Florida 2023 Regular Session

Florida House Bill H1245 Compare Versions

Only one version of the bill is available at this time.

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10	10	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	14	A bill to be entitled 1
15	15	An act relating to Florida Kidcare program income 2
16	16	eligibility; creating s. 409.8141, F.S.; establishing 3
17	17	a tiered system of family premiums for Title -XXI 4
18	18	coverage under the Florida Kidcare program beginning 5
19	19	on a specified date; authorizing the Agency for Health 6
20	20	Care Administration to seek federal waiver approval or 7
21	21	submit any state plan amendments as necessary; 8
22	22	amending ss. 409.8132, 409.814, and 624.91, F.S.; 9
23	23	increasing the income eligibility threshold for 10
24	24	coverage under the program to conform to changes made 11
25	25	by the act; providing that specified amendments are 12
26	26	subject to federal approval; requiring the agency to 13
27	27	notify the Division of Law Revision within a specifie d 14
28	28	timeframe after receiving federal approval through a 15
29	29	waiver or state plan amendment; providing an effective 16
30	30	date. 17
31	31	18
32	32	Be It Enacted by the Legislature of the State of Florida: 19
33	33	20
34	34	Section 1. Section 409.8141, Florida Statutes, is created 21
35	35	to read: 22
36	36	409.8141 Tiered system of family premiums for Title -XXI 23
37	37	coverage under the Florida Kidcare program. — 24
38	38	(1) Beginning January 1, 2024, and subject to federal 25
39	39
40	40	HB 1245 2023
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47	47	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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49	49
50	50
51	51	approval through a waiver or a state plan amendment, the 26
52	52	following tiered system of family premiums fo r Title-XXI 27
53	53	coverage under the Florida Kidcare program shall apply: 28
54	54	(a) For a child whose family has an income from 200.01 29
55	55	through 240 percent of the federal poverty level, a uniform 30
56	56	premium calculated by using the average household size in this 31
57	57	state multiplied by 1 percent of the highest potential income 32
58	58	within this range. 33
59	59	(b) For a child whose family has an income from 240.01 34
60	60	through 280 percent of the federal poverty level, a uniform 35
61	61	premium calculated by using the average household size in this 36
62	62	state multiplied by 1.5 percent of the highest potential income 37
63	63	within this range. 38
64	64	(c) For a child whose family has an income from 280.01 39
65	65	through 320 percent of the federal poverty level, a uniform 40
66	66	premium calculated by using the average household size in t his 41
67	67	state multiplied by 2 percent of the highest potential income 42
68	68	within this range. 43
69	69	(d) For a child whose family has an income from 320.01 44
70	70	through 360 percent of the federal poverty level, a uniform 45
71	71	premium calculated by using the average household size in this 46
72	72	state multiplied by 2.5 percent of the highest potential income 47
73	73	within this range. 48
74	74	(e) For a child whose family has an income from 360.01 49
75	75	through 400 percent of the federal poverty level, a uniform 50
76	76
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84	84	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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86	86
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88	88	premium calculated by using the average househo ld size in this 51
89	89	state multiplied by 3 percent of the highest potential income 52
90	90	within this range. 53
91	91	(2) The agency may seek federal waiver approval or submit 54
92	92	any state plan amendments necessary to implement this section. 55
93	93	Section 2. Paragraph (a) of subs ection (6) of section 56
94	94	409.8132, Florida Statutes, is amended to read: 57
95	95	409.8132 Medikids program component. — 58
96	96	(6) ELIGIBILITY.— 59
97	97	(a) A child who has attained the age of 1 year but who is 60
98	98	under the age of 5 years is eligible to enroll in the Medikids 61
99	99	program component of the Florida Kidcare program, if the child 62
100	100	is a member of a family that has a family income which exceeds 63
101	101	the Medicaid applicable income level as specified in s. 409.903, 64
102	102	but which is equal to or below 400 200 percent of the current 65
103	103	federal poverty level. In determining the eligibility of such a 66
104	104	child, an assets test is not required. A child who is eligible 67
105	105	for Medikids may elect to enroll in Florida Healthy Kids 68
106	106	coverage or employer -sponsored group coverage. However, a child 69
107	107	who is eligible for Medikids may participate in the Florida 70
108	108	Healthy Kids program only if the child has a sibling 71
