Florida Senate - 2022 SB 1422
By Senator Perry
8-00804A-22 20221422__
1 A bill to be entitled
2 An act relating to Florida Kidcare program
3 eligibility; amending s. 409.8132, F.S.; conforming a
4 provision to changes made by the act; amending s.
5 409.814, F.S.; increasing the income eligibility
6 threshold for coverage under the Florida Kidcare
7 program; requiring an applicant seeking coverage under
8 the program to provide certain documentation if
9 eligibility cannot be verified using reliable data
10 sources; amending s. 409.816, F.S.; requiring that
11 premiums for certain enrollees under the program be
12 based on a tiered system of uniform premiums; amending
13 s. 624.91, F.S.; conforming a provision to changes
14 made by the act; providing effective dates.
15
16 WHEREAS, as families progress up the economic ladder they
17 are adversely affected by the fiscal cliff, disincentivizing
18 upward mobility, and
19 WHEREAS, some of these families have lost access to Florida
20 Healthy Kids, which subsidizes children’s health insurance,
21 creating a health care coverage gap, and
22 WHEREAS, the Legislature seeks to remove these barriers and
23 intends to facilitate a glide path for families to achieve
24 economic self-sufficiency and access the necessary health care
25 services for their children, NOW, THEREFORE,
26
27 Be It Enacted by the Legislature of the State of Florida:
28
29 Section 1. Paragraph (a) of subsection (6) of section
30 409.8132, Florida 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 which exceeds
37 the Medicaid applicable income level as specified in s. 409.903,
38 but which is equal to or below 250 200 percent of the current
39 federal poverty level. In determining the eligibility of such a
40 child, an assets test is not required. A child who is eligible
41 for Medikids may elect to enroll in Florida Healthy Kids
42 coverage or employer-sponsored group coverage. However, a child
43 who is eligible for Medikids may participate in the Florida
44 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 Section 2. Effective July 1, 2023, paragraph (a) of
48 subsection (6) of section 409.8132, Florida Statutes, as amended
49 by this act, is amended to read:
50 409.8132 Medikids program component.—
51 (6) ELIGIBILITY.—
52 (a) A child who has attained the age of 1 year but who is
53 under the age of 5 years is eligible to enroll in the Medikids
54 program component of the Florida Kidcare program, if the child
55 is a member of a family that has a family income which exceeds
56 the Medicaid applicable income level as specified in s. 409.903,
57 but which is equal to or below 300 250 percent of the current
58 federal poverty level. In determining the eligibility of such a
59 child, an assets test is not required. A child who is eligible
60 for Medikids may elect to enroll in Florida Healthy Kids
61 coverage or employer-sponsored group coverage. However, a child
62 who is eligible for Medikids may participate in the Florida
63 Healthy Kids program only if the child has a sibling
64 participating in the Florida Healthy Kids program and the
65 child’s county of residence permits such enrollment.
66 Section 3. Section 409.814, Florida Statutes, is amended to
67 read:
68 409.814 Eligibility.—A child who has not reached 19 years
69 of age whose family income is equal to or below 250 200 percent
70 of the federal poverty level is eligible for the Florida Kidcare
71 program as provided in this section. If an enrolled individual
72 is determined to be ineligible for coverage, he or she must be
73 immediately disenrolled from the respective Florida Kidcare
74 program component.
75 (1) A child who is eligible for Medicaid coverage under s.
76 409.903 or s. 409.904 must be enrolled in Medicaid and is not
77 eligible to receive health benefits under any other health
78 benefits coverage authorized under the Florida Kidcare program.
79 (2) A child who is not eligible for Medicaid, but who is
80 eligible for the Florida Kidcare program, may obtain health
81 benefits coverage under any of the other components listed in s.
82 409.813 if such coverage is approved and available in the county
83 in which the child resides.
84 (3) A Title XXI-funded child who is eligible for the
85 Florida Kidcare program who is a child with special health care
86 needs, as determined through a medical or behavioral screening
87 instrument, is eligible for health benefits coverage from and
88 shall be assigned to and may opt out of the Children’s Medical
89 Services Network.
90 (4) The following children are not eligible to receive
91 Title XXI-funded premium assistance for health benefits coverage
92 under the Florida Kidcare program, except under Medicaid if the
93 child would have been eligible for Medicaid under s. 409.903 or
94 s. 409.904 as of June 1, 1997:
95 (a) A child who is covered under a family member’s group
96 health benefit plan or under other private or employer health
97 insurance coverage, if the cost of the child’s participation is
98 not greater than 5 percent of the family’s income. If a child is
99 otherwise eligible for a subsidy under the Florida Kidcare
100 program and the cost of the child’s participation in the family
101 member’s health insurance benefit plan is greater than 5 percent
102 of the family’s income, the child may enroll in the appropriate
103 subsidized Kidcare program.
