HB 1545

1	A bill to be entitled
2	An act relating to the Florida Kidcare program; amending
3	s. 409.8132, F.S.; providing that children under the age
4	of 1 may participate in the Medikids program; conforming
5	cross-references; amending s. 409.814, F.S.; providing
6	that children who are eligible for a state-sponsored
7	health benefit plan and the subsidized Kidcare program may
8	enroll in the program; providing that an eligible child
9	who is a lawful immigrant may enroll in the Florida
10	Kidcare program regardless of the child's date of entry;
11	conforming provisions to changes made by the act; amending
12	s. 409.815, F.S.; authorizing Kidcare coverage for
13	temporomandibular joint disease; amending s. 409.816,
14	F.S.; conforming cross-references; amending s. 409.904,
15	F.S.; providing that Medicaid-eligible children are deemed
16	eligible for 12 months of coverage regardless of any
17	change in circumstances; providing that a pregnant woman
18	is eligible for Medicaid for the duration of her pregnancy
19	and for the postpartum period; amending s. 624.91, F.S.,
20	relating to the Florida Healthy Kids Corporation;
21	conforming provisions to changes made by the act;
22	expanding the membership of the board of directors of the
23	Florida Healthy Kids Corporation; directing the Agency for
24	Health Care Administration to implement the federal Family
25	Opportunity Act; providing an effective date.
26
27	Be It Enacted by the Legislature of the State of Florida:
28
29	Section 1.  Subsection (6) of section 409.8132, Florida
30	Statutes, is amended to read:
31	409.8132  Medikids program component.-
32	(6)  ELIGIBILITY.-
33	(a)  A child who has attained the age of 1 year but who is
34	under the age of 5 years is eligible to enroll in the Medikids
35	program component of the Florida Kidcare program, if the child
36	is a member of a family that has a family income that which
37	exceeds the Medicaid applicable income level as specified in s.
38	409.903, but which is equal to or below 200 percent of the
39	current federal poverty level. In determining the eligibility of
40	such a child, an assets test is not required. A child who is
41	eligible for Medikids may elect to enroll in Florida Healthy
42	Kids coverage or employer-sponsored group coverage. However, a
43	child who is eligible for Medikids may participate in the
44	Florida Healthy Kids program only if the child has a sibling
45	participating in the Florida Healthy Kids program and the
46	child's county of residence permits such enrollment.
47	(b)  The provisions of s. 409.814(3)-(8) are 409.814(3),
48	(4), (5), and (6) shall be applicable to the Medikids program.
49	Section 2.  Section 409.814, Florida Statutes, is amended
50	to read:
51	409.814  Eligibility.-A child who has not reached 19 years
52	of age whose family income is equal to or below 200 percent of
53	the federal poverty level is eligible for the Florida Kidcare
54	program as provided in this section. For enrollment in the
55	Children's Medical Services Network, a complete application
56	includes the medical or behavioral health screening. If,
57	subsequently, an individual is determined to be ineligible for
58	coverage, he or she must be immediately be disenrolled from the
59	respective Florida Kidcare program component.
60	(1)  A child who is eligible for Medicaid coverage under s.
61	409.903 or s. 409.904 must be enrolled in Medicaid and is not
62	eligible to receive health benefits under any other health
63	benefits coverage authorized under the Florida Kidcare program.
64	(2)  A child who is not eligible for Medicaid, but who is
65	eligible for the Florida Kidcare program, may obtain health
66	benefits coverage under any of the other components listed in s.
67	409.813 if such coverage is approved and available in the county
68	in which the child resides.
69	(3)  A Title XXI-funded child who is eligible for the
70	Florida Kidcare program and who is a child with special health
71	care needs, as determined through a medical or behavioral
72	screening instrument, is eligible for health benefits coverage
73	from and shall be assigned to and may opt out of the Children's
74	Medical Services Network.
75	(4)  A child who is eligible for a state-sponsored health
76	benefit plan through a family member or guardian employed by the
77	state and who meets the eligibility requirements for the
78	subsidized Florida Kidcare program may enroll in the subsidized
79	Florida Kidcare program, subject to an appropriation or the
80	availability of local contributions collected pursuant to s.
81	624.91.
82	(5)  A child who is an immigrant lawfully residing in the
83	United States and who meets the eligibility requirements for the
84	Florida Kidcare program may enroll in the program regardless of
85	the child's date of entry.
