November 25, 2020
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_h1545__
HB 1545

1
A bill to be entitled
2An act relating to the Florida Kidcare program; amending
3s. 409.8132, F.S.; providing that children under the age
4of 1 may participate in the Medikids program; conforming
5cross-references; amending s. 409.814, F.S.; providing
6that children who are eligible for a state-sponsored
7health benefit plan and the subsidized Kidcare program may
8enroll in the program; providing that an eligible child
9who is a lawful immigrant may enroll in the Florida
10Kidcare program regardless of the child's date of entry;
11conforming provisions to changes made by the act; amending
12s. 409.815, F.S.; authorizing Kidcare coverage for
13temporomandibular joint disease; amending s. 409.816,
14F.S.; conforming cross-references; amending s. 409.904,
15F.S.; providing that Medicaid-eligible children are deemed
16eligible for 12 months of coverage regardless of any
17change in circumstances; providing that a pregnant woman
18is eligible for Medicaid for the duration of her pregnancy
19and for the postpartum period; amending s. 624.91, F.S.,
20relating to the Florida Healthy Kids Corporation;
21conforming provisions to changes made by the act;
22expanding the membership of the board of directors of the
23Florida Healthy Kids Corporation; directing the Agency for
24Health Care Administration to implement the federal Family
25Opportunity Act; providing an effective date.
26
27Be It Enacted by the Legislature of the State of Florida:
28
29     Section 1.  Subsection (6) of section 409.8132, Florida
30Statutes, 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
34under the age of 5 years is eligible to enroll in the Medikids
35program component of the Florida Kidcare program, if the child
36is a member of a family that has a family income that which
37exceeds the Medicaid applicable income level as specified in s.
38409.903, but which is equal to or below 200 percent of the
39current federal poverty level. In determining the eligibility of
40such a child, an assets test is not required. A child who is
41eligible for Medikids may elect to enroll in Florida Healthy
42Kids coverage or employer-sponsored group coverage. However, a
43child who is eligible for Medikids may participate in the
44Florida Healthy Kids program only if the child has a sibling
45participating in the Florida Healthy Kids program and the
46child's county of residence permits such enrollment.
47     (b)  The provisions of s. 409.814(3)-(8) are 409.814(3),
48(4), (5), and (6) shall be applicable to the Medikids program.
49     Section 2.  Section 409.814, Florida Statutes, is amended
50to read:
51     409.814  Eligibility.-A child who has not reached 19 years
52of age whose family income is equal to or below 200 percent of
53the federal poverty level is eligible for the Florida Kidcare
54program as provided in this section. For enrollment in the
55Children's Medical Services Network, a complete application
56includes the medical or behavioral health screening. If,
57subsequently, an individual is determined to be ineligible for
58coverage, he or she must be immediately be disenrolled from the
59respective Florida Kidcare program component.
60     (1)  A child who is eligible for Medicaid coverage under s.
61409.903 or s. 409.904 must be enrolled in Medicaid and is not
62eligible to receive health benefits under any other health
63benefits coverage authorized under the Florida Kidcare program.
64     (2)  A child who is not eligible for Medicaid, but who is
65eligible for the Florida Kidcare program, may obtain health
66benefits coverage under any of the other components listed in s.
67409.813 if such coverage is approved and available in the county
68in which the child resides.
69     (3)  A Title XXI-funded child who is eligible for the
70Florida Kidcare program and who is a child with special health
71care needs, as determined through a medical or behavioral
72screening instrument, is eligible for health benefits coverage
73from and shall be assigned to and may opt out of the Children's
74Medical Services Network.
75     (4)  A child who is eligible for a state-sponsored health
76benefit plan through a family member or guardian employed by the
77state and who meets the eligibility requirements for the
78subsidized Florida Kidcare program may enroll in the subsidized
79Florida Kidcare program, subject to an appropriation or the
80availability of local contributions collected pursuant to s.
81624.91.
82     (5)  A child who is an immigrant lawfully residing in the
83United States and who meets the eligibility requirements for the
84Florida Kidcare program may enroll in the program regardless of
85the child's date of entry.