104 (b) A child who is seeking premium assistance for the
105 Florida Kidcare program through employer-sponsored group
106 coverage, if the child has been covered by the same employer’s
107 group coverage during the 60 days before the family submitted an
108 application for determination of eligibility under the program.
109 (c) A child who is an alien but who does not meet the
110 definition of a lawfully residing child. This paragraph does not
111 extend eligibility for the Florida Kidcare program to an
112 undocumented immigrant.
113 (d) A child who is an inmate of a public institution or a
114 patient in an institution for mental diseases.
115 (e) A child who is otherwise eligible for premium
116 assistance for the Florida Kidcare program and has had his or
117 her coverage in an employer-sponsored or private health benefit
118 plan voluntarily canceled in the last 60 days, except those
119 children whose coverage was voluntarily canceled for good cause,
120 including, but not limited to, the following circumstances:
121 1. The cost of participation in an employer-sponsored
122 health benefit plan is greater than 5 percent of the family’s
123 income;
124 2. The parent lost a job that provided an employer
125 sponsored health benefit plan for children;
126 3. The parent who had health benefits coverage for the
127 child is deceased;
128 4. The child has a medical condition that, without medical
129 care, would cause serious disability, loss of function, or
130 death;
131 5. The employer of the parent canceled health benefits
132 coverage for children;
133 6. The child’s health benefits coverage ended because the
134 child reached the maximum lifetime coverage amount;
135 7. The child has exhausted coverage under a COBRA
136 continuation provision;
137 8. The health benefits coverage does not cover the child’s
138 health care needs; or
139 9. Domestic violence led to loss of coverage.
140 (5) A child who is otherwise eligible for the Florida
141 Kidcare program and who has a preexisting condition that
142 prevents coverage under another insurance plan as described in
143 paragraph (4)(a) which would have disqualified the child for the
144 Florida Kidcare program if the child were able to enroll in the
145 plan is eligible for Florida Kidcare coverage when enrollment is
146 possible.
147 (6) A child whose family income is above 250 200 percent of
148 the federal poverty level or a child who is excluded under the
149 provisions of subsection (4) may participate in the Florida
150 Kidcare program as provided in s. 409.8132 or, if the child is
151 ineligible for Medikids by reason of age, in the Florida Healthy
152 Kids program, subject to the following:
153 (a) The family is not eligible for premium assistance
154 payments and must pay the full cost of the premium, including
155 any administrative costs.
156 (b) The board of directors of the Florida Healthy Kids
157 Corporation may offer a reduced benefit package to these
158 children in order to limit program costs for such families.
159 (7) Once a child is enrolled in the Florida Kidcare
160 program, the child is eligible for coverage for 12 months
161 without a redetermination or reverification of eligibility, if
162 the family continues to pay the applicable premium. Eligibility
163 for program components funded through Title XXI of the Social
164 Security Act terminates when a child attains the age of 19. A
165 child who has not attained the age of 5 and who has been
166 determined eligible for the Medicaid program is eligible for
167 coverage for 12 months without a redetermination or
168 reverification of eligibility.
169 (8) When determining or reviewing a child’s eligibility
170 under the Florida Kidcare program, the applicant shall be
171 provided with reasonable notice of changes in eligibility which
172 may affect enrollment in one or more of the program components.
173 If a transition from one program component to another is
174 authorized, there shall be cooperation between the program
175 components and the affected family which promotes continuity of
176 health care coverage. Any authorized transfers must be managed
177 within the program’s overall appropriated or authorized levels
178 of funding. Each component of the program shall establish a
179 reserve to ensure that transfers between components will be
180 accomplished within current year appropriations. These reserves
181 shall be reviewed by each convening of the Social Services
182 Estimating Conference to determine the adequacy of such reserves
183 to meet actual experience.
