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