109	109	participating in the Florida Hea lthy Kids program and the 72
110	110	child's county of residence permits such enrollment. 73
111	111	Section 3. Section 409.814, Florida Statutes, is amended 74
112	112	to read: 75
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121	121	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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125	125	409.814 Eligibility. —A child who has not reached 19 years 76
126	126	of age whose family income is equal to or below 400 200 percent 77
127	127	of the federal poverty level is eligible for the Florida Kidcare 78
128	128	program as provided in this section. If an enrolled individual 79
129	129	is determined to be ineligible for coverage, he or she must be 80
130	130	immediately disenrolled from the respective Flor ida Kidcare 81
131	131	program component. 82
132	132	(1) A child who is eligible for Medicaid coverage under s. 83
133	133	409.903 or s. 409.904 must be enrolled in Medicaid and is not 84
134	134	eligible to receive health benefits under any other health 85
135	135	benefits coverage authorized under the Flor ida Kidcare program. 86
136	136	(2) A child who is not eligible for Medicaid, but who is 87
137	137	eligible for the Florida Kidcare program, may obtain health 88
138	138	benefits coverage under any of the other components listed in s. 89
139	139	409.813 if such coverage is approved and available in the county 90
140	140	in which the child resides. 91
141	141	(3) A Title XXI-funded child who is eligible for the 92
142	142	Florida Kidcare program who is a child with special health care 93
143	143	needs, as determined through a medical or behavioral screening 94
144	144	instrument, is eligible for heal th benefits coverage from and 95
145	145	shall be assigned to and may opt out of the Children's Medical 96
146	146	Services Network. 97
147	147	(4) A Title XXI-funded child who reaches 19 years of age 98
148	148	is eligible for continued Title XXI -funded coverage for the 99
149	149	duration of a pregnancy an d the postpartum period consisting of 100
150	150
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158	158	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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160	160
161	161
162	162	the 12-month period beginning on the last day of a pregnancy, if 101
163	163	such pregnancy or postpartum period begins prior to the child 102
164	164	reaching 19 years of age, and if the child is ineligible for 103
165	165	Medicaid. 104
166	166	(5) The following children are not eligible to receive 105
167	167	Title XXI-funded premium assistance for health benefits coverage 106
168	168	under the Florida Kidcare program, except under Medicaid if the 107
169	169	child would have been eligible for Medicaid under s. 409.903 or 108
170	170	s. 409.904 as of June 1, 1 997: 109
171	171	(a) A child who is covered under a family member's group 110
172	172	health benefit plan or under other private or employer health 111
173	173	insurance coverage, if the cost of the child's participation is 112
174	174	not greater than 5 percent of the family's income. If a child is 113
175	175	otherwise eligible for a subsidy under the Florida Kidcare 114
176	176	program and the cost of the child's participation in the family 115
177	177	member's health insurance benefit plan is greater than 5 percent 116
178	178	of the family's income, the child may enroll in the appropriate 117
179	179	subsidized Kidcare program. 118
180	180	(b) A child who is seeking premium assistance for the 119
181	181	Florida Kidcare program through employer -sponsored group 120
182	182	coverage, if the child has been covered by the same employer's 121
183	183	group coverage during the 60 days before the family submi tted an 122
184	184	application for determination of eligibility under the program. 123
185	185	(c) A child who is an alien but who does not meet the 124
186	186	definition of a lawfully residing child. This paragraph does not 125
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195	195	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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199	199	extend eligibility for the Florida Kidcare program to an 126
200	200	undocumented immigrant. 127
201	201	(d) A child who is an inmate of a public institution or a 128
202	202	patient in an institution for mental diseases. 129
203	203	(e) A child who is otherwise eligible for premium 130
204	204	assistance for the Florida Kidcare program and has had his or 131
205	205	her coverage in an employer-sponsored or private health benefit 132
206	206	plan voluntarily canceled in the last 60 days, except those 133
207	207	children whose coverage was voluntarily canceled for good cause, 134
208	208	including, but not limited to, the following circumstances: 135
