Senate Bill 2520
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Florida Senate - 1999 SB 2520
By Senator Dawson-White
30-1526A-99 See HB
1 A bill to be entitled
2 An act relating to children's health; amending
3 s. 409.8132, F.S.; providing for year-round
4 enrollment in the Medikids program; revising
5 enrollment procedures; amending s. 409.8134,
6 F.S.; providing for a statewide enrollment
7 ceiling for the Florida Kidcare program;
8 amending s. 409.814, F.S.; revising eligibility
9 for certain children under the Florida Kidcare
10 program; amending s. 409.904, F.S.; revising
11 eligibility for certain children under the
12 Medicaid program; providing for presumptive
13 eligibility under certain circumstances;
14 amending s. 624.91, F.S.; providing for
15 year-round enrollment under the Florida Healthy
16 Kids Corporation program; revising contract
17 standards; eliminating authority of the
18 corporation to establish local matching fund
19 requirements; providing an effective date.
20
21 Be It Enacted by the Legislature of the State of Florida:
22
23 Section 1. Subsection (7) of section 409.8132, Florida
24 Statutes, 1998 Supplement, is amended to read:
25 409.8132 Medikids program component.--
26 (7) ENROLLMENT.--Enrollment in the Medikids program
27 shall occur year-round until the enrollment ceiling is met.
28 However, component may only occur during periodic open
29 enrollment periods as specified by the agency. During the
30 first 12 months of the program, there shall be at least one,
31 but no more than three, open enrollment periods. The initial
1
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Florida Senate - 1999 SB 2520
30-1526A-99 See HB
1 open enrollment period shall be for 90 days, and subsequent
2 open enrollment periods during the first year of operation of
3 the program shall be for 30 days. After the first year of the
4 program, the agency shall determine the frequency and duration
5 of open enrollment periods. An applicant may apply for
6 enrollment in the Medikids program component and proceed
7 through the eligibility determination process at any time
8 throughout the year. However, enrollment in Medikids shall not
9 begin until the next open enrollment period; and a child may
10 not receive services under the Medikids program until the
11 child is enrolled in a managed care plan or MediPass. In
12 addition, Once determined eligible, an applicant may receive
13 choice counseling and select a managed care plan or MediPass.
14 If the applicant does not select a managed care plan or
15 MediPass within 30 days after receiving choice counseling, the
16 agency shall assign the applicant to a managed care plan or
17 MediPass. Assignments shall be divided equally between the
18 MediPass program and managed care plans. An applicant may
19 select MediPass under the Medikids program component only in
20 counties that have fewer than two managed care plans available
21 to serve Medicaid recipients and only if the federal Health
22 Care Financing Administration determines that MediPass
23 constitutes "health insurance coverage" as defined in Title
24 XXI of the Social Security Act.
25 Section 2. Subsection (1) of section 409.8134, Florida
26 Statutes, 1998 Supplement, is amended to read:
27 409.8134 Program enrollment and expenditure
28 ceilings.--
29 (1) Except for the Medicaid program, a ceiling shall
30 be placed on annual federal and state expenditures and on
31 enrollment in the Florida Kidcare program as provided each
2
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Florida Senate - 1999 SB 2520
30-1526A-99 See HB
1 year in the General Appropriations Act. Except for the
2 Medicaid program, a statewide enrollment ceiling shall be
3 established for each Florida Kidcare program component, and
4 children may be enrolled in each Florida Kidcare program
5 component on a first-come, first-served basis until enrollment
6 ceilings are met or the procedures in subsection (2) are
7 invoked. The agency, in consultation with the Department of
8 Health, may propose to increase the enrollment ceiling in
9 accordance with chapter 216.
10 Section 3. Present subsections (4) and (6) of section
11 409.814, Florida Statutes, 1998 Supplement, are amended, and
12 subsection (7) is added to that section, to read:
13 409.814 Eligibility.--A child whose family income is
14 equal to or below 200 percent of the federal poverty level is
15 eligible for the Florida Kidcare program as provided in this
16 section. In determining the eligibility of such a child, an
17 assets test is not required.
18 (4) The following children are not eligible to receive
19 premium assistance for health benefits coverage under ss.
