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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.; increasing 3
the income eligibility threshold for coverage under 4
the Medikids program component; amending s. 409.814, 5
F.S.; increasing the income eligibility threshold for 6
coverage under the Florida Kidcare program; requiring 7
an applicant seeking coverage under the program to 8
provide certain documentation if eligibility cannot be 9
verified using reliable data sources; amending s. 10
409.816, F.S.; requiring that premiums for certain 11
enrollees under the Florida Kidcare program be based 12
on a tiered system of uniform premiums; amending s. 13
624.91, F.S.; conforming a provision to changes made 14
by the act; providing effective dates. 15
16
Be It Enacted by the Legislature of the State of Florida: 17
18
Section 1. Effective January 1, 2024, paragraph (a) of 19
subsection (6) of section 409.8132, Florida Statutes, is amended 20
to read: 21
409.8132 Medikids program component.— 22
(6) ELIGIBILITY.— 23
(a) A child who has attained the age of 1 year but who is 24
under the age of 5 years is eligible to enroll in the Medikids 25
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program component of the Florida Kidcare program, if the child 26
is a member of a family that has a family income which exceeds 27
the Medicaid applicable income level as specified in s. 409.903, 28
but which is equal to or below 300 200 percent of the current 29
federal poverty level. In determining the eligibility of such a 30
child, an assets test is not re quired. A child who is eligible 31
for Medikids may elect to enroll in Florida Healthy Kids 32
coverage or employer -sponsored group coverage. However, a child 33
who is eligible for Medikids may participate in the Florida 34
Healthy Kids program only if the child has a sibling 35
participating in the Florida Healthy Kids program and the 36
child's county of residence permits such enrollment. 37
Section 2. Effective January 1, 2024, section 409.814, 38
Florida Statutes, is amended to read: 39
409.814 Eligibility. —A child who has not reached 19 years 40
of age whose family income is equal to or below 300 200 percent 41
of the federal poverty level is eligible for the Florida Kidcare 42
program as provided in this section. If an enrolled individual 43
is determined to be ineligible for coverag e, he or she must be 44
immediately disenrolled from the respective Florida Kidcare 45
program component. 46
(1) A child who is eligible for Medicaid coverage under s. 47
409.903 or s. 409.904 must be enrolled in Medicaid and is not 48
eligible to receive health benefi ts under any other health 49
benefits coverage authorized under the Florida Kidcare program. 50
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(2) A child who is not eligible for Medicaid, but who is 51
eligible for the Florida Kidcare program, may obtain health 52
benefits coverage under any of the other compon ents listed in s. 53
409.813 if such coverage is approved and available in the county 54
in which the child resides. 55
(3) A Title XXI-funded child who is eligible for the 56
Florida Kidcare program who is a child with special health care 57
needs, as determined throu gh a medical or behavioral screening 58
instrument, is eligible for health benefits coverage from and 59
shall be assigned to and may opt out of the Children's Medical 60
Services Network. 61
(4) A Title XXI-funded child who reaches 19 years of age 62
is eligible for continued Title XXI-funded coverage for the 63
duration of a pregnancy and the postpartum period consisting of 64
the 12-month period beginning on the last day of a pregnancy, if 65
such pregnancy or postpartum period begins prior to the child 66
reaching 19 years of a ge, and if the child is ineligible for 67
Medicaid. 68
(5) The following children are not eligible to receive 69
Title XXI-funded premium assistance for health benefits coverage 70
under the Florida Kidcare program, except under Medicaid if the 71
child would have been eligible for Medicaid under s. 409.903 or 72
s. 409.904 as of June 1, 1997: 73
(a) A child who is covered under a family member's group 74
health benefit plan or under other private or employer health 75
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insurance coverage, if the cost of the child's participation is 76
not greater than 5 percent of the family's income. If a child is 77
otherwise eligible for a subsidy under the Florida Kidcare 78
program and the cost of the child's participation in the family 79
member's health insurance benefit plan is greater than 5 percent 80
of the family's income, the child may enroll in the appropriate 81
subsidized Kidcare program. 82
(b) A child who is seeking premium assistance for the 83
Florida Kidcare program through employer -sponsored group 84
coverage, if the child has been covered by the same employer's 85
group coverage during the 60 days before the family submitted an 86
application for determination of eligibility under the program. 87