86     (6)(4)  The following children are not eligible to receive
87Title XXI-funded premium assistance for health benefits coverage
88under the Florida Kidcare program, except under Medicaid if the
89child would have been eligible for Medicaid under s. 409.903 or
90s. 409.904 as of June 1, 1997:
91     (a)  A child who is eligible for coverage under a state
92health benefit plan on the basis of a family member's employment
93with a public agency in the state.
94     (a)(b)  A child who is covered under a family member's
95group health benefit plan or under other private or employer
96health insurance coverage, if the cost of the child's
97participation is not greater than 5 percent of the family's
98income. If a child is otherwise eligible for a subsidy under the
99Florida Kidcare program and the cost of the child's
100participation in the family member's health insurance benefit
101plan is greater than 5 percent of the family's income, the child
102may enroll in the appropriate subsidized Kidcare program.
103     (b)(c)  A child who is seeking premium assistance for the
104Florida Kidcare program through employer-sponsored group
105coverage, if the child has been covered by the same employer's
106group coverage during the 60 days before the family submitted
107prior to the family's submitting an application for
108determination of eligibility under the program.
109     (d)  A child who is an alien, but who does not meet the
110definition of qualified alien, in the United States.
111     (c)(e)  A child who is an inmate of a public institution or
112a patient in an institution for mental diseases.
113     (d)(f)  A child who is otherwise eligible for premium
114assistance for the Florida Kidcare program and has had his or
115her coverage in an employer-sponsored or private health benefit
116plan voluntarily canceled in the last 60 days, except those
117children whose coverage was voluntarily canceled for good cause,
118including, but not limited to, the following circumstances:
119     1.  The cost of participation in an employer-sponsored
120health benefit plan is greater than 5 percent of the family's
121income;
122     2.  The parent lost a job that provided an employer-
123sponsored health benefit plan for children;
124     3.  The parent who had health benefits coverage for the
125child is deceased;
126     4.  The child has a medical condition that, without medical
127care, would cause serious disability, loss of function, or
128death;
129     5.  The employer of the parent canceled health benefits
130coverage for children;
131     6.  The child's health benefits coverage ended because the
132child reached the maximum lifetime coverage amount;
133     7.  The child has exhausted coverage under a COBRA
134continuation provision;
135     8.  The health benefits coverage does not cover the child's
136health care needs; or
137     9.  Domestic violence led to loss of coverage.
138     (7)(5)  A child who is otherwise eligible for the Florida
139Kidcare program and who has a preexisting condition that
140prevents coverage under another insurance plan as described in
141paragraph (6)(a) (4)(b) which would have disqualified the child
142for the Florida Kidcare program if the child were able to enroll
143in the plan is shall be eligible for Florida Kidcare coverage
144when enrollment is possible.
145     (8)(6)  A child whose family income is above 200 percent of
146the federal poverty level or a child who is excluded under the
147provisions of subsection (6) (4) may participate in the Florida
148Kidcare program as provided in s. 409.8132 or, if the child is
149ineligible for Medikids by reason of age, in the Florida Healthy
150Kids program, subject to the following provisions:
151     (a)  The family is not eligible for premium assistance
152payments and must pay the full cost of the premium, including
153any administrative costs.
154     (b)  The board of directors of the Florida Healthy Kids
155Corporation may offer a reduced benefit package to these
156children in order to limit program costs for such families.
157     (9)(7)  Once a child is enrolled in the Florida Kidcare
158program, the child is eligible for coverage under the program
159for 12 months without a redetermination or reverification of
160eligibility, if the family continues to pay the applicable
161premium. Eligibility for program components funded through Title
162XXI of the Social Security Act shall terminate when a child
163attains the age of 19. A child who has not attained the age of 5
164and who has been determined eligible for the Medicaid program is
165eligible for coverage for 12 months without a redetermination or
166reverification of eligibility.
167     (10)(8)  When determining or reviewing a child's
168eligibility under the Florida Kidcare program, the applicant
169shall be provided with reasonable notice of changes in
170eligibility which may affect enrollment in one or more of the
171program components. If When a transition from one program
172component to another is authorized, there shall be cooperation
173between the program components and the affected family which
174promotes continuity of health care coverage. Any authorized
175transfers must be managed within the program's overall
176appropriated or authorized levels of funding. Each component of
177the program shall establish a reserve to ensure that transfers
178between components will be accomplished within current year
179appropriations. These reserves shall be reviewed by each
180convening of the Social Services Estimating Conference to
181determine the adequacy of such reserves to meet actual
182experience.