20 409.810-409.820, except under Medicaid if the child would have
21 been eligible for Medicaid under s. 409.903 or s. 409.904 as
22 of June 1, 1997:
23 (a) A child who is eligible for coverage under a state
24 health benefit plan on the basis of a family member's
25 employment with a public agency in the state;
26 (b) A child who is covered under a group health
27 benefit plan or under other health insurance coverage,
28 excluding coverage provided under the Florida Healthy Kids
29 Corporation as established under s. 624.91;
30 (c) A child who is seeking premium assistance for
31 employer-sponsored group coverage, if the child has been
3
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Florida Senate - 1999 SB 2520
30-1526A-99 See HB
1 covered by the same employer's group coverage during the 6
2 months prior to the family's submitting an application for
3 determination of eligibility under the Florida Kidcare
4 program; or
5 (d) A child who is an alien, but who does not meet the
6 definition of qualified alien, in the United States; or
7 (d)(e) A child who is an inmate of a public
8 institution or a patient in an institution for mental
9 diseases.
10 (6) Once a child is determined eligible for the
11 Florida Kidcare program, the child is eligible for coverage
12 under the program for 12 6 months without a redetermination or
13 reverification of eligibility, if the family continues to pay
14 the applicable premium. Effective January 1, 1999, a child who
15 has not attained the age of 5 and who has been determined
16 eligible for the Medicaid program is eligible for coverage for
17 12 months without a redetermination or reverification of
18 eligibility.
19 (7) Children who are ineligible for federal funding
20 under Medicaid and Title XXI of the Social Security Act due to
21 their immigration status shall be enrolled in the appropriate
22 Florida Kidcare program based on the family income, and their
23 coverage shall be provided by state funds only.
24 Section 4. Subsection (7) of section 409.904, Florida
25 Statutes, 1998 Supplement, is amended, and subsection (8) is
26 added to that section, to read:
27 409.904 Optional payments for eligible persons.--The
28 agency may make payments for medical assistance and related
29 services on behalf of the following persons who are determined
30 to be eligible subject to the income, assets, and categorical
31 eligibility tests set forth in federal and state law. Payment
4
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Florida Senate - 1999 SB 2520
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1 on behalf of these Medicaid eligible persons is subject to the
2 availability of moneys and any limitations established by the
3 General Appropriations Act or chapter 216.
4 (7) A child who has not attained the age of 19 who has
5 been determined eligible for the Medicaid program is deemed to
6 be eligible for a total of 12 6 months, regardless of changes
7 in circumstances other than attainment of the maximum age.
8 Effective January 1, 1999, a child who has not attained the
9 age of 5 and who has been determined eligible for the Medicaid
10 program is deemed to be eligible for a total of 12 months
11 regardless of changes in circumstances other than attainment
12 of the maximum age.
13 (8) A child who has not attained the age of 19 who
14 applies for eligibility for the Medicaid program through a
15 qualified Medicaid provider must be offered the opportunity,
16 subject to federal rules, to be made presumptively eligible
17 for the Medicaid program.
