FL
Florida House Bill H0121

Florida 2023 Regular Session

Florida House Bill H0121 Compare Versions

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1010 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
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14+A bill to be entitled 1
1515 An act relating to Florida Kidcare program 2
1616 eligibility; amending s. 409.8132, F.S.; increasing 3
1717 the income eligibility threshold for coverage under 4
1818 the Medikids program component; amending s. 409.814, 5
1919 F.S.; increasing the income eligibility threshold for 6
2020 coverage under the Florida Kidcare program; requiring 7
2121 an applicant seeking coverage under the program to 8
2222 provide certain documentation if eligibility cannot be 9
2323 verified using reliable data sources; amending s. 10
2424 409.816, F.S.; requiring that premiums for certain 11
2525 enrollees under the Florida Kidcare program be based 12
2626 on a tiered system of uniform premiums; amending s. 13
2727 624.91, F.S.; conforming a provision to changes made 14
2828 by the act; providing effective dates. 15
2929 16
3030 Be It Enacted by the Legislature of the State of Florida: 17
3131 18
3232 Section 1. Effective January 1, 2024, paragraph (a) of 19
3333 subsection (6) of section 409.8132, Florida Statutes, is amended 20
3434 to read: 21
3535 409.8132 Medikids program component.— 22
3636 (6) ELIGIBILITY.— 23
3737 (a) A child who has attained the age of 1 year but who is 24
3838 under the age of 5 years is eligible to enroll in the Medikids 25
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4747 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
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5151 program component of the Florida Kidcare program, if the child 26
5252 is a member of a family that has a family income which exceeds 27
5353 the Medicaid applicable income level as specified in s. 409.903, 28
5454 but which is equal to or below 300 200 percent of the current 29
5555 federal poverty level. In determining the eligibility of such a 30
5656 child, an assets test is not re quired. A child who is eligible 31
5757 for Medikids may elect to enroll in Florida Healthy Kids 32
5858 coverage or employer -sponsored group coverage. However, a child 33
5959 who is eligible for Medikids may participate in the Florida 34
6060 Healthy Kids program only if the child has a sibling 35
6161 participating in the Florida Healthy Kids program and the 36
6262 child's county of residence permits such enrollment. 37
6363 Section 2. Effective January 1, 2024, section 409.814, 38
6464 Florida Statutes, is amended to read: 39
6565 409.814 Eligibility. —A child who has not reached 19 years 40
6666 of age whose family income is equal to or below 300 200 percent 41
6767 of the federal poverty level is eligible for the Florida Kidcare 42
6868 program as provided in this section. If an enrolled individual 43
6969 is determined to be ineligible for coverag e, he or she must be 44
7070 immediately disenrolled from the respective Florida Kidcare 45
7171 program component. 46
7272 (1) A child who is eligible for Medicaid coverage under s. 47
7373 409.903 or s. 409.904 must be enrolled in Medicaid and is not 48
7474 eligible to receive health benefi ts under any other health 49
7575 benefits coverage authorized under the Florida Kidcare program. 50
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8484 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
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8888 (2) A child who is not eligible for Medicaid, but who is 51
8989 eligible for the Florida Kidcare program, may obtain health 52
9090 benefits coverage under any of the other compon ents listed in s. 53
9191 409.813 if such coverage is approved and available in the county 54
9292 in which the child resides. 55
9393 (3) A Title XXI-funded child who is eligible for the 56
9494 Florida Kidcare program who is a child with special health care 57
9595 needs, as determined throu gh a medical or behavioral screening 58
9696 instrument, is eligible for health benefits coverage from and 59
9797 shall be assigned to and may opt out of the Children's Medical 60
9898 Services Network. 61
9999 (4) A Title XXI-funded child who reaches 19 years of age 62
100100 is eligible for continued Title XXI-funded coverage for the 63
101101 duration of a pregnancy and the postpartum period consisting of 64
102102 the 12-month period beginning on the last day of a pregnancy, if 65
103103 such pregnancy or postpartum period begins prior to the child 66
104104 reaching 19 years of a ge, and if the child is ineligible for 67
105105 Medicaid. 68
106106 (5) The following children are not eligible to receive 69
107107 Title XXI-funded premium assistance for health benefits coverage 70
108108 under the Florida Kidcare program, except under Medicaid if the 71
109109 child would have been eligible for Medicaid under s. 409.903 or 72
110110 s. 409.904 as of June 1, 1997: 73
111111 (a) A child who is covered under a family member's group 74
112112 health benefit plan or under other private or employer health 75
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121121 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
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125125 insurance coverage, if the cost of the child's participation is 76
126126 not greater than 5 percent of the family's income. If a child is 77
127127 otherwise eligible for a subsidy under the Florida Kidcare 78
128128 program and the cost of the child's participation in the family 79
129129 member's health insurance benefit plan is greater than 5 percent 80
130130 of the family's income, the child may enroll in the appropriate 81
131131 subsidized Kidcare program. 82
132132 (b) A child who is seeking premium assistance for the 83
133133 Florida Kidcare program through employer -sponsored group 84
134134 coverage, if the child has been covered by the same employer's 85
135135 group coverage during the 60 days before the family submitted an 86
