Florida Senate - 2012                              CS for SB 510
       By the Committee on Health Regulation; and Senators Rich, Lynn,
       and Sobel
       588-01852-12                                           2012510c1
    1                        A bill to be entitled                      
    2         An act relating to the Florida Kidcare program;
    3         amending s. 409.8132, F.S.; revising a cross
    4         reference; amending s. 409.814, F.S.; deleting a
    5         prohibition preventing children who are eligible for
    6         coverage under a state health benefit plan from being
    7         eligible for services provided through the subsidized
    8         program; providing an effective date.
   10  Be It Enacted by the Legislature of the State of Florida:
   12         Section 1. Paragraph (b) of subsection (6) of section
   13  409.8132, Florida Statutes, is amended to read:
   14         409.8132 Medikids program component.—
   15         (6) ELIGIBILITY.—
   16         (b) The provisions of s. 409.814 apply 409.814(3), (4),
   17  (5), and (6) shall be applicable to the Medikids program.
   18         Section 2. Section 409.814, Florida Statutes, is amended to
   19  read:
   20         409.814 Eligibility.—A child who has not reached 19 years
   21  of age whose family income is equal to or below 200 percent of
   22  the federal poverty level is eligible for the Florida Kidcare
   23  program as provided in this section. For enrollment in the
   24  Children’s Medical Services Network, a complete application
   25  includes the medical or behavioral health screening. If,
   26  subsequently, an enrolled individual is determined to be
   27  ineligible for coverage, he or she must be immediately be
   28  disenrolled from the respective Florida Kidcare program
   29  component.
   30         (1) A child who is eligible for Medicaid coverage under s.
   31  409.903 or s. 409.904 must be enrolled in Medicaid and is not
   32  eligible to receive health benefits under any other health
   33  benefits coverage authorized under the Florida Kidcare program.
   34         (2) A child who is not eligible for Medicaid, but who is
   35  eligible for the Florida Kidcare program, may obtain health
   36  benefits coverage under any of the other components listed in s.
   37  409.813 if such coverage is approved and available in the county
   38  in which the child resides.
   39         (3) A Title XXI-funded child who is eligible for the
   40  Florida Kidcare program who is a child with special health care
   41  needs, as determined through a medical or behavioral screening
   42  instrument, is eligible for health benefits coverage from and
   43  shall be assigned to and may opt out of the Children’s Medical
   44  Services Network.
   45         (4) The following children are not eligible to receive
   46  Title XXI-funded premium assistance for health benefits coverage
   47  under the Florida Kidcare program, except under Medicaid if the
   48  child would have been eligible for Medicaid under s. 409.903 or
   49  s. 409.904 as of June 1, 1997:
   50         (a) A child who is eligible for coverage under a state
   51  health benefit plan on the basis of a family member’s employment
   52  with a public agency in the state.
   53         (a)(b) A child who is covered under a family member’s group
   54  health benefit plan or under other private or employer health
   55  insurance coverage, if the cost of the child’s participation is
   56  not greater than 5 percent of the family’s income. If a child is
   57  otherwise eligible for a subsidy under the Florida Kidcare
   58  program and the cost of the child’s participation in the family
   59  member’s health insurance benefit plan is greater than 5 percent
   60  of the family’s income, the child may enroll in the appropriate
   61  subsidized Kidcare program.
   62         (b)(c) A child who is seeking premium assistance for the
   63  Florida Kidcare program through employer-sponsored group
   64  coverage, if the child has been covered by the same employer’s
   65  group coverage during the 60 days before the family submitted
   66  prior to the family’s submitting an application for
   67  determination of eligibility under the program.
   68         (c)(d) A child who is an alien, but who does not meet the
   69  definition of qualified alien, in the United States.
   70         (d)(e) A child who is an inmate of a public institution or
   71  a patient in an institution for mental diseases.
   72         (e)(f) A child who is otherwise eligible for premium
   73  assistance for the Florida Kidcare program and has had his or
   74  her coverage in an employer-sponsored or private health benefit
   75  plan voluntarily canceled in the last 60 days, except those
   76  children whose coverage was voluntarily canceled for good cause,
   77  including, but not limited to, the following circumstances:
   78         1. The cost of participation in an employer-sponsored
   79  health benefit plan is greater than 5 percent of the family’s
   80  income;
   81         2. The parent lost a job that provided an employer
   82  sponsored health benefit plan for children;
   83         3. The parent who had health benefits coverage for the
   84  child is deceased;
   85         4. The child has a medical condition that, without medical
   86  care, would cause serious disability, loss of function, or
   87  death;
   88         5. The employer of the parent canceled health benefits
   89  coverage for children;
   90         6. The child’s health benefits coverage ended because the
   91  child reached the maximum lifetime coverage amount;
   92         7. The child has exhausted coverage under a COBRA
   93  continuation provision;
   94         8. The health benefits coverage does not cover the child’s
   95  health care needs; or
   96         9. Domestic violence led to loss of coverage.