184 (9) In determining the eligibility of a child, an assets
185 test is not required. If eligibility for the Florida Kidcare
186 program cannot be verified using reliable data sources in
187 accordance with federal requirements, each applicant shall
188 provide documentation during the application process and the
189 redetermination process, including, but not limited to, the
190 following:
191 (a) Proof of family income, which must be verified
192 electronically to determine financial eligibility for the
193 Florida Kidcare program. Written documentation, which may
194 include wages and earnings statements or pay stubs, W-2 forms,
195 or a copy of the applicant’s most recent federal income tax
196 return, is required only if the electronic verification is not
197 available or does not substantiate the applicant’s income.
198 (b) A statement from all applicable, employed family
199 members that:
200 1. Their employers do not sponsor health benefit plans for
201 employees;
202 2. The potential enrollee is not covered by an employer
203 sponsored health benefit plan; or
204 3. The potential enrollee is covered by an employer
205 sponsored health benefit plan and the cost of the employer
206 sponsored health benefit plan is more than 5 percent of the
207 family’s income.
208 (c) To enroll in the Children’s Medical Services Network, a
209 completed application, including a clinical screening.
210 (10) Subject to paragraph (4)(a), the Florida Kidcare
211 program shall withhold benefits from an enrollee if the program
212 obtains evidence that the enrollee is no longer eligible,
213 submitted incorrect or fraudulent information in order to
214 establish eligibility, or failed to provide verification of
215 eligibility. The applicant or enrollee shall be notified that
216 because of such evidence program benefits will be withheld
217 unless the applicant or enrollee contacts a designated
218 representative of the program by a specified date, which must be
219 within 10 working days after the date of notice, to discuss and
220 resolve the matter. The program shall make every effort to
221 resolve the matter within a timeframe that will not cause
222 benefits to be withheld from an eligible enrollee.
223 (11) The following individuals may be subject to
224 prosecution in accordance with s. 414.39:
225 (a) An applicant obtaining or attempting to obtain benefits
226 for a potential enrollee under the Florida Kidcare program when
227 the applicant knows or should have known the potential enrollee
228 does not qualify for the Florida Kidcare program.
229 (b) An individual who assists an applicant in obtaining or
230 attempting to obtain benefits for a potential enrollee under the
231 Florida Kidcare program when the individual knows or should have
232 known the potential enrollee does not qualify for the Florida
233 Kidcare program.
234 Section 4. Effective July 1, 2023, section 409.814, Florida
235 Statutes, as amended by this act, is amended to read:
236 409.814 Eligibility.—A child who has not reached 19 years
237 of age whose family income is equal to or below 300 250 percent
238 of the federal poverty level is eligible for the Florida Kidcare
239 program as provided in this section. If an enrolled individual
240 is determined to be ineligible for coverage, he or she must be
241 immediately disenrolled from the respective Florida Kidcare
242 program component.
243 (1) A child who is eligible for Medicaid coverage under s.
244 409.903 or s. 409.904 must be enrolled in Medicaid and is not
245 eligible to receive health benefits under any other health
246 benefits coverage authorized under the Florida Kidcare program.
247 (2) A child who is not eligible for Medicaid, but who is
248 eligible for the Florida Kidcare program, may obtain health
249 benefits coverage under any of the other components listed in s.
250 409.813 if such coverage is approved and available in the county
251 in which the child resides.
252 (3) A Title XXI-funded child who is eligible for the
253 Florida Kidcare program who is a child with special health care
254 needs, as determined through a medical or behavioral screening
255 instrument, is eligible for health benefits coverage from and
256 shall be assigned to and may opt out of the Children’s Medical
257 Services Network.
258 (4) The following children are not eligible to receive
259 Title XXI-funded premium assistance for health benefits coverage
260 under the Florida Kidcare program, except under Medicaid if the
261 child would have been eligible for Medicaid under s. 409.903 or
262 s. 409.904 as of June 1, 1997:
263 (a) A child who is covered under a family member’s group
264 health benefit plan or under other private or employer health
265 insurance coverage, if the cost of the child’s participation is
266 not greater than 5 percent of the family’s income. If a child is
267 otherwise eligible for a subsidy under the Florida Kidcare
268 program and the cost of the child’s participation in the family
269 member’s health insurance benefit plan is greater than 5 percent
270 of the family’s income, the child may enroll in the appropriate
271 subsidized Kidcare program.
272 (b) A child who is seeking premium assistance for the
273 Florida Kidcare program through employer-sponsored group
274 coverage, if the child has been covered by the same employer’s
275 group coverage during the 60 days before the family submitted an
276 application for determination of eligibility under the program.
277 (c) A child who is an alien but who does not meet the
278 definition of a lawfully residing child. This paragraph does not
279 extend eligibility for the Florida Kidcare program to an
280 undocumented immigrant.
