HB 849

1	A bill to be entitled
2	An act relating to the Florida Kidcare program;
3	amending s. 409.8132, F.S.; conforming cross-
4	references; amending s. 409.814, F.S.; providing that
5	children who are eligible for a state-sponsored health
6	benefit plan and the subsidized Kidcare program may
7	enroll in the program; conforming provisions to
8	changes made by the act; amending s. 409.816, F.S.;
9	conforming a cross-reference; providing an effective
10	date.
11
12	Be It Enacted by the Legislature of the State of Florida:
13
14	Section 1.  Paragraph (b) of subsection (6) of section
15	409.8132, 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
21	to read:
22	409.814  Eligibility.-A child who has not reached 19 years
23	of age whose family income is equal to or below 200 percent of
24	the federal poverty level is eligible for the Florida Kidcare
25	program as provided in this section. For enrollment in the
26	Children's Medical Services Network, a complete application
27	includes the medical or behavioral health screening. If,
28	subsequently, an enrolled individual is determined to be
29	ineligible for coverage, he or she must be immediately be
30	disenrolled from the respective Florida Kidcare program
31	component.
32	(1)  A child who is eligible for Medicaid coverage under s.
33	409.903 or s. 409.904 must be enrolled in Medicaid and is not
34	eligible to receive health benefits under any other health
35	benefits coverage authorized under the Florida Kidcare program.
36	(2)  A child who is not eligible for Medicaid, but who is
37	eligible for the Florida Kidcare program, may obtain health
38	benefits coverage under any of the other components listed in s.
39	409.813 if such coverage is approved and available in the county
40	in which the child resides.
41	(3)  A Title XXI-funded child who is eligible for the
42	Florida Kidcare program who is a child with special health care
43	needs, as determined through a medical or behavioral screening
44	instrument, is eligible for health benefits coverage from and
45	shall be assigned to and may opt out of the Children's Medical
46	Services Network.
47	(4)  A child who is eligible for a state-sponsored health
48	benefit plan through a family member or guardian employed by the
49	state and who meets the eligibility requirements for the
50	subsidized Florida Kidcare program may enroll in the subsidized
51	Florida Kidcare program.
52	(5)(4)  The following children are not eligible to receive
53	Title XXI-funded premium assistance for health benefits coverage
54	under the Florida Kidcare program, except under Medicaid if the
55	child would have been eligible for Medicaid under s. 409.903 or
56	s. 409.904 as of June 1, 1997:
57	(a)  A child who is eligible for coverage under a state
58	health benefit plan on the basis of a family member's employment
59	with a public agency in the state.
60	(a)(b)  A child who is covered under a family member's
61	group health benefit plan or under other private or employer
62	health insurance coverage, if the cost of the child's
63	participation is not greater than 5 percent of the family's
64	income. If a child is otherwise eligible for a subsidy under the
65	Florida Kidcare program and the cost of the child's
66	participation in the family member's health insurance benefit
67	plan is greater than 5 percent of the family's income, the child
68	may enroll in the appropriate subsidized Kidcare program.
69	(b)(c)  A child who is seeking premium assistance for the
70	Florida Kidcare program through employer-sponsored group
71	coverage, if the child has been covered by the same employer's
72	group coverage during the 60 days before the family submitted
73	prior to the family's submitting an application for
74	determination of eligibility under the program.
75	(c)(d)  A child who is an alien, but who does not meet the
76	definition of qualified alien, in the United States.
77	(d)(e)  A child who is an inmate of a public institution or
78	a patient in an institution for mental diseases.
79	(e)(f)  A child who is otherwise eligible for premium
80	assistance for the Florida Kidcare program and has had his or
81	her coverage in an employer-sponsored or private health benefit
82	plan voluntarily canceled in the last 60 days, except those
83	children whose coverage was voluntarily canceled for good cause,
84	including, but not limited to, the following circumstances:
85	1.  The cost of participation in an employer-sponsored
86	health benefit plan is greater than 5 percent of the family's
87	income;
88	2.  The parent lost a job that provided an employer-
89	sponsored health benefit plan for children;
90	3.  The parent who had health benefits coverage for the
91	child is deceased;
92	4.  The child has a medical condition that, without medical
93	care, would cause serious disability, loss of function, or
94	death;
95	5.  The employer of the parent canceled health benefits
96	coverage for children;
97	6.  The child's health benefits coverage ended because the
98	child reached the maximum lifetime coverage amount;
99	7.  The child has exhausted coverage under a COBRA
100	continuation provision;
101	8.  The health benefits coverage does not cover the child's
102	health care needs; or
103	9.  Domestic violence led to loss of coverage.
104	(6)(5)  A child who is otherwise eligible for the Florida
105	Kidcare program and who has a preexisting condition that
106	prevents coverage under another insurance plan as described in
107	paragraph (5)(a) (4)(b) which would have disqualified the child
108	for the Florida Kidcare program if the child were able to enroll
109	in the plan is shall be eligible for Florida Kidcare coverage
110	when enrollment is possible.