183     (11)(9)  In determining the eligibility of a child, an
184assets test is not required. Each applicant shall provide
185documentation during the application process and the
186redetermination process, including, but not limited to, the
187following:
188     (a)  Each applicant's Proof of family income, which must
189shall be verified electronically to determine financial
190eligibility for the Florida Kidcare program. Written
191documentation, which may include wages and earnings statements
192or pay stubs, W-2 forms, or a copy of the applicant's most
193recent federal income tax return, are shall be required only if
194the electronic verification is not available or does not
195substantiate the applicant's income.
196     (b)  Each applicant shall provide A statement from all
197applicable, employed family members that:
198     1.  Their employers do not sponsor health benefit plans for
199employees;
200     2.  the potential enrollee is not covered by an employer-
201sponsored health benefit plan; or
202     3.  The potential enrollee is covered by an employer-
203sponsored health benefit plan and the cost of the employer-
204sponsored health benefit plan is more than 5 percent of the
205family's income.
206     (12)(10)  Subject to paragraph (6)(a) (4)(b), the Florida
207Kidcare program shall withhold benefits from an enrollee if the
208program obtains evidence that the enrollee is no longer
209eligible, submitted incorrect or fraudulent information in order
210to establish eligibility, or failed to provide verification of
211eligibility. The applicant or enrollee shall be notified that
212because of such evidence program benefits will be withheld
213unless the applicant or enrollee contacts a designated
214representative of the program by a specified date, which must be
215within 10 working days after the date of notice, to discuss and
216resolve the matter. The program shall make every effort to
217resolve the matter within a timeframe that will not cause
218benefits to be withheld from an eligible enrollee.
219     (13)(11)  The following individuals may be subject to
220prosecution in accordance with s. 414.39:
221     (a)  An applicant obtaining or attempting to obtain
222benefits for a potential enrollee under the Florida Kidcare
223program if when the applicant knows or should have known that
224the potential enrollee does not qualify for the Florida Kidcare
225program.
226     (b)  An individual who assists an applicant in obtaining or
227attempting to obtain benefits for a potential enrollee under the
228Florida Kidcare program if when the individual knows or should
229have known that the potential enrollee does not qualify for the
230Florida Kidcare program.
231     Section 3.  Paragraph (f) of subsection (2) of section
232409.815, Florida Statutes, is amended to read:
233     409.815  Health benefits coverage; limitations.-
234     (2)  BENCHMARK BENEFITS.-In order for health benefits
235coverage to qualify for premium assistance payments for an
236eligible child under ss. 409.810-409.821, the health benefits
237coverage, except for coverage under Medicaid and Medikids, must
238include the following minimum benefits, as medically necessary.
239     (f)  Outpatient services.-Covered services include
240preventive, diagnostic, therapeutic, palliative care, and other
241services authorized by the enrollee's health benefits coverage
242provider and provided to an enrollee in the outpatient portion
243of a health facility licensed under chapter 395, except for the
244following limitations:
245     1.  Services must be authorized by the enrollee's health
246benefits coverage provider; and
247     2.  Treatment for temporomandibular joint disease (TMJ) is
248specifically excluded.
249     Section 4.  Subsection (3) of section 409.816, Florida
250Statutes, is amended to read:
251     409.816  Limitations on premiums and cost-sharing.-The
252following limitations on premiums and cost-sharing are
253established for the program.
254     (3)  Enrollees in families with a family income above 150
255percent of the federal poverty level who are not receiving
256coverage under the Medicaid program or who are not eligible
257under s. 409.814(8) 409.814(7) may be required to pay enrollment
258fees, premiums, copayments, deductibles, coinsurance, or similar
259charges on a sliding scale related to income, except that the
260total annual aggregate cost-sharing with respect to all children
261in a family may not exceed 5 percent of the family's income.
262However, copayments, deductibles, coinsurance, or similar
263charges may not be imposed for preventive services, including
264well-baby and well-child care, age-appropriate immunizations,
265and routine hearing and vision screenings.
266     Section 5.  Subsections (6) and (7) of section 409.904,
267Florida Statutes, are amended to read:
268     409.904  Optional payments for eligible persons.-The agency
269may make payments for medical assistance and related services on
270behalf of the following persons who are determined to be
271eligible subject to the income, assets, and categorical
272eligibility tests set forth in federal and state law. Payment on
273behalf of these Medicaid eligible persons is subject to the
274availability of moneys and any limitations established by the
275General Appropriations Act or chapter 216.
