Florida Senate - 2012                        COMMITTEE AMENDMENT
       Bill No. SB 510
                                Barcode 647240                          
                              LEGISLATIVE ACTION                        
                    Senate             .             House              
                  Comm: RCS            .                                
                  01/12/2012           .                                

       The Committee on Health Regulation (Fasano) recommended the
    1         Senate Amendment (with title amendment)
    3         Delete everything after the enacting clause
    4  and insert:
    5         Section 1. Paragraph (b) of subsection (6) of section
    6  409.8132, Florida Statutes, is amended to read:
    7         409.8132 Medikids program component.—
    8         (6) ELIGIBILITY.—
    9         (b) The provisions of s. 409.814 apply 409.814(3), (4),
   10  (5), and (6) shall be applicable to the Medikids program.
   11         Section 2. Section 409.814, Florida Statutes, is amended to
   12  read:
   13         409.814 Eligibility.—A child who has not reached 19 years
   14  of age whose family income is equal to or below 200 percent of
   15  the federal poverty level is eligible for the Florida Kidcare
   16  program as provided in this section. For enrollment in the
   17  Children’s Medical Services Network, a complete application
   18  includes the medical or behavioral health screening. If,
   19  subsequently, an enrolled individual is determined to be
   20  ineligible for coverage, he or she must be immediately be
   21  disenrolled from the respective Florida Kidcare program
   22  component.
   23         (1) A child who is eligible for Medicaid coverage under s.
   24  409.903 or s. 409.904 must be enrolled in Medicaid and is not
   25  eligible to receive health benefits under any other health
   26  benefits coverage authorized under the Florida Kidcare program.
   27         (2) A child who is not eligible for Medicaid, but who is
   28  eligible for the Florida Kidcare program, may obtain health
   29  benefits coverage under any of the other components listed in s.
   30  409.813 if such coverage is approved and available in the county
   31  in which the child resides.
   32         (3) A Title XXI-funded child who is eligible for the
   33  Florida Kidcare program who is a child with special health care
   34  needs, as determined through a medical or behavioral screening
   35  instrument, is eligible for health benefits coverage from and
   36  shall be assigned to and may opt out of the Children’s Medical
   37  Services Network.
   38         (4) The following children are not eligible to receive
   39  Title XXI-funded premium assistance for health benefits coverage
   40  under the Florida Kidcare program, except under Medicaid if the
   41  child would have been eligible for Medicaid under s. 409.903 or
   42  s. 409.904 as of June 1, 1997:
   43         (a) A child who is eligible for coverage under a state
   44  health benefit plan on the basis of a family member’s employment
   45  with a public agency in the state.
   46         (a)(b) A child who is covered under a family member’s group
   47  health benefit plan or under other private or employer health
   48  insurance coverage, if the cost of the child’s participation is
   49  not greater than 5 percent of the family’s income. If a child is
   50  otherwise eligible for a subsidy under the Florida Kidcare
   51  program and the cost of the child’s participation in the family
   52  member’s health insurance benefit plan is greater than 5 percent
   53  of the family’s income, the child may enroll in the appropriate
   54  subsidized Kidcare program.
   55         (b)(c) A child who is seeking premium assistance for the
   56  Florida Kidcare program through employer-sponsored group
   57  coverage, if the child has been covered by the same employer’s
   58  group coverage during the 60 days before the family submitted
   59  prior to the family’s submitting an application for
   60  determination of eligibility under the program.
   61         (c)(d) A child who is an alien, but who does not meet the
   62  definition of qualified alien, in the United States.
   63         (d)(e) A child who is an inmate of a public institution or
   64  a patient in an institution for mental diseases.
   65         (e)(f) A child who is otherwise eligible for premium
   66  assistance for the Florida Kidcare program and has had his or
   67  her coverage in an employer-sponsored or private health benefit
   68  plan voluntarily canceled in the last 60 days, except those
   69  children whose coverage was voluntarily canceled for good cause,
   70  including, but not limited to, the following circumstances:
   71         1. The cost of participation in an employer-sponsored
   72  health benefit plan is greater than 5 percent of the family’s
   73  income;
   74         2. The parent lost a job that provided an employer
   75  sponsored health benefit plan for children;
   76         3. The parent who had health benefits coverage for the
   77  child is deceased;
   78         4. The child has a medical condition that, without medical
   79  care, would cause serious disability, loss of function, or
   80  death;
   81         5. The employer of the parent canceled health benefits
   82  coverage for children;
   83         6. The child’s health benefits coverage ended because the
   84  child reached the maximum lifetime coverage amount;
   85         7. The child has exhausted coverage under a COBRA
   86  continuation provision;
   87         8. The health benefits coverage does not cover the child’s
   88  health care needs; or
   89         9. Domestic violence led to loss of coverage.
   90         (5) A child who is otherwise eligible for the Florida
   91  Kidcare program and who has a preexisting condition that
   92  prevents coverage under another insurance plan as described in
   93  paragraph (4)(a) (4)(b) which would have disqualified the child
   94  for the Florida Kidcare program if the child were able to enroll
   95  in the plan is shall be eligible for Florida Kidcare coverage
   96  when enrollment is possible.
