations. 41
(3) The state customer service workload and performance, 42
including the average processing time for new applications, the 43
number of calls, the average call wait time, and the call 44
abandonment rate. 45
Section 2. Subsection (3) of section 409.816, Florida 46
Statutes, is amended to read: 47
409.816 Limitations on premiums and cost sharing. —The 48
following limitations on premiums and cost sharing are 49
established for the program. 50
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(3)(a) Except as otherwise provided in paragraph (b), 51
enrollees in families with a family income above 150 percent of 52
the federal poverty level who are not receiving coverage under 53
the Medicaid program or who are not eligible under s. 409.814(7) 54
may be required to pay enrollment fees, premiums, copayments, 55
deductibles, coinsurance, or similar charges on a sliding scale 56
related to income, except that the total annual aggregate cost 57
sharing with respect to all children in a family may not exceed 58
5 percent of the family's income. However, copayments, 59
deductibles, coinsurance, or similar charges may not be imposed 60
for preventive services, including well -baby and well-child 61
care, age-appropriate immunizations, and routine hearing and 62
vision screenings. Premiums for enrollees paying enrollment 63
fees, premiums, copaymen ts, deductibles, coinsurance, or similar 64
charges as provided in this subsection shall be based on at 65
least three but no more than six tiers of uniform premiums that 66
increase with each tier as a percentage of the applicable 67
threshold amount of the federal p overty level, by tier. 68
(b) On or after the effective date of this act, enrollees 69
in families with a family income at or below 200 percent of the 70
federal poverty level who are not receiving coverage under the 71
Medicaid program may not be required to pay an y premium. 72
Copayments, deductibles, coinsurance, or similar charges may not 73
be imposed on such enrollees for preventive services, including 74
well-baby and well-child care, age-appropriate immunizations, 75
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and routine hearing and vision screenings. This paragr aph 76
expires on July 1, 2024, unless reviewed and saved from repeal 77
through reenactment by the Legislature. 78
Section 3. Paragraph (a) of subsection (3) of section 79
409.818, Florida Statutes, is amended to read: 80
409.818 Administration. —In order to implement ss. 409.810-81
409.821, the following agencies shall have the following duties: 82
(3) The Agency for Health Care Administration, under the 83
authority granted in s. 409.914(1), shall: 84
(a)1. Calculate the premium assistance payment necessary 85
to comply with the premium and cost -sharing limitations 86
specified in s. 409.816. The premium assistance payment for each 87
enrollee in a health insurance plan participating in the Florida 88
Healthy Kids Corporation shall equal the premium approved by the 89
Florida Healthy Kids Corporation and the Office of Insurance 90
Regulation of the Financial Services Commission pursuant to ss. 91
627.410 and 641.31, less any enrollee's share of the premium 92
established within the limitations specified in s. 409.816. The 93
premium assistance payment for each enrollee in an employer -94
sponsored health insurance plan approved under ss. 409.810 -95
409.821 shall equal the premium for the plan adjusted for any 96
benchmark benefit plan actuarial equivalent benefit rider 97
approved by the Office of In surance Regulation pursuant to ss. 98
627.410 and 641.31, less any enrollee's share of the premium 99
established within the limitations specified in s. 409.816. In 100
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calculating the premium assistance payment levels for children 101
with family coverage, the agency s hall set the premium 102
assistance payment levels for each child proportionately to the 103
total cost of family coverage. 104
2. On or after the effective date of this act, for an 105
enrollee in a health insurance plan participating in the Florida 106
Healthy Kids Corporation, or in an employer -sponsored health 107
insurance plan approved under ss. 409.810 -409.821, whose family 108
income is at or below 200 percent federal poverty level, the 109
premium assistance payment shall equal the premium approved by 110
the Florida Healthy Kids C orporation and the Office of Insurance 111
Regulation of the Financial Services Commission pursuant to ss. 112
627.410 and 641.31, or the premium for the plan adjusted for any 113
benchmark benefit plan actuarial equivalent benefit rider 114
approved by the Office of Insu rance Regulation pursuant to ss. 115
627.410 and 641.31, and the enrollee is not responsible for any 116
share of the premium. This subparagraph expires on July 1, 2024, 117
unless reviewed and saved from repeal through reenactment by the 118
Legislature. 119
120
The agency is designated the lead state agency for Title XXI of 121
the Social Security Act for purposes of receipt of federal 122
funds, for reporting purposes, and for ensuring compliance with 123
federal and state regulations and rules. 124
Section 4. Subsection (12) of section 4 09.904, Florida 125
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Statutes, is renumbered as subsection (13), subsections (1) and 126
(6) are amended, and a new subsection (12) is added to that 127
section, to read: 128
409.904 Optional payments for eligible persons. —The agency 129
may make payments for medical assista nce and related services on 130
behalf of the following persons who are determined to be 131
eligible subject to the income, assets, and categorical 132
eligibility tests set forth in federal and state law. Payment on 133
behalf of these Medicaid eligible persons is subje ct to the 134
availability of moneys and any limitations established by the 135
General Appropriations Act or chapter 216. 136
(1) Subject to federal waiver approval, a person who is 137
age 65 or older or is determined to be disabled, whose income is 138
at or below 133 88 percent of the federal poverty level, whose 139
assets do not exceed established limitations, and who is not 140
eligible for Medicare or, if eligible for Medicare, is also 141
eligible for and receiving Medicaid -covered institutional care 142
services, hospice services, or home and community -based 143
services. The agency shall seek federal authorization through a 144
waiver to provide this coverage. 145
(6) A child who has not attained the age of 19 who has 146
been determined eligible for the Medicaid program is deemed to 147
be eligible for a total of 12 6 months, regardless of changes in 148
circumstances other than attainment of the maximum age. 149
Effective January 1, 1999, a child who has not attained the age 150
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of 5 and who has been determined eligible for the Medicaid 151
program is deemed to b e eligible for a total of 12 months 152
regardless of changes in circumstances other than attainment of 153
the maximum age. 154
(12) Subject to federal waiver approval, a person who is 155
age 18 or over, whose income is at or below 133 percent of the 156
federal poverty level, whose assets do not exceed established 157
limitations, and who is not eligible for Medicare. The agency 158
shall seek federal authorization through a waiver to provide 159
this coverage. 160
Section 5. Section 409.91333, Florida Statutes, is created 161
to read: 162
409.91333 Medicaid Ombudsman. —There is created within the 163
agency the Office of the Medicaid Ombudsman to provide consumer 164
protection and perform advocacy functions related to Medicaid, 165
including assisting individuals with: 166
(1) Filing complaints and obta ining information on filed 167
complaints. 168
(2) Eligibility criteria and enrollment issues. 169
(3) Service denials and reductions. 170
(4) Access to care issues, including barriers to service 171
and provider availability. 172
(5) Elevating matters within the Medicaid program that 173
individuals feel are being overlooked. 174
(6) Facilitating interactions with the agency, the 175
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Department of Children and Families, the Department of Health, 176
the Agency for Persons with Disabilities, the Department of 177
Elderly Affairs, or any oth er state agency. 178
Section 6. The Division of Law Revision is directed to 179
replace the phrase "the effective date of this act" wherever it 180
occurs in this act with the date this act becomes a law. 181
Section 7. This act shall take effect upon becoming a law. 182