136136 application for determination of eligibility under the program. 87
137137 (c) A child who is an alien but who does not meet the 88
138138 definition of a lawfully residing child. This paragraph does not 89
139139 extend eligibility for the Florida Kidcare program to an 90
140140 undocumented immigrant. 91
141141 (d) A child who is an inmate of a public institution or a 92
142142 patient in an institution for mental diseases. 93
143143 (e) A child who is otherwise eligible for premium 94
144144 assistance for the Florida Kidcare program and has had his or 95
145145 her coverage in an employer -sponsored or private health benefit 96
146146 plan voluntarily canceled in the last 60 days, except those 97
147147 children whose coverage was voluntarily canceled for good cause, 98
148148 including, but not limited to, the following circumstances: 99
149149 1. The cost of participation in an employer -sponsored 100
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158158 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
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162162 health benefit plan is greater than 5 percent of the family's 101
163163 income; 102
164164 2. The parent lost a job that provided an employer -103
165165 sponsored health benefit plan for children; 104
166166 3. The parent who had health benefits coverage for the 105
167167 child is deceased; 106
168168 4. The child has a medical condition that, without medical 107
169169 care, would cause serious disability, loss of function, or 108
170170 death; 109
171171 5. The employer of the parent cancel ed health benefits 110
172172 coverage for children; 111
173173 6. The child's health benefits coverage ended because the 112
174174 child reached the maximum lifetime coverage amount; 113
175175 7. The child has exhausted coverage under a COBRA 114
176176 continuation provision; 115
177177 8. The health benefits c overage does not cover the child's 116
178178 health care needs; or 117
179179 9. Domestic violence led to loss of coverage. 118
180180 (6) A child who is otherwise eligible for the Florida 119
181181 Kidcare program and who has a preexisting condition that 120
182182 prevents coverage under another insura nce plan as described in 121
183183 paragraph (5)(a) which would have disqualified the child for the 122
184184 Florida Kidcare program if the child were able to enroll in the 123
185185 plan is eligible for Florida Kidcare coverage when enrollment is 124
186186 possible. 125
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195195 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
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199199 (7) A child whose family income is above 300 200 percent 126
200200 of the federal poverty level or a child who is excluded under 127
201201 the provisions of subsection (5) may participate in the Florida 128
202202 Kidcare program as provided in s. 409.8132 or, if the child is 129
203203 ineligible for Medikids by reason o f age, in the Florida Healthy 130
204204 Kids program, subject to the following: 131
205205 (a) The family is not eligible for premium assistance 132
206206 payments and must pay the full cost of the premium, including 133
207207 any administrative costs. 134
208208 (b) The board of directors of the Florid a Healthy Kids 135
209209 Corporation may offer a reduced benefit package to these 136
210210 children in order to limit program costs for such families. 137
211211 (8) Once a child is enrolled in the Florida Kidcare 138
212212 program, the child is eligible for coverage for 12 months 139
213213 without a redetermination or reverification of eligibility, if 140
214214 the family continues to pay the applicable premium. Eligibility 141
215215 for program components funded through Title XXI of the Social 142
216216 Security Act terminates when a child attains the age of 19. A 143
217217 child who has not attained the age of 5 and who has been 144
218218 determined eligible for the Medicaid program is eligible for 145
219219 coverage for 12 months without a redetermination or 146
220220 reverification of eligibility. 147
221221 (9) When determining or reviewing a child's eligibility 148
222222 under the Florida Kidcare program, the applicant shall be 149
223223 provided with reasonable notice of changes in eligibility which 150
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232232 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
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236236 may affect enrollment in one or more of the program components. 151
237237 If a transition from one program component to another is 152
238238 authorized, there shall be cooperation between the program 153
239239 components and the affected family which promotes continuity of 154
240240 health care coverage. Any authorized transfers must be managed 155
241241 within the program's overall appropriated or authorized levels 156
242242 of funding. Each component of the program shall establish a 157
243243 reserve to ensure that transfers between components will be 158
244244 accomplished within current year appropriations. These reserves 159
245245 shall be reviewed by each convening of the Social Services 160
246246 Estimating Conference to determine the adequacy of such reserves 161
247247 to meet actual experience. 162
248248 (10) In determining the eligibility of a child, an assets 163
249249 test is not required. If eligibility for the Florida Kidcare 164
250250 program cannot be verified using reliable data sources in 165
251251 accordance with federal requirem ents, each applicant shall 166
252252 provide documentation during the application process and the 167
253253 redetermination process, including, but not limited to, the 168
254254 following: 169
255255 (a) Proof of family income, which must be verified 170
256256 electronically to determine financial eligib ility for the 171
257257 Florida Kidcare program. Written documentation, which may 172
258258 include wages and earnings statements or pay stubs, W -2 forms, 173
