Florida Senate - 2023 CS for CS for SB 246
By the Committee on Fiscal Policy; the Appropriations Committee
on Health and Human Services; and Senators Calatayud, Perry,
Osgood, and Rodriguez
594-04101-23 2023246c2
1 A bill to be entitled
2 An act relating to Florida Kidcare program
3 eligibility; amending s. 409.8132, F.S.; increasing
4 the income eligibility threshold for coverage under
5 the Medikids program component; amending s. 409.814,
6 F.S.; increasing the income eligibility threshold for
7 coverage under the Florida Kidcare program; requiring
8 an applicant seeking coverage under the program to
9 provide certain documentation if eligibility cannot be
10 verified using reliable data sources; amending s.
11 409.816, F.S.; requiring that premiums for certain
12 enrollees under the Florida Kidcare program be based
13 on a tiered system of uniform premiums; amending s.
14 624.91, F.S.; conforming a provision to changes made
15 by the act; providing effective dates.
16
17 Be It Enacted by the Legislature of the State of Florida:
18
19 Section 1. Effective January 1, 2024, paragraph (a) of
20 subsection (6) of section 409.8132, Florida Statutes, is amended
21 to read:
22 409.8132 Medikids program component.—
23 (6) ELIGIBILITY.—
24 (a) A child who has attained the age of 1 year but who is
25 under the age of 5 years is eligible to enroll in the Medikids
26 program component of the Florida Kidcare program, if the child
27 is a member of a family that has a family income which exceeds
28 the Medicaid applicable income level as specified in s. 409.903,
29 but which is equal to or below 300 200 percent of the current
30 federal poverty level. In determining the eligibility of such a
31 child, an assets test is not required. A child who is eligible
32 for Medikids may elect to enroll in Florida Healthy Kids
33 coverage or employer-sponsored group coverage. However, a child
34 who is eligible for Medikids may participate in the Florida
35 Healthy Kids program only if the child has a sibling
36 participating in the Florida Healthy Kids program and the
37 child’s county of residence permits such enrollment.
38 Section 2. Effective January 1, 2024, section 409.814,
39 Florida Statutes, is amended to read:
40 409.814 Eligibility.—A child who has not reached 19 years
41 of age whose family income is equal to or below 300 200 percent
42 of the federal poverty level is eligible for the Florida Kidcare
43 program as provided in this section. If an enrolled individual
44 is determined to be ineligible for coverage, he or she must be
45 immediately disenrolled from the respective Florida Kidcare
46 program component.
47 (1) A child who is eligible for Medicaid coverage under s.
48 409.903 or s. 409.904 must be enrolled in Medicaid and is not
49 eligible to receive health benefits under any other health
50 benefits coverage authorized under the Florida Kidcare program.
51 (2) A child who is not eligible for Medicaid, but who is
52 eligible for the Florida Kidcare program, may obtain health
53 benefits coverage under any of the other components listed in s.
54 409.813 if such coverage is approved and available in the county
55 in which the child resides.
56 (3) A Title XXI-funded child who is eligible for the
57 Florida Kidcare program who is a child with special health care
58 needs, as determined through a medical or behavioral screening
59 instrument, is eligible for health benefits coverage from and
60 shall be assigned to and may opt out of the Children’s Medical
61 Services Network.
62 (4) A Title XXI-funded child who reaches 19 years of age is
63 eligible for continued Title XXI-funded coverage for the
64 duration of a pregnancy and the postpartum period consisting of
65 the 12-month period beginning on the last day of a pregnancy, if
66 such pregnancy or postpartum period begins prior to the child
67 reaching 19 years of age, and if the child is ineligible for
68 Medicaid.
69 (5) The following children are not eligible to receive
70 Title XXI-funded premium assistance for health benefits coverage
71 under the Florida Kidcare program, except under Medicaid if the
72 child would have been eligible for Medicaid under s. 409.903 or
73 s. 409.904 as of June 1, 1997:
74 (a) A child who is covered under a family member’s group
75 health benefit plan or under other private or employer health
76 insurance coverage, if the cost of the child’s participation is
77 not greater than 5 percent of the family’s income. If a child is
78 otherwise eligible for a subsidy under the Florida Kidcare
79 program and the cost of the child’s participation in the family
80 member’s health insurance benefit plan is greater than 5 percent
81 of the family’s income, the child may enroll in the appropriate
82 subsidized Kidcare program.
83 (b) A child who is seeking premium assistance for the
84 Florida Kidcare program through employer-sponsored group
85 coverage, if the child has been covered by the same employer’s
86 group coverage during the 60 days before the family submitted an
87 application for determination of eligibility under the program.
88 (c) A child who is an alien but who does not meet the
89 definition of a lawfully residing child. This paragraph does not
90 extend eligibility for the Florida Kidcare program to an
91 undocumented immigrant.
92 (d) A child who is an inmate of a public institution or a
93 patient in an institution for mental diseases.