(c) A child who is an alien but who does not meet the 88
definition of a lawfully residing child. This paragraph does not 89
extend eligibility for the Florida Kidcare program to an 90
undocumented immigrant. 91
(d) A child who is an inmate of a public institution or a 92
patient in an institution for mental diseases. 93
(e) A child who is otherwise eligible for premium 94
assistance for the Florida Kidcare program and has had his or 95
her coverage in an employer -sponsored or private health benefit 96
plan voluntarily canceled in the last 60 days, except those 97
children whose coverage was voluntarily canceled for good cause, 98
including, but not limited to, the following circumstances: 99
1. The cost of participation in an employer -sponsored 100
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health benefit plan is greater than 5 percent of the family's 101
income; 102
2. The parent lost a job that provided an employer -103
sponsored health benefit plan for children; 104
3. The parent who had health benefits coverage for the 105
child is deceased; 106
4. The child has a medical condition that, without medical 107
care, would cause serious disability, loss of function, or 108
death; 109
5. The employer of the parent cancel ed health benefits 110
coverage for children; 111
6. The child's health benefits coverage ended because the 112
child reached the maximum lifetime coverage amount; 113
7. The child has exhausted coverage under a COBRA 114
continuation provision; 115
8. The health benefits c overage does not cover the child's 116
health care needs; or 117
9. Domestic violence led to loss of coverage. 118
(6) A child who is otherwise eligible for the Florida 119
Kidcare program and who has a preexisting condition that 120
prevents coverage under another insura nce plan as described in 121
paragraph (5)(a) which would have disqualified the child for the 122
Florida Kidcare program if the child were able to enroll in the 123
plan is eligible for Florida Kidcare coverage when enrollment is 124
possible. 125
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(7) A child whose family income is above 300 200 percent 126
of the federal poverty level or a child who is excluded under 127
the provisions of subsection (5) may participate in the Florida 128
Kidcare program as provided in s. 409.8132 or, if the child is 129
ineligible for Medikids by reason o f age, in the Florida Healthy 130
Kids program, subject to the following: 131
(a) The family is not eligible for premium assistance 132
payments and must pay the full cost of the premium, including 133
any administrative costs. 134
(b) The board of directors of the Florid a Healthy Kids 135
Corporation may offer a reduced benefit package to these 136
children in order to limit program costs for such families. 137
(8) Once a child is enrolled in the Florida Kidcare 138
program, the child is eligible for coverage for 12 months 139
without a redetermination or reverification of eligibility, if 140
the family continues to pay the applicable premium. Eligibility 141
for program components funded through Title XXI of the Social 142
Security Act terminates when a child attains the age of 19. A 143
child who has not attained the age of 5 and who has been 144
determined eligible for the Medicaid program is eligible for 145
coverage for 12 months without a redetermination or 146
reverification of eligibility. 147
(9) When determining or reviewing a child's eligibility 148
under the Florida Kidcare program, the applicant shall be 149
provided with reasonable notice of changes in eligibility which 150
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may affect enrollment in one or more of the program components. 151
If a transition from one program component to another is 152
authorized, there shall be cooperation between the program 153
components and the affected family which promotes continuity of 154
health care coverage. Any authorized transfers must be managed 155
within the program's overall appropriated or authorized levels 156
of funding. Each component of the program shall establish a 157
reserve to ensure that transfers between components will be 158
accomplished within current year appropriations. These reserves 159
shall be reviewed by each convening of the Social Services 160
Estimating Conference to determine the adequacy of such reserves 161
to meet actual experience. 162
(10) In determining the eligibility of a child, an assets 163
test is not required. If eligibility for the Florida Kidcare 164
program cannot be verified using reliable data sources in 165
accordance with federal requirem ents, each applicant shall 166
provide documentation during the application process and the 167
redetermination process, including, but not limited to, the 168
following: 169
(a) Proof of family income, which must be verified 170
electronically to determine financial eligib ility for the 171
Florida Kidcare program. Written documentation, which may 172
include wages and earnings statements or pay stubs, W -2 forms, 173
