STORAGE NAME: h1227.HFS
DATE: 3/26/2025
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FLORIDA HOUSE OF REPRESENTATIVES
BILL ANALYSIS
This bill analysis was prepared by nonpartisan committee staff and does not constitute an official statement of legislative intent.
BILL #: HB 1227
TITLE: Medicaid Enrollment for Permanently Disabled
Individuals
SPONSOR(S): Tramont
COMPANION BILL: None
LINKED BILLS: None
RELATED BILLS: None
Committee References
Health Care Facilities & Systems
Health Care Budget
Health & Human Services
SUMMARY
Effect of the Bill:
The bill requires the Agency for Health Care Administration (AHCA) to seek federal approval to allow eligibility
determinations for Medicaid and the Children’s Health Insurance Program to be completed every five years, instead
of annually, for Medicaid-qualified individuals who are permanently disabled. For a permanently disabled
individual to qualify for such a redetermination, the individual must have a lifelong physical or intellectual
impairment that substantially limits one or more major life activities, or have a history or record of such an
impairment, or is perceived by others as having such an impairment.
The bill requires the Department of Children and Families (DCF) to collaborate with AHCA and the Agency for
Persons with Disabilities to adopt guidelines and procedures for determining if an individual is permanently
disabled.
Fiscal or Economic Impact:
The bill will have a negative fiscal impact on DCF and AHCA.
(See Fiscal Impact on State Government Section)
JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
ANALYSIS
EFFECT OF THE BILL:
Under current Florida laws and regulations governing the Florida Medicaid program, a permanently disabled
Medicaid recipient is required to undergo a Medicaid eligibility redetermination every 12 months. Few members of
this population ever become disqualified for exceeding income and asset limits because their permanent disability
prevents them from receiving sufficient income through gainful employment.
The bill requires the Agency for Health Care Administration (AHCA) to seek federal approval to allow eligibility
determinations for Medicaid and the Children’s Health Insurance Program to be completed every five years,
instead of annually, for Medicaid-qualified individuals who are permanently disabled. For a permanently disabled
individual to qualify for such a redetermination, the individual must have a lifelong physical or intellectual
impairment that substantially limits one or more major life activities, or have a history or record of such an
impairment, or is perceived by others as having such an impairment. (Section 1)
The bill requires the Department of Children and Families (DCF) to collaborate with AHCA and the Agency for
Persons with Disabilities (APD) to adopt guidelines and procedures for determining if an individual is permanently
disabled. (Section 1)
The bill provides an effective date of July 1, 2025. (Section 2) JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
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FISCAL OR ECONOMIC IMPACT:
STATE GOVERNMENT:
The bill is expected to have a negative fiscal impact of $708,000 on DCF resulting from costs associated with
updating their online Medicaid application platform.
1
AHCA will also have costs to make procedural and system updates, but they can be absorbed with existing
resources. Additionally, AHCA expects the bill to have an indeterminate negative fiscal impact for the cost of
coverage for any enrollees who would have been identified as ineligible, but for the bill’s provisions.
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RELEVANT INFORMATION
SUBJECT OVERVIEW:
Florida Medicaid
Medicaid is the health care safety net for low-income Floridians. Medicaid is a partnership of the federal and state
governments established to provide coverage for health services for eligible persons. The program is administered
by AHCA and financed by federal and state funds.
3 AHCA delegates certain functions to other state agencies,
including DCF, APD, the Department of Health (DOH), and the Department of Elderly Affairs (DOEA).
The structure of each state’s Medicaid program varies and what states must pay for is largely determined by the
federal government, as a condition of receiving federal funds. Federal law sets the amount, scope, and duration of
services offered in the program, among other requirements. These federal requirements create an entitlement that
comes with constitutional due process protections. The entitlement means that two parts of the Medicaid cost
equation – people and utilization – are largely predetermined for the states. The federal government sets the
minimum mandatory populations to be included in every state Medicaid program. The federal government also
sets the minimum mandatory benefits to be covered in every state Medicaid program. These benefits include
physician services, hospital services, home health services, and family planning.
4 States can add benefits, with
federal approval. Florida has added many optional benefits, including prescription drugs, adult dental services, and
dialysis.
5
States have some flexibility in the provision of Medicaid services. Section 1915(b) of the Social Security Act
provides authority for the Secretary of the U.S. Department of Health and Human Services (HHS) to waive
requirements to the extent that he or she “finds it to be cost-effective and efficient and not inconsistent with the
purposes of this title.” Section 1115 of the Social Security Act allows states to implement demonstrations of
innovative service delivery systems that improve care, increase efficiency, and reduce costs. These laws allow HHS
to waive federal requirements to expand populations or services, or to try new ways of service delivery.
Florida operates under a Section 1115 waiver to use a comprehensive managed care delivery model for primary
and acute care services, the Statewide Medicaid Managed Care (SMMC) Managed Medical Assistance (MMA)
program. Florida also has waivers under Sections 1915(b) and (c) of the Social Security Act to operate the SMMC
Long-Term Care (LTC) program and the Development Disabilities Individual Budgeting (iBudget) Waiver.
6
Children’s Health Insurance Program
1 DCF, Agency Analysis of HB 1227 (March 17, 2025).
2 AHCA, Agency Analysis of HB 1227 (March 4, 2025).
3 Title 42 U.S.C. §§ 1396-1396w-5; Title 42 C.F.R. Part 430-456 (§§ 430.0-456.725) (2016).
4 S. 409.905, F.S.
5 S. 409.906, F.S.
6 S. 409.964, F.S. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
3
Florida Kidcare Program
The Florida Kidcare Program (Kidcare or Program) was created by the Florida Legislature in 1998 in response to
the passage of the Children’s Health Insurance Program (CHIP) in 1997.