   97         (6) A child whose family income is above 200 percent of the
   98  federal poverty level or a child who is excluded under the
   99  provisions of subsection (4) may participate in the Florida
  100  Kidcare program as provided in s. 409.8132 or, if the child is
  101  ineligible for Medikids by reason of age, in the Florida Healthy
  102  Kids program, subject to the following provisions:
  103         (a) The family is not eligible for premium assistance
  104  payments and must pay the full cost of the premium, including
  105  any administrative costs.
  106         (b) The board of directors of the Florida Healthy Kids
  107  Corporation may offer a reduced benefit package to these
  108  children in order to limit program costs for such families.
  109         (7) Once a child is enrolled in the Florida Kidcare
  110  program, the child is eligible for coverage under the program
  111  for 12 months without a redetermination or reverification of
  112  eligibility, if the family continues to pay the applicable
  113  premium. Eligibility for program components funded through Title
  114  XXI of the Social Security Act terminates shall terminate when a
  115  child attains the age of 19. A child who has not attained the
  116  age of 5 and who has been determined eligible for the Medicaid
  117  program is eligible for coverage for 12 months without a
  118  redetermination or reverification of eligibility.
  119         (8) When determining or reviewing a child’s eligibility
  120  under the Florida Kidcare program, the applicant shall be
  121  provided with reasonable notice of changes in eligibility which
  122  may affect enrollment in one or more of the program components.
  123  If When a transition from one program component to another is
  124  authorized, there shall be cooperation between the program
  125  components and the affected family which promotes continuity of
  126  health care coverage. Any authorized transfers must be managed
  127  within the program’s overall appropriated or authorized levels
  128  of funding. Each component of the program shall establish a
  129  reserve to ensure that transfers between components will be
  130  accomplished within current year appropriations. These reserves
  131  shall be reviewed by each convening of the Social Services
  132  Estimating Conference to determine the adequacy of such reserves
  133  to meet actual experience.
  134         (9) In determining the eligibility of a child, an assets
  135  test is not required. Each applicant shall provide documentation
  136  during the application process and the redetermination process,
  137  including, but not limited to, the following:
  138         (a) Each applicant’s Proof of family income, which must
  139  shall be verified electronically to determine financial
  140  eligibility for the Florida Kidcare program. Written
  141  documentation, which may include wages and earnings statements
  142  or pay stubs, W-2 forms, or a copy of the applicant’s most
  143  recent federal income tax return, is shall be required only if
  144  the electronic verification is not available or does not
  145  substantiate the applicant’s income.
  146         (b) Each applicant shall provide A statement from all
  147  applicable, employed family members that:
  148         1. Their employers do not sponsor health benefit plans for
  149  employees;
  150         2. The potential enrollee is not covered by an employer
  151  sponsored health benefit plan; or
  152         3. The potential enrollee is covered by an employer
  153  sponsored health benefit plan and the cost of the employer
  154  sponsored health benefit plan is more than 5 percent of the
  155  family’s income.
  156         (c) To enroll in the Children’s Medical Services Network, a
  157  completed application, including a clinical screening.
  158         (10) Subject to paragraph (4)(a) (4)(b), the Florida
  159  Kidcare program shall withhold benefits from an enrollee if the
  160  program obtains evidence that the enrollee is no longer
  161  eligible, submitted incorrect or fraudulent information in order
  162  to establish eligibility, or failed to provide verification of
  163  eligibility. The applicant or enrollee shall be notified that
  164  because of such evidence program benefits will be withheld
  165  unless the applicant or enrollee contacts a designated
  166  representative of the program by a specified date, which must be
  167  within 10 working days after the date of notice, to discuss and
  168  resolve the matter. The program shall make every effort to
  169  resolve the matter within a timeframe that will not cause
  170  benefits to be withheld from an eligible enrollee.
  171         (11) The following individuals may be subject to
  172  prosecution in accordance with s. 414.39:
  173         (a) An applicant obtaining or attempting to obtain benefits
  174  for a potential enrollee under the Florida Kidcare program if
  175  when the applicant knows or should have known that the potential
  176  enrollee does not qualify for the Florida Kidcare program.
  177         (b) An individual who assists an applicant in obtaining or
  178  attempting to obtain benefits for a potential enrollee under the
  179  Florida Kidcare program if when the individual knows or should
  180  have known that the potential enrollee does not qualify for the
  181  Florida Kidcare program.
  182         Section 3. This act shall take effect July 1, 2012.
  184  ================= T I T L E  A M E N D M E N T ================
  185         And the title is amended as follows:
  186         Delete everything before the enacting clause
  187  and insert:
  188                        A bill to be entitled                      
  189         An act relating to the Florida Kidcare program;
  190         amending s. 409.8132, F.S.; revising a cross
  191         reference; amending s. 409.814, F.S.; deleting a
  192         prohibition preventing children who are eligible for
  193         coverage under a state health benefit plan from being
  194         eligible for services provided through the subsidized
  195         program; providing an effective date.