276     (6)  A child who has not attained the age of 19 who has
277been determined eligible for the Medicaid program is deemed to
278be eligible for a total of 6 months, regardless of changes in
279circumstances other than attainment of the maximum age.
280Effective January 1, 1999, a child who has not attained the age
281of 5 and who has been determined eligible for the Medicaid
282program is deemed to be eligible for a total of 12 months
283regardless of changes in circumstances other than attainment of
284the maximum age.
285     (7)  A pregnant woman for the duration of her pregnancy and
286for the postpartum period as defined in federal law and rule, or
287a child under 1 year of age who lives in a family that has an
288income above 185 percent of the most recently published federal
289poverty level, but which is at or below 200 percent of such
290poverty level. In determining the eligibility of such child, an
291assets test is not required. An individual A child who is
292eligible for Medicaid under this subsection must be offered the
293opportunity, subject to federal rules, to be made presumptively
294eligible.
295     Section 6.  Subsection (3), paragraph (b) of subsection
296(5), and paragraph (a) of subsection (6) of section 624.91,
297Florida Statutes, are amended to read:
298     624.91  The Florida Healthy Kids Corporation Act.-
299     (3)  ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.-Only the
300following individuals are eligible for state-funded assistance
301in paying Florida Healthy Kids premiums:
302     (a)  Residents of this state who are eligible for the
303Florida Kidcare program pursuant to s. 409.814.
304     (b)  Notwithstanding s. 409.814, Legal aliens who are
305enrolled in the Florida Healthy Kids program as of January 31,
3062004, who do not qualify for Title XXI federal funds because
307they are not qualified aliens as defined in s. 409.811.
308     (5)  CORPORATION AUTHORIZATION, DUTIES, POWERS.-
309     (b)  The Florida Healthy Kids Corporation shall:
310     1.  Arrange for the collection of any family, local
311contributions, or employer payment or premium, in an amount to
312be determined by the board of directors, to provide for payment
313of premiums for comprehensive insurance coverage and for the
314actual or estimated administrative expenses.
315     2.  Arrange for the collection of any voluntary
316contributions to provide for payment of Florida Kidcare program
317premiums for children who are not eligible for medical
318assistance under Title XIX or Title XXI of the Social Security
319Act.
320     3.  Subject to the provisions of s. 409.8134, accept
321voluntary supplemental local match contributions that comply
322with the requirements of Title XXI of the Social Security Act
323for the purpose of providing additional Florida Kidcare coverage
324in contributing counties under Title XXI.
325     4.  Establish the administrative and accounting procedures
326for the operation of the corporation.
327     5.  Establish, with consultation from appropriate
328professional organizations, standards for preventive health
329services and providers and comprehensive insurance benefits
330appropriate to children if, provided that such standards for
331rural areas do shall not limit primary care providers to board-
332certified pediatricians.
333     6.  Determine eligibility for children seeking to
334participate in the Title XXI-funded components of the Florida
335Kidcare program consistent with the requirements specified in s.
336409.814, as well as the non-Title-XXI-eligible children as
337provided in subsection (3).
338     7.  Establish procedures under which providers of local
339match to, applicants to, and participants in the program may
340have grievances reviewed by an impartial body and reported to
341the board of directors of the corporation.
342     8.  Establish participation criteria and, if appropriate,
343contract with an authorized insurer, health maintenance
344organization, or third-party administrator to provide
345administrative services to the corporation.
346     9.  Establish enrollment criteria that include penalties or
34730-day waiting periods of 30 days for reinstatement of coverage
348upon voluntary cancellation for nonpayment of family premiums.