7 The CHIP provides federal funding to
states to provide subsidized health insurance coverage to uninsured children in families with incomes that are too
high to qualify for Medicaid but who meet other eligibility requirements. When created, CHIP was initially
authorized and allotted funding for 10 years. However, due the program’s capped funding structure, the federal
government has had to repeatedly reauthorize and extend funding.
8 Most recently, the 2023 Consolidated
Appropriations Act extended federal funding for CHIP through fiscal year 2029.
9
Kidcare encompasses four programs:
1. Medicaid for children;
2. The Medikids program;
3. The Children’s Medical Services Network (for children with special needs); and
4. The Florida Health Kids Program.
Kidcare is governed by part II of ch. 409, F.S., and is administered jointly by the Agency for Health Care
Administration (AHCA), the Department of Children and Families (DCF), the Department of Health (DOH), and the
Florida Healthy Kids Corporation (Corporation) established in ch. 624, F.S.
Eligibility is determined in part by age and household income, as a percent of the Federal Poverty Level.
Medicaid Eligibility
Medicaid eligibility in Florida is determined either by DCF or the Social Security Administration (SSA) for SSI
recipients. Since Medicaid is designed for low-income individuals, Medicaid eligibility is based on an evaluation of
the individual’s income and assets.
Section 1614(3) of the Social Security Act provides that an individual shall be considered to be disabled if they are
unable to engage in any substantial gainful activity by reason of any medically determinable physical or mental
impairment which can be expected to result in death or which has lasted or can be expected to last for a continuous
period of not less than twelve months. Further, an individual under the age of 18 shall be considered disabled if
that individual has a medically determinable physical or mental impairment, which results in marked and severe
functional limitations, and which can be expected to result in death or which has lasted or can be expected to last
for a continuous period of not less than 12 months.
Under Florida’s Medicaid State Plan permanent and total disability is a physical or mental condition of major
significance which is expected to continue throughout the lifetime of an individual and is not expected to be
removed or substantially improved by medical treatment. It is expected to continue for a prolonged period of
disability and the eventual prognosis may be indefinite. Total disability exists when the permanent impairment, or
combination of permanent impairments, substantially precludes the individual from engaging in a useful
occupation.
DCF uses the same criteria that the SSA uses to determine disability for benefits. If SSA determines an individual is
disabled, DCF adopts their disability decision.
10 If an individual does not have a disability decision from SSA, then
DCF must obtain a disability determination based on the individual's circumstances:
7 CHIP was created as part of the Balanced Budget Act of 1997 (BBA 97, Pub. L. No. 105.33, s. 4901).
8 The Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA, Pub. L. No. 111–3, s.101) reauthorized CHIP through fiscal
year (FY) 2013, the Patient Protection and Affordable Care Act of 2010, (ACA, Pub. L. No. 111–148, s. 10203) extended CHIP funding through
FY 2015, the Medicare Access and CHIP Reauthorization Act of 2015 (Pub. L. No. 114–10, s. 301) extended funding through FY 2017, the
Healthy Kids Act extended funding to FY 2023 (Pub. L. No. 115-120, s. 3002), and the Bipartisan Budget Act of 2018, (Pub. L. No. 115-123, s.
50101) extended funding for CHIP through 2023 .
9 Consolidated Appropriations Act, 2023, Pub. L. No. 117-328, s. 5111.
10 Supra note 1. JUMP TO SUMMARY ANALYSIS RELEVANT INFORMATION BILL HISTORY
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For individuals residing at home in MEDS-AD (Aged and Disabled) and Medically Needy (Disabled), DCF
uses determinations made by DOH.
For individuals requesting Institutional Care Program or Home and Community Based-Services (HCBS)
Waivers, DCF utilizes their disability medical review team.
DOEA is responsible for conducting clinical level of care evaluations under the LTC Waiver, while APD is
responsible for conducting clinical level of care evaluations under the iBudget Waiver. To be eligible for Medicaid
under 1915(c) waivers, the individual must be determined to need the level of care provided by a hospital, nursing
home, or intermediate care facility for the developmentally disabled.
11 The clinical level of care is determined
during an initial evaluation and the individual must be reevaluated at least annually.
12
Federal regulations require DCF make a redetermination of eligibility without requiring information from the
individual if it is possible to make a redetermination based on reliable information contained in the individual’s
account or obtained from another state agency or federal agency.
13 If DCF is unable to verify the individual’s
eligibility, they send the recipient a renewal notice, electronically and by mail, requesting the required information
to make an eligibility determination.
14
Between April 2023 and February 2025, approximately 534 disabled individuals lost their Medicaid coverage
15
because they failed to provide information requested by DCF to make an eligibility determination.
16 The number of
those individuals that would have still been eligible for Medicaid if they would have sent the requested information
to DCF is unknown. Over that same period of time, approximately 3,357 disabled individuals lost their Medicaid
coverage because they did not meet the income and asset eligibility requirements.
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BILL HISTORY
COMMITTEE REFERENCE ACTION DATE
STAFF
DIRECTOR/
POLICY CHIEF
ANALYSIS
PREPARED BY
Health Care Facilities & Systems
Subcommittee
Calamas Guzzo
Health Care Budget Subcommittee
Health & Human Services
Committee
11 42 C.F.R., § 441.301(b).
12 42 C.F.R., § 441.302(c).
13 42 C.F.R., § 435.916.
14 Supra note 1.
15 Includes the following categories of Medicaid that cover disabled populations: Family Related Medicaid; Long-term Care Medicaid; HCBS
Waiver Medicaid; Community Hospice Medicaid; and Medicaid for Aged and Disabled (MEDS-AD).
16 Supra note 1.
17 Id.