281 (d) A child who is an inmate of a public institution or a
282 patient in an institution for mental diseases.
283 (e) A child who is otherwise eligible for premium
284 assistance for the Florida Kidcare program and has had his or
285 her coverage in an employer-sponsored or private health benefit
286 plan voluntarily canceled in the last 60 days, except those
287 children whose coverage was voluntarily canceled for good cause,
288 including, but not limited to, the following circumstances:
289 1. The cost of participation in an employer-sponsored
290 health benefit plan is greater than 5 percent of the family’s
291 income;
292 2. The parent lost a job that provided an employer
293 sponsored health benefit plan for children;
294 3. The parent who had health benefits coverage for the
295 child is deceased;
296 4. The child has a medical condition that, without medical
297 care, would cause serious disability, loss of function, or
298 death;
299 5. The employer of the parent canceled health benefits
300 coverage for children;
301 6. The child’s health benefits coverage ended because the
302 child reached the maximum lifetime coverage amount;
303 7. The child has exhausted coverage under a COBRA
304 continuation provision;
305 8. The health benefits coverage does not cover the child’s
306 health care needs; or
307 9. Domestic violence led to loss of coverage.
308 (5) A child who is otherwise eligible for the Florida
309 Kidcare program and who has a preexisting condition that
310 prevents coverage under another insurance plan as described in
311 paragraph (4)(a) which would have disqualified the child for the
312 Florida Kidcare program if the child were able to enroll in the
313 plan is eligible for Florida Kidcare coverage when enrollment is
314 possible.
315 (6) A child whose family income is above 300 250 percent of
316 the federal poverty level or a child who is excluded under the
317 provisions of subsection (4) may participate in the Florida
318 Kidcare program as provided in s. 409.8132 or, if the child is
319 ineligible for Medikids by reason of age, in the Florida Healthy
320 Kids program, subject to the following:
321 (a) The family is not eligible for premium assistance
322 payments and must pay the full cost of the premium, including
323 any administrative costs.
324 (b) The board of directors of the Florida Healthy Kids
325 Corporation may offer a reduced benefit package to these
326 children in order to limit program costs for such families.
327 (7) Once a child is enrolled in the Florida Kidcare
328 program, the child is eligible for coverage for 12 months
329 without a redetermination or reverification of eligibility, if
330 the family continues to pay the applicable premium. Eligibility
331 for program components funded through Title XXI of the Social
332 Security Act terminates when a child attains the age of 19. A
333 child who has not attained the age of 5 and who has been
334 determined eligible for the Medicaid program is eligible for
335 coverage for 12 months without a redetermination or
336 reverification of eligibility.
337 (8) When determining or reviewing a child’s eligibility
338 under the Florida Kidcare program, the applicant shall be
339 provided with reasonable notice of changes in eligibility which
340 may affect enrollment in one or more of the program components.
341 If a transition from one program component to another is
342 authorized, there shall be cooperation between the program
343 components and the affected family which promotes continuity of
344 health care coverage. Any authorized transfers must be managed
345 within the program’s overall appropriated or authorized levels
346 of funding. Each component of the program shall establish a
347 reserve to ensure that transfers between components will be
348 accomplished within current year appropriations. These reserves
349 shall be reviewed by each convening of the Social Services
350 Estimating Conference to determine the adequacy of such reserves
351 to meet actual experience.
352 (9) In determining the eligibility of a child, an assets
353 test is not required. If eligibility for the Florida Kidcare
354 program cannot be verified using reliable data sources in
355 accordance with federal requirements, each applicant shall
356 provide documentation during the application process and the
357 redetermination process, including, but not limited to, the
358 following:
359 (a) Proof of family income, which must be verified
360 electronically to determine financial eligibility for the
361 Florida Kidcare program. Written documentation, which may
362 include wages and earnings statements or pay stubs, W-2 forms,
363 or a copy of the applicant’s most recent federal income tax
364 return, is required only if the electronic verification is not
365 available or does not substantiate the applicant’s income.
366 (b) A statement from all applicable, employed family
367 members that:
368 1. Their employers do not sponsor health benefit plans for
369 employees;
370 2. The potential enrollee is not covered by an employer
371 sponsored health benefit plan; or
372 3. The potential enrollee is covered by an employer
373 sponsored health benefit plan and the cost of the employer
374 sponsored health benefit plan is more than 5 percent of the
375 family’s income.