86	(6)(4)  The following children are not eligible to receive
87	Title XXI-funded premium assistance for health benefits coverage
88	under the Florida Kidcare program, except under Medicaid if the
89	child would have been eligible for Medicaid under s. 409.903 or
90	s. 409.904 as of June 1, 1997:
91	(a)  A child who is eligible for coverage under a state
92	health benefit plan on the basis of a family member's employment
93	with a public agency in the state.
94	(a)(b)  A child who is covered under a family member's
95	group health benefit plan or under other private or employer
96	health insurance coverage, if the cost of the child's
97	participation is not greater than 5 percent of the family's
98	income. If a child is otherwise eligible for a subsidy under the
99	Florida Kidcare program and the cost of the child's
100	participation in the family member's health insurance benefit
101	plan is greater than 5 percent of the family's income, the child
102	may enroll in the appropriate subsidized Kidcare program.
103	(b)(c)  A child who is seeking premium assistance for the
104	Florida Kidcare program through employer-sponsored group
105	coverage, if the child has been covered by the same employer's
106	group coverage during the 60 days before the family submitted
107	prior to the family's submitting an application for
108	determination of eligibility under the program.
109	(d)  A child who is an alien, but who does not meet the
110	definition of qualified alien, in the United States.
111	(c)(e)  A child who is an inmate of a public institution or
112	a patient in an institution for mental diseases.
113	(d)(f)  A child who is otherwise eligible for premium
114	assistance for the Florida Kidcare program and has had his or
115	her coverage in an employer-sponsored or private health benefit
116	plan voluntarily canceled in the last 60 days, except those
117	children whose coverage was voluntarily canceled for good cause,
118	including, but not limited to, the following circumstances:
119	1.  The cost of participation in an employer-sponsored
120	health benefit plan is greater than 5 percent of the family's
121	income;
122	2.  The parent lost a job that provided an employer-
123	sponsored health benefit plan for children;
124	3.  The parent who had health benefits coverage for the
125	child is deceased;
126	4.  The child has a medical condition that, without medical
127	care, would cause serious disability, loss of function, or
128	death;
129	5.  The employer of the parent canceled health benefits
130	coverage for children;
131	6.  The child's health benefits coverage ended because the
132	child reached the maximum lifetime coverage amount;
133	7.  The child has exhausted coverage under a COBRA
134	continuation provision;
135	8.  The health benefits coverage does not cover the child's
136	health care needs; or
137	9.  Domestic violence led to loss of coverage.
138	(7)(5)  A child who is otherwise eligible for the Florida
139	Kidcare program and who has a preexisting condition that
140	prevents coverage under another insurance plan as described in
141	paragraph (6)(a) (4)(b) which would have disqualified the child
142	for the Florida Kidcare program if the child were able to enroll
143	in the plan is shall be eligible for Florida Kidcare coverage
144	when enrollment is possible.
145	(8)(6)  A child whose family income is above 200 percent of
146	the federal poverty level or a child who is excluded under the
147	provisions of subsection (6) (4) may participate in the Florida
148	Kidcare program as provided in s. 409.8132 or, if the child is
149	ineligible for Medikids by reason of age, in the Florida Healthy
150	Kids program, subject to the following provisions:
151	(a)  The family is not eligible for premium assistance
152	payments and must pay the full cost of the premium, including
153	any administrative costs.
154	(b)  The board of directors of the Florida Healthy Kids
155	Corporation may offer a reduced benefit package to these
156	children in order to limit program costs for such families.
157	(9)(7)  Once a child is enrolled in the Florida Kidcare
158	program, the child is eligible for coverage under the program
159	for 12 months without a redetermination or reverification of
160	eligibility, if the family continues to pay the applicable
161	premium. Eligibility for program components funded through Title
162	XXI of the Social Security Act shall terminate when a child
163	attains the age of 19. A child who has not attained the age of 5
164	and who has been determined eligible for the Medicaid program is
165	eligible for coverage for 12 months without a redetermination or
166	reverification of eligibility.
167	(10)(8)  When determining or reviewing a child's
168	eligibility under the Florida Kidcare program, the applicant
169	shall be provided with reasonable notice of changes in
170	eligibility which may affect enrollment in one or more of the
171	program components. If When a transition from one program
172	component to another is authorized, there shall be cooperation
173	between the program components and the affected family which
174	promotes continuity of health care coverage. Any authorized
175	transfers must be managed within the program's overall
176	appropriated or authorized levels of funding. Each component of
177	the program shall establish a reserve to ensure that transfers
178	between components will be accomplished within current year
179	appropriations. These reserves shall be reviewed by each
180	convening of the Social Services Estimating Conference to
181	determine the adequacy of such reserves to meet actual
182	experience.