209	209	1. The cost of partici pation in an employer -sponsored 136
210	210	health benefit plan is greater than 5 percent of the family's 137
211	211	income; 138
212	212	2. The parent lost a job that provided an employer -139
213	213	sponsored health benefit plan for children; 140
214	214	3. The parent who had health benefits coverage for the 141
215	215	child is deceased; 142
216	216	4. The child has a medical condition that, without medical 143
217	217	care, would cause serious disability, loss of function, or 144
218	218	death; 145
219	219	5. The employer of the parent canceled health benefits 146
220	220	coverage for children; 147
221	221	6. The child's health benefi ts coverage ended because the 148
222	222	child reached the maximum lifetime coverage amount; 149
223	223	7. The child has exhausted coverage under a COBRA 150
224	224
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232	232	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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234	234
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236	236	continuation provision; 151
237	237	8. The health benefits coverage does not cover the child's 152
238	238	health care needs; or 153
239	239	9. Domestic violence led to loss of coverage. 154
240	240	(6) A child who is otherwise eligible for the Florida 155
241	241	Kidcare program and who has a preexisting condition that 156
242	242	prevents coverage under another insurance plan as described in 157
243	243	paragraph (5)(a) which would have disqualified the child for the 158
244	244	Florida Kidcare program if the child were able to enroll in the 159
245	245	plan is eligible for Florida Kidcare coverage when enrollment is 160
246	246	possible. 161
247	247	(7) A child whose family income is above 400 200 percent 162
248	248	of the federal poverty level or a child who is excluded under 163
249	249	the provisions of subsection (5) may participate in the Florida 164
250	250	Kidcare program as provided in s. 409.8132 or, if the child is 165
251	251	ineligible for Medikids by reason of age, in the Florida Healthy 166
252	252	Kids program, subject to the following: 167
253	253	(a) The family is not eligible for premium assistance 168
254	254	payments and must pay the full cost of the premium, including 169
255	255	any administrative costs. 170
256	256	(b) The board of directors of the Florida Healthy Kids 171
257	257	Corporation may offer a reduced benefit package to these 172
258	258	children in order to limit program costs for such families. 173
259	259	(8) Once a child is enrolled in the Florida Kidcare 174
260	260	program, the child is eligible for coverage for 12 months 175
261	261
262	262	HB 1245 2023
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269	269	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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273	273	without a redetermination or reverification of eligibility, if 176
274	274	the family continues to pay the applicable premium. Eligibility 177
275	275	for program components funded through Title XXI of the Social 178
276	276	Security Act terminates when a child attains the age of 19. A 179
277	277	child who has not attained the age of 5 and who has been 180
278	278	determined eligible for the Medi caid program is eligible for 181
279	279	coverage for 12 months without a redetermination or 182
280	280	reverification of eligibility. 183
281	281	(9) When determining or reviewing a child's eligibility 184
282	282	under the Florida Kidcare program, the applicant shall be 185
283	283	provided with reasonable not ice of changes in eligibility which 186
284	284	may affect enrollment in one or more of the program components. 187
285	285	If a transition from one program component to another is 188
286	286	authorized, there shall be cooperation between the program 189
287	287	components and the affected family which promotes continuity of 190
288	288	health care coverage. Any authorized transfers must be managed 191
289	289	within the program's overall appropriated or authorized levels 192
290	290	of funding. Each component of the program shall establish a 193
291	291	reserve to ensure that transfers between compo nents will be 194
292	292	accomplished within current year appropriations. These reserves 195
293	293	shall be reviewed by each convening of the Social Services 196
294	294	Estimating Conference to determine the adequacy of such reserves 197
295	295	to meet actual experience. 198
296	296	(10) In determining the e ligibility of a child, an assets 199
297	297	test is not required. Each applicant shall provide documentation 200
298	298
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306	306	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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310	310	during the application process and the redetermination process, 201