or a copy of the applicant's most recent federal income tax 174
return, is required only if the electronic verification is no t 175
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available or does not substantiate the applicant's income. 176
(b) A statement from all applicable, employed family 177
members that: 178
1. Their employers do not sponsor health benefit plans for 179
employees; 180
2. The potential enrollee is not covered by an emplo yer-181
sponsored health benefit plan; or 182
3. The potential enrollee is covered by an employer -183
sponsored health benefit plan and the cost of the employer -184
sponsored health benefit plan is more than 5 percent of the 185
family's income. 186
(c) To enroll in the Child ren's Medical Services Network, 187
a completed application, including a clinical screening. 188
(11) Subject to paragraph (5)(a), the Florida Kidcare 189
program shall withhold benefits from an enrollee if the program 190
obtains evidence that the enrollee is no longer eligible, 191
submitted incorrect or fraudulent information in order to 192
establish eligibility, or failed to provide verification of 193
eligibility. The applicant or enrollee shall be notified that 194
because of such evidence program benefits will be withheld 195
unless the applicant or enrollee contacts a designated 196
representative of the program by a specified date, which must be 197
within 10 working days after the date of notice, to discuss and 198
resolve the matter. The program shall make every effort to 199
resolve the matter within a timeframe that will not cause 200
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benefits to be withheld from an eligible enrollee. 201
(12) The following individuals may be subject to 202
prosecution in accordance with s. 414.39: 203
(a) An applicant obtaining or attempting to obtain 204
benefits for a poten tial enrollee under the Florida Kidcare 205
program when the applicant knows or should have known the 206
potential enrollee does not qualify for the Florida Kidcare 207
program. 208
(b) An individual who assists an applicant in obtaining or 209
attempting to obtain benefit s for a potential enrollee under the 210
Florida Kidcare program when the individual knows or should have 211
known the potential enrollee does not qualify for the Florida 212
Kidcare program. 213
Section 3. Effective January 1, 2024, subsection (3) of 214
section 409.816, Florida Statutes, is amended to read: 215
409.816 Limitations on premiums and cost sharing. —The 216
following limitations on premiums and cost sharing are 217
established for the program. 218
(3) Enrollees in families with a family income above 150 219
percent of the federal poverty level who are not receiving 220
coverage under the Medicaid program or who are not eligible 221
under s. 409.814(7) may be required to pay enrollment fees, 222
premiums, copayments, deductibles, coinsurance, or similar 223
charges on a sliding scale r elated to income, except that the 224
total annual aggregate cost sharing with respect to all children 225
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in a family may not exceed 5 percent of the family's income. 226
However, copayments, deductibles, coinsurance, or similar 227
charges may not be imposed for prevent ive services, including 228
well-baby and well-child care, age-appropriate immunizations, 229
and routine hearing and vision screenings. Premiums for 230
enrollees paying enrollment fees, premiums, copayments, 231
deductibles, coinsurance, or similar charges as provided i n this 232
subsection shall be based on at least three but no more than six 233
tiers of uniform premiums that increase with each tier as a 234
percentage of the applicable threshold amount of the federal 235
poverty level, by tier. 236
Section 4. Effective January 1, 202 4, paragraph (b) of 237
subsection (2) of section 624.91, Florida Statutes, is amended 238
to read: 239
624.91 The Florida Healthy Kids Corporation Act. — 240
(2) LEGISLATIVE INTENT. — 241
(b) It is the intent of the Legislature that the Florida 242
Healthy Kids Corporation s erve as one of several providers of 243
services to children eligible for medical assistance under Title 244
XXI of the Social Security Act. Although the corporation may 245
serve other children, the Legislature intends the primary 246
recipients of services provided thro ugh the corporation be 247
school-age children with a family income equal to or below 300 248
200 percent of the federal poverty level, who do not qualify for 249
Medicaid. It is also the intent of the Legislature that state 250
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and local government Florida Healthy Kids f unds be used to 251
continue coverage, subject to specific appropriations in the 252
General Appropriations Act, to children not eligible for federal 253
matching funds under Title XXI. 254
Section 5. Except as otherwise expressly provided in this 255
act, this act shall take effect upon becoming a law. 256