183	(11)(9)  In determining the eligibility of a child, an
184	assets test is not required. Each applicant shall provide
185	documentation during the application process and the
186	redetermination process, including, but not limited to, the
187	following:
188	(a)  Each applicant's Proof of family income, which must
189	shall be verified electronically to determine financial
190	eligibility for the Florida Kidcare program. Written
191	documentation, which may include wages and earnings statements
192	or pay stubs, W-2 forms, or a copy of the applicant's most
193	recent federal income tax return, are shall be required only if
194	the electronic verification is not available or does not
195	substantiate the applicant's income.
196	(b)  Each applicant shall provide A statement from all
197	applicable, employed family members that:
198	1.  Their employers do not sponsor health benefit plans for
199	employees;
200	2.  the potential enrollee is not covered by an employer-
201	sponsored health benefit plan; or
202	3.  The potential enrollee is covered by an employer-
203	sponsored health benefit plan and the cost of the employer-
204	sponsored health benefit plan is more than 5 percent of the
205	family's income.
206	(12)(10)  Subject to paragraph (6)(a) (4)(b), the Florida
207	Kidcare program shall withhold benefits from an enrollee if the
208	program obtains evidence that the enrollee is no longer
209	eligible, submitted incorrect or fraudulent information in order
210	to establish eligibility, or failed to provide verification of
211	eligibility. The applicant or enrollee shall be notified that
212	because of such evidence program benefits will be withheld
213	unless the applicant or enrollee contacts a designated
214	representative of the program by a specified date, which must be
215	within 10 working days after the date of notice, to discuss and
216	resolve the matter. The program shall make every effort to
217	resolve the matter within a timeframe that will not cause
218	benefits to be withheld from an eligible enrollee.
219	(13)(11)  The following individuals may be subject to
220	prosecution in accordance with s. 414.39:
221	(a)  An applicant obtaining or attempting to obtain
222	benefits for a potential enrollee under the Florida Kidcare
223	program if when the applicant knows or should have known that
224	the potential enrollee does not qualify for the Florida Kidcare
225	program.
226	(b)  An individual who assists an applicant in obtaining or
227	attempting to obtain benefits for a potential enrollee under the
228	Florida Kidcare program if when the individual knows or should
229	have known that the potential enrollee does not qualify for the
230	Florida Kidcare program.
231	Section 3.  Paragraph (f) of subsection (2) of section
232	409.815, Florida Statutes, is amended to read:
233	409.815  Health benefits coverage; limitations.-
234	(2)  BENCHMARK BENEFITS.-In order for health benefits
235	coverage to qualify for premium assistance payments for an
236	eligible child under ss. 409.810-409.821, the health benefits
237	coverage, except for coverage under Medicaid and Medikids, must
238	include the following minimum benefits, as medically necessary.
239	(f)  Outpatient services.-Covered services include
240	preventive, diagnostic, therapeutic, palliative care, and other
241	services authorized by the enrollee's health benefits coverage
242	provider and provided to an enrollee in the outpatient portion
243	of a health facility licensed under chapter 395, except for the
244	following limitations:
245	1.  Services must be authorized by the enrollee's health
246	benefits coverage provider; and
247	2.  Treatment for temporomandibular joint disease (TMJ) is
248	specifically excluded.
249	Section 4.  Subsection (3) of section 409.816, Florida
250	Statutes, is amended to read:
251	409.816  Limitations on premiums and cost-sharing.-The
252	following limitations on premiums and cost-sharing are
253	established for the program.
254	(3)  Enrollees in families with a family income above 150
255	percent of the federal poverty level who are not receiving
256	coverage under the Medicaid program or who are not eligible
257	under s. 409.814(8) 409.814(7) may be required to pay enrollment
258	fees, premiums, copayments, deductibles, coinsurance, or similar
259	charges on a sliding scale related to income, except that the
260	total annual aggregate cost-sharing with respect to all children
261	in a family may not exceed 5 percent of the family's income.
262	However, copayments, deductibles, coinsurance, or similar
263	charges may not be imposed for preventive services, including
264	well-baby and well-child care, age-appropriate immunizations,
265	and routine hearing and vision screenings.
