HB 849

A bill to be entitled
2An act relating to the Florida Kidcare program;
3amending s. 409.8132, F.S.; conforming cross-
4references; amending s. 409.814, F.S.; providing that
5children who are eligible for a state-sponsored health
6benefit plan and the subsidized Kidcare program may
7enroll in the program; conforming provisions to
8changes made by the act; amending s. 409.816, F.S.;
9conforming a cross-reference; providing an effective
12Be It Enacted by the Legislature of the State of Florida:
14     Section 1.  Paragraph (b) of subsection (6) of section
15409.8132, Florida Statutes, is amended to read:
16     409.8132  Medikids program component.-
17     (6)  ELIGIBILITY.-
18     (b)  The provisions of s. 409.814(3)-(7) apply 409.814(3),
19(4), (5), and (6) shall be applicable to the Medikids program.
20     Section 2.  Section 409.814, Florida Statutes, is amended
21to read:
22     409.814  Eligibility.-A child who has not reached 19 years
23of age whose family income is equal to or below 200 percent of
24the federal poverty level is eligible for the Florida Kidcare
25program as provided in this section. For enrollment in the
26Children's Medical Services Network, a complete application
27includes the medical or behavioral health screening. If,
28subsequently, an enrolled individual is determined to be
29ineligible for coverage, he or she must be immediately be
30disenrolled from the respective Florida Kidcare program
32     (1)  A child who is eligible for Medicaid coverage under s.
33409.903 or s. 409.904 must be enrolled in Medicaid and is not
34eligible to receive health benefits under any other health
35benefits coverage authorized under the Florida Kidcare program.
36     (2)  A child who is not eligible for Medicaid, but who is
37eligible for the Florida Kidcare program, may obtain health
38benefits coverage under any of the other components listed in s.
39409.813 if such coverage is approved and available in the county
40in which the child resides.
41     (3)  A Title XXI-funded child who is eligible for the
42Florida Kidcare program who is a child with special health care
43needs, as determined through a medical or behavioral screening
44instrument, is eligible for health benefits coverage from and
45shall be assigned to and may opt out of the Children's Medical
46Services Network.
47     (4)  A child who is eligible for a state-sponsored health
48benefit plan through a family member or guardian employed by the
49state and who meets the eligibility requirements for the
50subsidized Florida Kidcare program may enroll in the subsidized
51Florida Kidcare program.
52     (5)(4)  The following children are not eligible to receive
53Title XXI-funded premium assistance for health benefits coverage
54under the Florida Kidcare program, except under Medicaid if the
55child would have been eligible for Medicaid under s. 409.903 or
56s. 409.904 as of June 1, 1997:
57     (a)  A child who is eligible for coverage under a state
58health benefit plan on the basis of a family member's employment
59with a public agency in the state.
60     (a)(b)  A child who is covered under a family member's
61group health benefit plan or under other private or employer
62health insurance coverage, if the cost of the child's
63participation is not greater than 5 percent of the family's
64income. If a child is otherwise eligible for a subsidy under the
65Florida Kidcare program and the cost of the child's
66participation in the family member's health insurance benefit
67plan is greater than 5 percent of the family's income, the child
68may enroll in the appropriate subsidized Kidcare program.
69     (b)(c)  A child who is seeking premium assistance for the
70Florida Kidcare program through employer-sponsored group
71coverage, if the child has been covered by the same employer's
72group coverage during the 60 days before the family submitted
73prior to the family's submitting an application for
74determination of eligibility under the program.
75     (c)(d)  A child who is an alien, but who does not meet the
76definition of qualified alien, in the United States.
77     (d)(e)  A child who is an inmate of a public institution or
78a patient in an institution for mental diseases.
79     (e)(f)  A child who is otherwise eligible for premium
80assistance for the Florida Kidcare program and has had his or
81her coverage in an employer-sponsored or private health benefit
82plan voluntarily canceled in the last 60 days, except those
83children whose coverage was voluntarily canceled for good cause,
84including, but not limited to, the following circumstances:
85     1.  The cost of participation in an employer-sponsored
86health benefit plan is greater than 5 percent of the family's
88     2.  The parent lost a job that provided an employer-
89sponsored health benefit plan for children;
90     3.  The parent who had health benefits coverage for the
91child is deceased;
92     4.  The child has a medical condition that, without medical
93care, would cause serious disability, loss of function, or
95     5.  The employer of the parent canceled health benefits
96coverage for children;
97     6.  The child's health benefits coverage ended because the
98child reached the maximum lifetime coverage amount;
99     7.  The child has exhausted coverage under a COBRA
100continuation provision;
101     8.  The health benefits coverage does not cover the child's
102health care needs; or
103     9.  Domestic violence led to loss of coverage.
104     (6)(5)  A child who is otherwise eligible for the Florida
105Kidcare program and who has a preexisting condition that
106prevents coverage under another insurance plan as described in
107paragraph (5)(a) (4)(b) which would have disqualified the child
108for the Florida Kidcare program if the child were able to enroll
109in the plan is shall be eligible for Florida Kidcare coverage
110when enrollment is possible.