311	311	including, but not limited to, the following: 202
312	312	(a) Proof of family income, which must be verified 203
313	313	electronically to determine financial eligibility for the 204
314	314	Florida Kidcare program. Written documentation, which may 205
315	315	include wages and earnings statements or pay stubs, W -2 forms, 206
316	316	or a copy of the applicant's most recent federal income tax 207
317	317	return, is required only if the electronic verification is not 208
318	318	available or does not substantiate the applicant's income. 209
319	319	(b) A statement from all applicable, employed family 210
320	320	members that: 211
321	321	1. Their employers do not sponsor health benefit plans for 212
322	322	employees; 213
323	323	2. The potential enrollee is not covered by an employer -214
324	324	sponsored health benefit plan; or 215
325	325	3. The potential enrollee is covered by an employer -216
326	326	sponsored health benefit plan and the cost of the employer -217
327	327	sponsored health benefit plan is more than 5 percent of the 218
328	328	family's income. 219
329	329	(c) To enroll in the Children's Medical Services Network, 220
330	330	a completed application, including a clinical screening. 221
331	331	(11) Subject to paragraph (5)(a), the Florida Kidcare 222
332	332	program shall withhold benefits from an enrollee if the pr ogram 223
333	333	obtains evidence that the enrollee is no longer eligible, 224
334	334	submitted incorrect or fraudulent information in order to 225
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343	343	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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347	347	establish eligibility, or failed to provide verification of 226
348	348	eligibility. The applicant or enrollee shall be notified that 227
349	349	because of such evidence program benefits will be withheld 228
350	350	unless the applicant or enrollee contacts a designated 229
351	351	representative of the program by a specified date, which must be 230
352	352	within 10 working days after the date of notice, to discuss and 231
353	353	resolve the matter. The p rogram shall make every effort to 232
354	354	resolve the matter within a timeframe that will not cause 233
355	355	benefits to be withheld from an eligible enrollee. 234
356	356	(12) The following individuals may be subject to 235
357	357	prosecution in accordance with s. 414.39: 236
358	358	(a) An applicant obtaining or attempting to obtain 237
359	359	benefits for a potential enrollee under the Florida Kidcare 238
360	360	program when the applicant knows or should have known the 239
361	361	potential enrollee does not qualify for the Florida Kidcare 240
362	362	program. 241
363	363	(b) An individual who assists an a pplicant in obtaining or 242
364	364	attempting to obtain benefits for a potential enrollee under the 243
365	365	Florida Kidcare program when the individual knows or should have 244
366	366	known the potential enrollee does not qualify for the Florida 245
367	367	Kidcare program. 246
368	368	Section 4. Paragraph (b) of subsection (2) of section 247
369	369	624.91, Florida Statutes, is amended to read: 248
370	370	624.91 The Florida Healthy Kids Corporation Act. — 249
371	371	(2) LEGISLATIVE INTENT. — 250
372	372
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380	380	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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384	384	(b) It is the intent of the Legislature that the Florida 251
385	385	Healthy Kids Corporation serve as on e of several providers of 252
386	386	services to children eligible for medical assistance under Title 253
387	387	XXI of the Social Security Act. Although the corporation may 254
388	388	serve other children, the Legislature intends the primary 255
389	389	recipients of services provided through the co rporation be 256
390	390	school-age children with a family income equal to or below 400 257
391	391	200 percent of the federal poverty level, who do not qualify for 258
392	392	Medicaid. It is also the intent of the Legislature that state 259
393	393	and local government Florida Healthy Kids funds be us ed to 260
394	394	continue coverage, subject to specific appropriations in the 261
395	395	General Appropriations Act, to children not eligible for federal 262
396	396	matching funds under Title XXI. 263
397	397	Section 5. (1) The amendments to ss. 409.8132, 409.814, 264
398	398	and 624.91, Florida Statutes, m ade by this act are subject to 265
399	399	federal approval through a waiver or state plan amendment. 266
400	400	(2) The Agency for Health Care Administration shall notify 267
401	401	the Division of Law Revision within 10 days after receiving 268
402	402	federal approval through a waiver or state pl an amendment. 269
403	403	Section 6. This act shall take effect January 1, 2024. 270