266	Section 5.  Subsections (6) and (7) of section 409.904,
267	Florida Statutes, are amended to read:
268	409.904  Optional payments for eligible persons.-The agency
269	may make payments for medical assistance and related services on
270	behalf of the following persons who are determined to be
271	eligible subject to the income, assets, and categorical
272	eligibility tests set forth in federal and state law. Payment on
273	behalf of these Medicaid eligible persons is subject to the
274	availability of moneys and any limitations established by the
275	General Appropriations Act or chapter 216.
276	(6)  A child who has not attained the age of 19 who has
277	been determined eligible for the Medicaid program is deemed to
278	be eligible for a total of 6 months, regardless of changes in
279	circumstances other than attainment of the maximum age.
280	Effective January 1, 1999, a child who has not attained the age
281	of 5 and who has been determined eligible for the Medicaid
282	program is deemed to be eligible for a total of 12 months
283	regardless of changes in circumstances other than attainment of
284	the maximum age.
285	(7)  A pregnant woman for the duration of her pregnancy and
286	for the postpartum period as defined in federal law and rule, or
287	a child under 1 year of age who lives in a family that has an
288	income above 185 percent of the most recently published federal
289	poverty level, but which is at or below 200 percent of such
290	poverty level. In determining the eligibility of such child, an
291	assets test is not required. An individual A child who is
292	eligible for Medicaid under this subsection must be offered the
293	opportunity, subject to federal rules, to be made presumptively
294	eligible.
295	Section 6.  Subsection (3), paragraph (b) of subsection
296	(5), and paragraph (a) of subsection (6) of section 624.91,
297	Florida Statutes, are amended to read:
298	624.91  The Florida Healthy Kids Corporation Act.-
299	(3)  ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.-Only the
300	following individuals are eligible for state-funded assistance
301	in paying Florida Healthy Kids premiums:
302	(a)  Residents of this state who are eligible for the
303	Florida Kidcare program pursuant to s. 409.814.
304	(b)  Notwithstanding s. 409.814, Legal aliens who are
305	enrolled in the Florida Healthy Kids program as of January 31,
306	2004, who do not qualify for Title XXI federal funds because
307	they are not qualified aliens as defined in s. 409.811.
308	(5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.-
309	(b)  The Florida Healthy Kids Corporation shall:
310	1.  Arrange for the collection of any family, local
311	contributions, or employer payment or premium, in an amount to
312	be determined by the board of directors, to provide for payment
313	of premiums for comprehensive insurance coverage and for the
314	actual or estimated administrative expenses.
315	2.  Arrange for the collection of any voluntary
316	contributions to provide for payment of Florida Kidcare program
317	premiums for children who are not eligible for medical
318	assistance under Title XIX or Title XXI of the Social Security
319	Act.
320	3.  Subject to the provisions of s. 409.8134, accept
321	voluntary supplemental local match contributions that comply
322	with the requirements of Title XXI of the Social Security Act
323	for the purpose of providing additional Florida Kidcare coverage
324	in contributing counties under Title XXI.
325	4.  Establish the administrative and accounting procedures
326	for the operation of the corporation.
327	5.  Establish, with consultation from appropriate
328	professional organizations, standards for preventive health
329	services and providers and comprehensive insurance benefits
330	appropriate to children if, provided that such standards for
331	rural areas do shall not limit primary care providers to board-
332	certified pediatricians.
333	6.  Determine eligibility for children seeking to
334	participate in the Title XXI-funded components of the Florida
335	Kidcare program consistent with the requirements specified in s.
336	409.814, as well as the non-Title-XXI-eligible children as
337	provided in subsection (3).
338	7.  Establish procedures under which providers of local
339	match to, applicants to, and participants in the program may
340	have grievances reviewed by an impartial body and reported to
341	the board of directors of the corporation.
342	8.  Establish participation criteria and, if appropriate,
343	contract with an authorized insurer, health maintenance
344	organization, or third-party administrator to provide
345	administrative services to the corporation.
346	9.  Establish enrollment criteria that include penalties or
347	30-day waiting periods of 30 days for reinstatement of coverage
348	upon voluntary cancellation for nonpayment of family premiums.