   97         (5) A child who is otherwise eligible for the Florida
   98  Kidcare program and who has a preexisting condition that
   99  prevents coverage under another insurance plan as described in
  100  paragraph (4)(a) (4)(b) which would have disqualified the child
  101  for the Florida Kidcare program if the child were able to enroll
  102  in the plan is shall be eligible for Florida Kidcare coverage
  103  when enrollment is possible.
  104         (6) A child whose family income is above 200 percent of the
  105  federal poverty level or a child who is excluded under the
  106  provisions of subsection (4) may participate in the Florida
  107  Kidcare program as provided in s. 409.8132 or, if the child is
  108  ineligible for Medikids by reason of age, in the Florida Healthy
  109  Kids program, subject to the following provisions:
  110         (a) The family is not eligible for premium assistance
  111  payments and must pay the full cost of the premium, including
  112  any administrative costs.
  113         (b) The board of directors of the Florida Healthy Kids
  114  Corporation may offer a reduced benefit package to these
  115  children in order to limit program costs for such families.
  116         (7) Once a child is enrolled in the Florida Kidcare
  117  program, the child is eligible for coverage under the program
  118  for 12 months without a redetermination or reverification of
  119  eligibility, if the family continues to pay the applicable
  120  premium. Eligibility for program components funded through Title
  121  XXI of the Social Security Act terminates shall terminate when a
  122  child attains the age of 19. A child who has not attained the
  123  age of 5 and who has been determined eligible for the Medicaid
  124  program is eligible for coverage for 12 months without a
  125  redetermination or reverification of eligibility.
  126         (8) When determining or reviewing a child’s eligibility
  127  under the Florida Kidcare program, the applicant shall be
  128  provided with reasonable notice of changes in eligibility which
  129  may affect enrollment in one or more of the program components.
  130  If When a transition from one program component to another is
  131  authorized, there shall be cooperation between the program
  132  components and the affected family which promotes continuity of
  133  health care coverage. Any authorized transfers must be managed
  134  within the program’s overall appropriated or authorized levels
  135  of funding. Each component of the program shall establish a
  136  reserve to ensure that transfers between components will be
  137  accomplished within current year appropriations. These reserves
  138  shall be reviewed by each convening of the Social Services
  139  Estimating Conference to determine the adequacy of such reserves
  140  to meet actual experience.
  141         (9) In determining the eligibility of a child, an assets
  142  test is not required. Each applicant shall provide documentation
  143  during the application process and the redetermination process,
  144  including, but not limited to, the following:
  145         (a) Each applicant’s Proof of family income, which must
  146  shall be verified electronically to determine financial
  147  eligibility for the Florida Kidcare program. Written
  148  documentation, which may include wages and earnings statements
  149  or pay stubs, W-2 forms, or a copy of the applicant’s most
  150  recent federal income tax return, is shall be required only if
  151  the electronic verification is not available or does not
  152  substantiate the applicant’s income.
  153         (b) Each applicant shall provide A statement from all
  154  applicable, employed family members that:
  155         1. Their employers do not sponsor health benefit plans for
  156  employees;
  157         2. The potential enrollee is not covered by an employer
  158  sponsored health benefit plan; or
  159         3. The potential enrollee is covered by an employer
  160  sponsored health benefit plan and the cost of the employer
  161  sponsored health benefit plan is more than 5 percent of the
  162  family’s income.
  163         (c) To enroll in the Children’s Medical Services Network, a
  164  completed application, including a clinical screening.
  165         (10) Subject to paragraph (4)(a) (4)(b), the Florida
  166  Kidcare program shall withhold benefits from an enrollee if the
  167  program obtains evidence that the enrollee is no longer
  168  eligible, submitted incorrect or fraudulent information in order
  169  to establish eligibility, or failed to provide verification of
  170  eligibility. The applicant or enrollee shall be notified that
  171  because of such evidence program benefits will be withheld
  172  unless the applicant or enrollee contacts a designated
  173  representative of the program by a specified date, which must be
  174  within 10 working days after the date of notice, to discuss and
  175  resolve the matter. The program shall make every effort to
  176  resolve the matter within a timeframe that will not cause
  177  benefits to be withheld from an eligible enrollee.
  178         (11) The following individuals may be subject to
  179  prosecution in accordance with s. 414.39:
  180         (a) An applicant obtaining or attempting to obtain benefits
  181  for a potential enrollee under the Florida Kidcare program if
  182  when the applicant knows or should have known that the potential
  183  enrollee does not qualify for the Florida Kidcare program.
  184         (b) An individual who assists an applicant in obtaining or
  185  attempting to obtain benefits for a potential enrollee under the
  186  Florida Kidcare program if when the individual knows or should
  187  have known that the potential enrollee does not qualify for the
  188  Florida Kidcare program.
  189         Section 3. This act shall take effect July 1, 2012.