18 Section 5. Paragraph (b) of subsection (4) of section
19 624.91, Florida Statutes, 1998 Supplement, is amended to read:
20 624.91 The Florida Healthy Kids Corporation Act.--
21 (4) CORPORATION AUTHORIZATION, DUTIES, POWERS.--
22 (b) The Florida Healthy Kids Corporation shall phase
23 in a program to:
24 1. Organize school children groups to facilitate the
25 provision of comprehensive health insurance coverage to
26 children;
27 2. Arrange for the collection of any family, local
28 contributions, or employer payment or premium, in an amount to
29 be determined by the board of directors, to provide for
30 payment of premiums for comprehensive insurance coverage and
31 for the actual or estimated administrative expenses;
5
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Florida Senate - 1999 SB 2520
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1 3. Establish the administrative and accounting
2 procedures for the operation of the corporation;
3 4. Establish, with consultation from appropriate
4 professional organizations, standards for preventive health
5 services and providers and comprehensive insurance benefits
6 appropriate to children; provided that such standards for
7 rural areas shall not limit primary care providers to
8 board-certified pediatricians;
9 5. Establish eligibility criteria which children must
10 meet in order to participate in the program;
11 6. Establish procedures under which applicants to and
12 participants in the program may have grievances reviewed by an
13 impartial body and reported to the board of directors of the
14 corporation;
15 7. Establish participation criteria and, if
16 appropriate, contract with an authorized insurer, health
17 maintenance organization, or insurance administrator to
18 provide administrative services to the corporation;
19 8. Establish enrollment criteria which shall include
20 year-round enrollment if space is available penalties or
21 waiting periods of not fewer than 60 days for reinstatement of
22 coverage upon voluntary cancellation for nonpayment of family
23 premiums;
24 9. If a space is available, establish a special open
25 enrollment period of 30 days' duration for any child who is
26 enrolled in Medicaid or Medikids if such child loses Medicaid
27 or Medikids eligibility and becomes eligible for the Florida
28 Healthy Kids program;
29 9.10. Contract with authorized insurers or any
30 provider of health care services, meeting standards
31 established by the corporation, for the provision of
6
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Florida Senate - 1999 SB 2520
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1 comprehensive insurance coverage to participants. Such
2 standards shall include criteria under which the corporation
3 shall may contract with more than one provider of health care
4 services in program sites. Health plans shall be selected
5 through a competitive bid process. The selection of health
6 plans shall be based primarily on quality criteria established
7 by the board. The health plan selection criteria and scoring
8 system, and the scoring results, shall be available upon
9 request for inspection after the bids have been awarded;
10 10.11. Develop and implement a plan to publicize the
11 Florida Healthy Kids Corporation, the eligibility requirements
12 of the program, and the procedures for enrollment in the
13 program and to maintain public awareness of the corporation
14 and the program;
15 11.12. Secure staff necessary to properly administer
16 the corporation. Staff costs shall be funded from state and
17 local matching funds and such other private or public funds as
18 become available. The board of directors shall determine the
19 number of staff members necessary to administer the
20 corporation;
21 12.13. As appropriate, enter into contracts with local
22 school boards or other agencies to provide onsite information,
23 enrollment, and other services necessary to the operation of
24 the corporation;
25 13.14. Provide a report on an annual basis to the
26 Governor, Insurance Commissioner, Commissioner of Education,
27 Senate President, Speaker of the House of Representatives, and
28 Minority Leaders of the Senate and the House of
29 Representatives;
30 15. Each fiscal year, establish a maximum number of
31 participants by county, on a statewide basis, who may enroll
7
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Florida Senate - 1999 SB 2520
30-1526A-99 See HB
1 in the program without the benefit of local matching funds.
2 Thereafter, the corporation may establish local matching
3 requirements for supplemental participation in the program.
4 The corporation may vary local matching requirements and
5 enrollment by county depending on factors which may influence
6 the generation of local match, including, but not limited to,
7 population density, per capita income, existing local tax
8 effort, and other factors. The corporation also may accept
9 in-kind match in lieu of cash for the local match requirement
10 to the extent allowed by Title XXI of the Social Security Act;
11 and
12 14.16. Establish eligibility criteria, premium and
13 cost-sharing requirements, and benefit packages which conform
14 to the provisions of the Florida Kidcare program, as created
15 in ss. 409.810-409.820.
16 Section 6. This act shall take effect upon becoming a
17 law.
18
19 *****************************************
20 LEGISLATIVE SUMMARY
21
Removes provisions relating to periodic open enrollment
22 under the Medikids program, and provides for year-round
enrollment until the enrollment ceiling is met. Provides
23 for assignment of applicants to a managed care plan or
MediPass, under described circumstances. Provides for
24 establishment of a statewide enrollment ceiling under the
Florida Kidcare program. Provides eligibility under the
25 Florida Kidcare program for certain immigrant children,
based on family income. Provides for coverage of such
26 children using state funds only. Provides for eligibility
redeterminations after 12 months, rather than 6 months,
27 for certain children under the Kidcare and Medicaid
programs, and provides for presumptive Medicaid
28 eligibility for certain children. Provides for year-round
enrollment on a space-available basis under the Florida
29 Healthy Kids Corporation program. Eliminates corporation
authority to establish local matching fund requirements
30 for supplemental participation in the program.
31
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