349	10.  Contract with authorized insurers or providers any
350	provider of health care services, who meet meeting standards
351	established by the corporation, for the provision of
352	comprehensive insurance coverage to participants. Such standards
353	must shall include criteria under which the corporation may
354	contract with more than one provider of health care services in
355	program sites. Health plans shall be selected through a
356	competitive bid process. The Florida Healthy Kids Corporation
357	shall purchase goods and services in the most cost-effective
358	manner consistent with the delivery of quality medical care. The
359	maximum administrative cost for a Florida Healthy Kids
360	Corporation contract is shall be 15 percent. For health care
361	contracts, the minimum medical loss ratio for a Florida Healthy
362	Kids Corporation contract is shall be 85 percent. For dental
363	contracts, the remaining compensation to be paid to the
364	authorized insurer or provider must be at least under a Florida
365	Healthy Kids Corporation contract shall be no
366	amount which is 85 percent of the premium; to the
367	contract provision does not provide for this minimum
368	compensation, this section prevails shall prevail. The health
369	plan selection criteria and scoring system, and the scoring
370	results, must shall be available upon request for inspection
371	after the bids have been awarded.
372	11.  Establish disenrollment criteria if in the event local
373	matching funds are insufficient to cover enrollments.
374	12.  Develop and implement a plan to publicize the Florida
375	Kidcare program, the eligibility requirements of the program,
376	and the procedures for enrollment in the program and to maintain
377	public awareness of the corporation and the program.
378	13.  Secure staff necessary to properly administer the
379	corporation. Staff costs shall be funded from state and local
380	matching funds and such other private or public funds as become
381	available. The board of directors shall determine the number of
382	staff members necessary to administer the corporation.
383	14.  In consultation with the partner agencies, provide a
384	report on the Florida Kidcare program annually to the Governor,
385	the Chief Financial Officer, the Commissioner of Education, the
386	President of the Senate, the Speaker of the House of
387	Representatives, and the Minority Leaders of the Senate and the
388	House of Representatives.
389	15.  Provide information on a quarterly basis to the
390	Legislature and the Governor which compares the costs and
391	utilization of the full-pay enrolled population and the Title
392	XXI-subsidized enrolled population in the Florida Kidcare
393	program. The information, At a minimum, the information must
394	include:
395	a.  The monthly enrollment and expenditure for full-pay
396	enrollees in the Medikids and Florida Healthy Kids programs
397	compared to the Title XXI-subsidized enrolled population; and
398	b.  The costs and utilization by service of the full-pay
399	enrollees in the Medikids and Florida Healthy Kids programs and
400	the Title XXI-subsidized enrolled population.
401
402	By February 1, 2010, the Florida Healthy Kids Corporation shall
403	provide a study to the Legislature and the Governor on premium
404	impacts to the subsidized portion of the program from the
405	inclusion of the full-pay program, which must shall include
406	recommendations on how to eliminate or mitigate possible impacts
407	to the subsidized premiums.
408	16.  Establish benefit packages that conform to the
409	provisions of the Florida Kidcare program, as created in ss.
410	409.810-409.821.
411	(6)  BOARD OF DIRECTORS.-
412	(a)  The Florida Healthy Kids Corporation is shall operate
413	subject to the supervision and approval of a board of directors
414	chaired by the Chief Financial Officer or her or his designee,
415	and composed of 12 11 other members selected for 3-year terms of
416	office as follows:
417	1.  The Secretary of Health Care Administration, or his or
418	her designee.
419	2.  One member appointed by the Commissioner of Education
420	from the Office of School Health Programs of the Florida
421	Department of Education.
422	3.  One member appointed by the Chief Financial Officer
423	from among three members nominated by the Florida Pediatric
424	Society.
425	4.  One member, appointed by the Governor, who represents
426	the Children's Medical Services Program.
427	5.  One member appointed by the Chief Financial Officer
428	from among three members nominated by the Florida Hospital
429	Association.
430	6.  One member, appointed by the Governor, who is an expert
431	on child health policy.
432	7.  One member, appointed by the Chief Financial Officer,
433	from among three members nominated by the Florida Academy of
434	Family Physicians.
435	8.  One member, appointed by the Governor, who represents
436	the state Medicaid program.
437	9.  One member, appointed by the Chief Financial Officer,
438	from among three members nominated by the Florida Association of
439	Counties.
440	10.  The State Health Officer, or her or his designee.
441	11.  The Secretary of Children and Family Services, or his
442	or her designee.
443	12.  One member, appointed by the Governor, from among
444	three members nominated by the Florida Dental Association.
445	Section 7.  Subject to appropriation, the Agency for Health
446	Care Administration shall implement the federal Family
447	Opportunity Act, ss. 6062-6071 of the Deficit Reduction Act of
448	2005, to allow families whose income is up to 300 percent of the
449	federal poverty level to buy Medicaid coverage for their
450	disabled children.
451	Section 8.  This act shall take effect October 1, 2010.

CODING: Words stricken are deletions; words underlined are additions.