376 (c) To enroll in the Children’s Medical Services Network, a
377 completed application, including a clinical screening.
378 (10) Subject to paragraph (4)(a), the Florida Kidcare
379 program shall withhold benefits from an enrollee if the program
380 obtains evidence that the enrollee is no longer eligible,
381 submitted incorrect or fraudulent information in order to
382 establish eligibility, or failed to provide verification of
383 eligibility. The applicant or enrollee shall be notified that
384 because of such evidence program benefits will be withheld
385 unless the applicant or enrollee contacts a designated
386 representative of the program by a specified date, which must be
387 within 10 working days after the date of notice, to discuss and
388 resolve the matter. The program shall make every effort to
389 resolve the matter within a timeframe that will not cause
390 benefits to be withheld from an eligible enrollee.
391 (11) The following individuals may be subject to
392 prosecution in accordance with s. 414.39:
393 (a) An applicant obtaining or attempting to obtain benefits
394 for a potential enrollee under the Florida Kidcare program when
395 the applicant knows or should have known the potential enrollee
396 does not qualify for the Florida Kidcare program.
397 (b) An individual who assists an applicant in obtaining or
398 attempting to obtain benefits for a potential enrollee under the
399 Florida Kidcare program when the individual knows or should have
400 known the potential enrollee does not qualify for the Florida
401 Kidcare program.
402 Section 5. Subsection (3) of section 409.816, Florida
403 Statutes, is amended to read:
404 409.816 Limitations on premiums and cost sharing.—The
405 following limitations on premiums and cost sharing are
406 established for the program.
407 (3) Enrollees in families with a family income above 150
408 percent of the federal poverty level who are not receiving
409 coverage under the Medicaid program or who are not eligible
410 under s. 409.814(6) may be required to pay enrollment fees,
411 premiums, copayments, deductibles, coinsurance, or similar
412 charges on a sliding scale related to income, except that the
413 total annual aggregate cost sharing with respect to all children
414 in a family may not exceed 5 percent of the family’s income.
415 However, copayments, deductibles, coinsurance, or similar
416 charges may not be imposed for preventive services, including
417 well-baby and well-child care, age-appropriate immunizations,
418 and routine hearing and vision screenings. Premiums for
419 enrollees paying enrollment fees, premiums, copayments,
420 deductibles, coinsurance, or similar charges as provided in this
421 subsection shall be based on at least three but no more than
422 five tiers of uniform premiums that increase with each tier as a
423 percentage of the applicable threshold amount of the federal
424 poverty level, by tier.
425 Section 6. Paragraph (b) of subsection (2) of section
426 624.91, Florida Statutes, is amended to read:
427 624.91 The Florida Healthy Kids Corporation Act.—
428 (2) LEGISLATIVE INTENT.—
429 (b) It is the intent of the Legislature that the Florida
430 Healthy Kids Corporation serve as one of several providers of
431 services to children eligible for medical assistance under Title
432 XXI of the Social Security Act. Although the corporation may
433 serve other children, the Legislature intends the primary
434 recipients of services provided through the corporation be
435 school-age children with a family income equal to or below 250
436 200 percent of the federal poverty level, who do not qualify for
437 Medicaid. It is also the intent of the Legislature that state
438 and local government Florida Healthy Kids funds be used to
439 continue coverage, subject to specific appropriations in the
440 General Appropriations Act, to children not eligible for federal
441 matching funds under Title XXI.
442 Section 7. Effective July 1, 2023, paragraph (b) of
443 subsection (2) of section 624.91, Florida Statutes, as amended
444 by this act, is amended to read:
445 624.91 The Florida Healthy Kids Corporation Act.—
446 (2) LEGISLATIVE INTENT.—
447 (b) It is the intent of the Legislature that the Florida
448 Healthy Kids Corporation serve as one of several providers of
449 services to children eligible for medical assistance under Title
450 XXI of the Social Security Act. Although the corporation may
451 serve other children, the Legislature intends the primary
452 recipients of services provided through the corporation be
453 school-age children with a family income equal to or below 300
454 250 percent of the federal poverty level, who do not qualify for
455 Medicaid. It is also the intent of the Legislature that state
456 and local government Florida Healthy Kids funds be used to
457 continue coverage, subject to specific appropriations in the
458 General Appropriations Act, to children not eligible for federal
459 matching funds under Title XXI.
460 Section 8. Except as otherwise expressly provided in this
461 act, this act shall take effect July 1, 2022.