111     (7)(6)  A child whose family income is above 200 percent of
112the federal poverty level or a child who is excluded under the
113provisions of subsection (5) (4) may participate in the Florida
114Kidcare program as provided in s. 409.8132 or, if the child is
115ineligible for Medikids by reason of age, in the Florida Healthy
116Kids program, subject to the following provisions:
117     (a)  The family is not eligible for premium assistance
118payments and must pay the full cost of the premium, including
119any administrative costs.
120     (b)  The board of directors of the Florida Healthy Kids
121Corporation may offer a reduced benefit package to these
122children in order to limit program costs for such families.
123     (8)(7)  Once a child is enrolled in the Florida Kidcare
124program, the child is eligible for coverage under the program
125for 12 months without a redetermination or reverification of
126eligibility, if the family continues to pay the applicable
127premium. Eligibility for program components funded through Title
128XXI of the Social Security Act terminates shall terminate when a
129child attains the age of 19. A child who has not attained the
130age of 5 and who has been determined eligible for the Medicaid
131program is eligible for coverage for 12 months without a
132redetermination or reverification of eligibility.
133     (9)(8)  When determining or reviewing a child's eligibility
134under the Florida Kidcare program, the applicant shall be
135provided with reasonable notice of changes in eligibility which
136may affect enrollment in one or more of the program components.
137If When a transition from one program component to another is
138authorized, there shall be cooperation between the program
139components and the affected family which promotes continuity of
140health care coverage. Any authorized transfers must be managed
141within the program's overall appropriated or authorized levels
142of funding. Each component of the program shall establish a
143reserve to ensure that transfers between components will be
144accomplished within current year appropriations. These reserves
145shall be reviewed by each convening of the Social Services
146Estimating Conference to determine the adequacy of such reserves
147to meet actual experience.
148     (10)(9)  In determining the eligibility of a child, an
149assets test is not required. Each applicant shall provide
150documentation during the application process and the
151redetermination process, including, but not limited to, the
153     (a)  Each applicant's Proof of family income, which must
154shall be verified electronically to determine financial
155eligibility for the Florida Kidcare program. Written
156documentation, which may include wages and earnings statements
157or pay stubs, W-2 forms, or a copy of the applicant's most
158recent federal income tax return, is shall be required only if
159the electronic verification is not available or does not
160substantiate the applicant's income.
161     (b)  Each applicant shall provide A statement from all
162applicable, employed family members that:
163     1.  Their employers do not sponsor health benefit plans for
165     2.  The potential enrollee is not covered by an employer-
166sponsored health benefit plan; or
167     3.  The potential enrollee is covered by an employer-
168sponsored health benefit plan and the cost of the employer-
169sponsored health benefit plan is more than 5 percent of the
170family's income.
171     (11)(10)  Subject to paragraph (5)(a) (4)(b), the Florida
172Kidcare program shall withhold benefits from an enrollee if the
173program obtains evidence that the enrollee is no longer
174eligible, submitted incorrect or fraudulent information in order
175to establish eligibility, or failed to provide verification of
176eligibility. The applicant or enrollee shall be notified that
177because of such evidence program benefits will be withheld
178unless the applicant or enrollee contacts a designated
179representative of the program by a specified date, which must be
180within 10 working days after the date of notice, to discuss and
181resolve the matter. The program shall make every effort to
182resolve the matter within a timeframe that will not cause
183benefits to be withheld from an eligible enrollee.
184     (12)(11)  The following individuals may be subject to
185prosecution in accordance with s. 414.39:
186     (a)  An applicant obtaining or attempting to obtain
187benefits for a potential enrollee under the Florida Kidcare
188program if when the applicant knows or should have known that
189the potential enrollee does not qualify for the Florida Kidcare
191     (b)  An individual who assists an applicant in obtaining or
192attempting to obtain benefits for a potential enrollee under the
193Florida Kidcare program if when the individual knows or should
194have known that the potential enrollee does not qualify for the
195Florida Kidcare program.
196     Section 3.  Subsection (3) of section 409.816, Florida
197Statutes, is amended to read:
198     409.816  Limitations on premiums and cost-sharing.-The
199following limitations on premiums and cost-sharing are
200established for the program.
201     (3)  Enrollees in families with a family income above 150
202percent of the federal poverty level who are not receiving
203coverage under the Medicaid program or who are not eligible
204under s. 409.814(7) 409.814(6) may be required to pay enrollment
205fees, premiums, copayments, deductibles, coinsurance, or similar
206charges on a sliding scale related to income, except that the
207total annual aggregate cost-sharing with respect to all children
208in a family may not exceed 5 percent of the family's income.
209However, copayments, deductibles, coinsurance, or similar
210charges may not be imposed for preventive services, including
211well-baby and well-child care, age-appropriate immunizations,
212and routine hearing and vision screenings.
213     Section 4.  This act shall take effect July 1, 2012.

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