349     10.  Contract with authorized insurers or providers any
350provider of health care services, who meet meeting standards
351established by the corporation, for the provision of
352comprehensive insurance coverage to participants. Such standards
353must shall include criteria under which the corporation may
354contract with more than one provider of health care services in
355program sites. Health plans shall be selected through a
356competitive bid process. The Florida Healthy Kids Corporation
357shall purchase goods and services in the most cost-effective
358manner consistent with the delivery of quality medical care. The
359maximum administrative cost for a Florida Healthy Kids
360Corporation contract is shall be 15 percent. For health care
361contracts, the minimum medical loss ratio for a Florida Healthy
362Kids Corporation contract is shall be 85 percent. For dental
363contracts, the remaining compensation to be paid to the
364authorized insurer or provider must be at least under a Florida
365Healthy Kids Corporation contract shall be no
366amount which is 85 percent of the premium; to the
367contract provision does not provide for this minimum
368compensation, this section prevails shall prevail. The health
369plan selection criteria and scoring system, and the scoring
370results, must shall be available upon request for inspection
371after the bids have been awarded.
372     11.  Establish disenrollment criteria if in the event local
373matching funds are insufficient to cover enrollments.
374     12.  Develop and implement a plan to publicize the Florida
375Kidcare program, the eligibility requirements of the program,
376and the procedures for enrollment in the program and to maintain
377public awareness of the corporation and the program.
378     13.  Secure staff necessary to properly administer the
379corporation. Staff costs shall be funded from state and local
380matching funds and such other private or public funds as become
381available. The board of directors shall determine the number of
382staff members necessary to administer the corporation.
383     14.  In consultation with the partner agencies, provide a
384report on the Florida Kidcare program annually to the Governor,
385the Chief Financial Officer, the Commissioner of Education, the
386President of the Senate, the Speaker of the House of
387Representatives, and the Minority Leaders of the Senate and the
388House of Representatives.
389     15.  Provide information on a quarterly basis to the
390Legislature and the Governor which compares the costs and
391utilization of the full-pay enrolled population and the Title
392XXI-subsidized enrolled population in the Florida Kidcare
393program. The information, At a minimum, the information must
394include:
395     a.  The monthly enrollment and expenditure for full-pay
396enrollees in the Medikids and Florida Healthy Kids programs
397compared to the Title XXI-subsidized enrolled population; and
398     b.  The costs and utilization by service of the full-pay
399enrollees in the Medikids and Florida Healthy Kids programs and
400the Title XXI-subsidized enrolled population.
401
402By February 1, 2010, the Florida Healthy Kids Corporation shall
403provide a study to the Legislature and the Governor on premium
404impacts to the subsidized portion of the program from the
405inclusion of the full-pay program, which must shall include
406recommendations on how to eliminate or mitigate possible impacts
407to the subsidized premiums.
408     16.  Establish benefit packages that conform to the
409provisions of the Florida Kidcare program, as created in ss.
410409.810-409.821.
411     (6)  BOARD OF DIRECTORS.-
412     (a)  The Florida Healthy Kids Corporation is shall operate
413subject to the supervision and approval of a board of directors
414chaired by the Chief Financial Officer or her or his designee,
415and composed of 12 11 other members selected for 3-year terms of
416office as follows:
417     1.  The Secretary of Health Care Administration, or his or
418her designee.
419     2.  One member appointed by the Commissioner of Education
420from the Office of School Health Programs of the Florida
421Department of Education.
422     3.  One member appointed by the Chief Financial Officer
423from among three members nominated by the Florida Pediatric
424Society.
425     4.  One member, appointed by the Governor, who represents
426the Children's Medical Services Program.
427     5.  One member appointed by the Chief Financial Officer
428from among three members nominated by the Florida Hospital
429Association.
430     6.  One member, appointed by the Governor, who is an expert
431on child health policy.
432     7.  One member, appointed by the Chief Financial Officer,
433from among three members nominated by the Florida Academy of
434Family Physicians.
435     8.  One member, appointed by the Governor, who represents
436the state Medicaid program.
437     9.  One member, appointed by the Chief Financial Officer,
438from among three members nominated by the Florida Association of
439Counties.
440     10.  The State Health Officer, or her or his designee.
441     11.  The Secretary of Children and Family Services, or his
442or her designee.
443     12.  One member, appointed by the Governor, from among
444three members nominated by the Florida Dental Association.
445     Section 7.  Subject to appropriation, the Agency for Health
446Care Administration shall implement the federal Family
447Opportunity Act, ss. 6062-6071 of the Deficit Reduction Act of
4482005, to allow families whose income is up to 300 percent of the
449federal poverty level to buy Medicaid coverage for their
450disabled children.
451     Section 8.  This act shall take effect October 1, 2010.


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