94 (e) A child who is otherwise eligible for premium
95 assistance for the Florida Kidcare program and has had his or
96 her coverage in an employer-sponsored or private health benefit
97 plan voluntarily canceled in the last 60 days, except those
98 children whose coverage was voluntarily canceled for good cause,
99 including, but not limited to, the following circumstances:
100 1. The cost of participation in an employer-sponsored
101 health benefit plan is greater than 5 percent of the family’s
102 income;
103 2. The parent lost a job that provided an employer
104 sponsored health benefit plan for children;
105 3. The parent who had health benefits coverage for the
106 child is deceased;
107 4. The child has a medical condition that, without medical
108 care, would cause serious disability, loss of function, or
109 death;
110 5. The employer of the parent canceled health benefits
111 coverage for children;
112 6. The child’s health benefits coverage ended because the
113 child reached the maximum lifetime coverage amount;
114 7. The child has exhausted coverage under a COBRA
115 continuation provision;
116 8. The health benefits coverage does not cover the child’s
117 health care needs; or
118 9. Domestic violence led to loss of coverage.
119 (6) A child who is otherwise eligible for the Florida
120 Kidcare program and who has a preexisting condition that
121 prevents coverage under another insurance plan as described in
122 paragraph (5)(a) which would have disqualified the child for the
123 Florida Kidcare program if the child were able to enroll in the
124 plan is eligible for Florida Kidcare coverage when enrollment is
125 possible.
126 (7) A child whose family income is above 300 200 percent of
127 the federal poverty level or a child who is excluded under the
128 provisions of subsection (5) may participate in the Florida
129 Kidcare program as provided in s. 409.8132 or, if the child is
130 ineligible for Medikids by reason of age, in the Florida Healthy
131 Kids program, subject to the following:
132 (a) The family is not eligible for premium assistance
133 payments and must pay the full cost of the premium, including
134 any administrative costs.
135 (b) The board of directors of the Florida Healthy Kids
136 Corporation may offer a reduced benefit package to these
137 children in order to limit program costs for such families.
138 (8) Once a child is enrolled in the Florida Kidcare
139 program, the child is eligible for coverage for 12 months
140 without a redetermination or reverification of eligibility, if
141 the family continues to pay the applicable premium. Eligibility
142 for program components funded through Title XXI of the Social
143 Security Act terminates when a child attains the age of 19. A
144 child who has not attained the age of 5 and who has been
145 determined eligible for the Medicaid program is eligible for
146 coverage for 12 months without a redetermination or
147 reverification of eligibility.
148 (9) When determining or reviewing a child’s eligibility
149 under the Florida Kidcare program, the applicant shall be
150 provided with reasonable notice of changes in eligibility which
151 may affect enrollment in one or more of the program components.
152 If a transition from one program component to another is
153 authorized, there shall be cooperation between the program
154 components and the affected family which promotes continuity of
155 health care coverage. Any authorized transfers must be managed
156 within the program’s overall appropriated or authorized levels
157 of funding. Each component of the program shall establish a
158 reserve to ensure that transfers between components will be
159 accomplished within current year appropriations. These reserves
160 shall be reviewed by each convening of the Social Services
161 Estimating Conference to determine the adequacy of such reserves
162 to meet actual experience.
163 (10) In determining the eligibility of a child, an assets
164 test is not required. If eligibility for the Florida Kidcare
165 program cannot be verified using reliable data sources in
166 accordance with federal requirements, each applicant must shall
167 provide documentation during the application process and the
168 redetermination process, including, but not limited to, the
169 following:
170 (a) Proof of family income, which must be verified
171 electronically to determine financial eligibility for the
172 Florida Kidcare program. Written documentation, which may
173 include wages and earnings statements or pay stubs, W-2 forms,
174 or a copy of the applicant’s most recent federal income tax
175 return, is required only if the electronic verification is not
176 available or does not substantiate the applicant’s income.
177 (b) A statement from all applicable, employed family
178 members that:
179 1. Their employers do not sponsor health benefit plans for
180 employees;
181 2. The potential enrollee is not covered by an employer
182 sponsored health benefit plan; or
183 3. The potential enrollee is covered by an employer
184 sponsored health benefit plan and the cost of the employer
185 sponsored health benefit plan is more than 5 percent of the
186 family’s income.
187 (c) To enroll in the Children’s Medical Services Network, a
188 completed application, including a clinical screening.
189 (11) Subject to paragraph (5)(a), the Florida Kidcare
190 program shall withhold benefits from an enrollee if the program
191 obtains evidence that the enrollee is no longer eligible,
192 submitted incorrect or fraudulent information in order to
193 establish eligibility, or failed to provide verification of
194 eligibility. The applicant or enrollee must shall be notified
195 that because of such evidence program benefits will be withheld
196 unless the applicant or enrollee contacts a designated
197 representative of the program by a specified date, which must be
198 within 10 working days after the date of notice, to discuss and
199 resolve the matter. The program shall make every effort to
200 resolve the matter within a timeframe that will not cause
201 benefits to be withheld from an eligible enrollee.
202 (12) The following individuals may be subject to
203 prosecution in accordance with s. 414.39:
204 (a) An applicant obtaining or attempting to obtain benefits
205 for a potential enrollee under the Florida Kidcare program when
206 the applicant knows or should have known the potential enrollee
207 does not qualify for the Florida Kidcare program.
208 (b) An individual who assists an applicant in obtaining or
209 attempting to obtain benefits 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 related to income, except that the
224 total annual aggregate cost sharing with respect to all children
225 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 preventive services, including
228 well-baby and well-child care, age-appropriate immunizations,
229 and routine hearing and vision screenings. Premiums for
230 enrollees who are paying enrollment fees, premiums, copayments,
231 deductibles, coinsurance, or similar charges as provided in this
232 subsection must 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, 2024, 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 serve 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 through 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 and local government Florida Healthy Kids funds 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.