259259 or a copy of the applicant's most recent federal income tax 174
260260 return, is required only if the electronic verification is no t 175
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269269 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
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273273 available or does not substantiate the applicant's income. 176
274274 (b) A statement from all applicable, employed family 177
275275 members that: 178
276276 1. Their employers do not sponsor health benefit plans for 179
277277 employees; 180
278278 2. The potential enrollee is not covered by an emplo yer-181
279279 sponsored health benefit plan; or 182
280280 3. The potential enrollee is covered by an employer -183
281281 sponsored health benefit plan and the cost of the employer -184
282282 sponsored health benefit plan is more than 5 percent of the 185
283283 family's income. 186
284284 (c) To enroll in the Child ren's Medical Services Network, 187
285285 a completed application, including a clinical screening. 188
286286 (11) Subject to paragraph (5)(a), the Florida Kidcare 189
287287 program shall withhold benefits from an enrollee if the program 190
288288 obtains evidence that the enrollee is no longer eligible, 191
289289 submitted incorrect or fraudulent information in order to 192
290290 establish eligibility, or failed to provide verification of 193
291291 eligibility. The applicant or enrollee shall be notified that 194
292292 because of such evidence program benefits will be withheld 195
293293 unless the applicant or enrollee contacts a designated 196
294294 representative of the program by a specified date, which must be 197
295295 within 10 working days after the date of notice, to discuss and 198
296296 resolve the matter. The program shall make every effort to 199
297297 resolve the matter within a timeframe that will not cause 200
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306306 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
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310310 benefits to be withheld from an eligible enrollee. 201
311311 (12) The following individuals may be subject to 202
312312 prosecution in accordance with s. 414.39: 203
313313 (a) An applicant obtaining or attempting to obtain 204
314314 benefits for a poten tial enrollee under the Florida Kidcare 205
315315 program when the applicant knows or should have known the 206
316316 potential enrollee does not qualify for the Florida Kidcare 207
317317 program. 208
318318 (b) An individual who assists an applicant in obtaining or 209
319319 attempting to obtain benefit s for a potential enrollee under the 210
320320 Florida Kidcare program when the individual knows or should have 211
321321 known the potential enrollee does not qualify for the Florida 212
322322 Kidcare program. 213
323323 Section 3. Effective January 1, 2024, subsection (3) of 214
324324 section 409.816, Florida Statutes, is amended to read: 215
325325 409.816 Limitations on premiums and cost sharing. —The 216
326326 following limitations on premiums and cost sharing are 217
327327 established for the program. 218
328328 (3) Enrollees in families with a family income above 150 219
329329 percent of the federal poverty level who are not receiving 220
330330 coverage under the Medicaid program or who are not eligible 221
331331 under s. 409.814(7) may be required to pay enrollment fees, 222
332332 premiums, copayments, deductibles, coinsurance, or similar 223
333333 charges on a sliding scale r elated to income, except that the 224
334334 total annual aggregate cost sharing with respect to all children 225
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343343 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
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347347 in a family may not exceed 5 percent of the family's income. 226
348348 However, copayments, deductibles, coinsurance, or similar 227
349349 charges may not be imposed for prevent ive services, including 228
350350 well-baby and well-child care, age-appropriate immunizations, 229
351351 and routine hearing and vision screenings. Premiums for 230
352352 enrollees paying enrollment fees, premiums, copayments, 231
353353 deductibles, coinsurance, or similar charges as provided i n this 232
354354 subsection shall be based on at least three but no more than six 233
355355 tiers of uniform premiums that increase with each tier as a 234
356356 percentage of the applicable threshold amount of the federal 235
357357 poverty level, by tier. 236
358358 Section 4. Effective January 1, 202 4, paragraph (b) of 237
359359 subsection (2) of section 624.91, Florida Statutes, is amended 238
360360 to read: 239
361361 624.91 The Florida Healthy Kids Corporation Act. — 240
362362 (2) LEGISLATIVE INTENT. — 241
363363 (b) It is the intent of the Legislature that the Florida 242
364364 Healthy Kids Corporation s erve as one of several providers of 243
365365 services to children eligible for medical assistance under Title 244
366366 XXI of the Social Security Act. Although the corporation may 245
367367 serve other children, the Legislature intends the primary 246
368368 recipients of services provided thro ugh the corporation be 247
369369 school-age children with a family income equal to or below 300 248
370370 200 percent of the federal poverty level, who do not qualify for 249
371371 Medicaid. It is also the intent of the Legislature that state 250
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380380 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
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384384 and local government Florida Healthy Kids f unds be used to 251
385385 continue coverage, subject to specific appropriations in the 252
386386 General Appropriations Act, to children not eligible for federal 253
387387 matching funds under Title XXI. 254
388388 Section 5. Except as otherwise expressly provided in this 255
389389 act, this act shall take effect upon becoming a law. 256