111	(7)(6)  A child whose family income is above 200 percent of
112	the federal poverty level or a child who is excluded under the
113	provisions of subsection (5) (4) may participate in the Florida
114	Kidcare program as provided in s. 409.8132 or, if the child is
115	ineligible for Medikids by reason of age, in the Florida Healthy
116	Kids program, subject to the following provisions:
117	(a)  The family is not eligible for premium assistance
118	payments and must pay the full cost of the premium, including
119	any administrative costs.
120	(b)  The board of directors of the Florida Healthy Kids
121	Corporation may offer a reduced benefit package to these
122	children in order to limit program costs for such families.
123	(8)(7)  Once a child is enrolled in the Florida Kidcare
124	program, the child is eligible for coverage under the program
125	for 12 months without a redetermination or reverification of
126	eligibility, if the family continues to pay the applicable
127	premium. Eligibility for program components funded through Title
128	XXI of the Social Security Act terminates shall terminate when a
129	child attains the age of 19. A child who has not attained the
130	age of 5 and who has been determined eligible for the Medicaid
131	program is eligible for coverage for 12 months without a
132	redetermination or reverification of eligibility.
133	(9)(8)  When determining or reviewing a child's eligibility
134	under the Florida Kidcare program, the applicant shall be
135	provided with reasonable notice of changes in eligibility which
136	may affect enrollment in one or more of the program components.
137	If When a transition from one program component to another is
138	authorized, there shall be cooperation between the program
139	components and the affected family which promotes continuity of
140	health care coverage. Any authorized transfers must be managed
141	within the program's overall appropriated or authorized levels
142	of funding. Each component of the program shall establish a
143	reserve to ensure that transfers between components will be
144	accomplished within current year appropriations. These reserves
145	shall be reviewed by each convening of the Social Services
146	Estimating Conference to determine the adequacy of such reserves
147	to meet actual experience.
148	(10)(9)  In determining the eligibility of a child, an
149	assets test is not required. Each applicant shall provide
150	documentation during the application process and the
151	redetermination process, including, but not limited to, the
152	following:
153	(a)  Each applicant's Proof of family income, which must
154	shall be verified electronically to determine financial
155	eligibility for the Florida Kidcare program. Written
156	documentation, which may include wages and earnings statements
157	or pay stubs, W-2 forms, or a copy of the applicant's most
158	recent federal income tax return, is shall be required only if
159	the electronic verification is not available or does not
160	substantiate the applicant's income.
161	(b)  Each applicant shall provide A statement from all
162	applicable, employed family members that:
163	1.  Their employers do not sponsor health benefit plans for
164	employees;
165	2.  The potential enrollee is not covered by an employer-
166	sponsored health benefit plan; or
167	3.  The potential enrollee is covered by an employer-
168	sponsored health benefit plan and the cost of the employer-
169	sponsored health benefit plan is more than 5 percent of the
170	family's income.
171	(11)(10)  Subject to paragraph (5)(a) (4)(b), the Florida
172	Kidcare program shall withhold benefits from an enrollee if the
173	program obtains evidence that the enrollee is no longer
174	eligible, submitted incorrect or fraudulent information in order
175	to establish eligibility, or failed to provide verification of
176	eligibility. The applicant or enrollee shall be notified that
177	because of such evidence program benefits will be withheld
178	unless the applicant or enrollee contacts a designated
179	representative of the program by a specified date, which must be
180	within 10 working days after the date of notice, to discuss and
181	resolve the matter. The program shall make every effort to
182	resolve the matter within a timeframe that will not cause
183	benefits to be withheld from an eligible enrollee.
184	(12)(11)  The following individuals may be subject to
185	prosecution in accordance with s. 414.39:
186	(a)  An applicant obtaining or attempting to obtain
187	benefits for a potential enrollee under the Florida Kidcare
188	program if when the applicant knows or should have known that
189	the potential enrollee does not qualify for the Florida Kidcare
190	program.
191	(b)  An individual who assists an applicant in obtaining or
192	attempting to obtain benefits for a potential enrollee under the
193	Florida Kidcare program if when the individual knows or should
194	have known that the potential enrollee does not qualify for the
195	Florida Kidcare program.
196	Section 3.  Subsection (3) of section 409.816, Florida
197	Statutes, is amended to read:
198	409.816  Limitations on premiums and cost-sharing.-The
199	following limitations on premiums and cost-sharing are
200	established for the program.
201	(3)  Enrollees in families with a family income above 150
202	percent of the federal poverty level who are not receiving
203	coverage under the Medicaid program or who are not eligible
204	under s. 409.814(7) 409.814(6) may be required to pay enrollment
205	fees, premiums, copayments, deductibles, coinsurance, or similar
206	charges on a sliding scale related to income, except that the
207	total annual aggregate cost-sharing with respect to all children
208	in a family may not exceed 5 percent of the family's income.
209	However, copayments, deductibles, coinsurance, or similar
210	charges may not be imposed for preventive services, including
211	well-baby and well-child care, age-appropriate immunizations,
212	and 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.