Florida Senate - 2010 SB 2082
By Senator Rich
1 A bill to be entitled
2 An act relating to the Florida Kidcare program;
3 amending s. 409.8132, F.S.; providing that children
4 under the age of 1 may participate in the Medikids
5 program; conforming cross-references; amending s.
6 409.814, F.S.; requiring that children who are
7 eligible for Kidcare be offered the opportunity to be
8 made presumptively eligible; providing that children
9 who are eligible for a state-sponsored health benefit
10 plan and the subsidized Kidcare program may enroll in
11 the program; providing that an eligible child who is a
12 lawful immigrant may enroll in the Florida Kidcare
13 program regardless of the child’s date of entry;
14 conforming provisions to changes made by the act;
15 amending s. 409.815, F.S.; authorizing Kidcare
16 coverage for temporomandibular joint disease; amending
17 s. 409.816, F.S.; conforming cross-references;
18 amending s. 409.818, F.S.; conforming provisions to
19 changes made by the act; amending s. 409.904, F.S.;
20 providing that Medicaid-eligible children are deemed
21 eligible for 12 months of coverage regardless of any
22 change in circumstances; requiring that such children
23 be offered the opportunity to be made presumptively
24 eligible; providing that a pregnant woman is eligible
25 for Medicaid for the duration of her pregnancy and for
26 the postpartum period; amending s. 624.91, F.S.,
27 relating to the Florida Healthy Kids Corporation;
28 conforming provisions to changes made by the act;
29 expanding the membership of the board of directors of
30 the Florida Healthy Kids Corporation; directing the
31 Agency for Health Care Administration to implement the
32 federal Family Opportunity Act; providing an effective
35 Be It Enacted by the Legislature of the State of Florida:
37 Section 1. Subsection (6) of section 409.8132, Florida
38 Statutes, is amended to read:
39 409.8132 Medikids program component.—
40 (6) ELIGIBILITY.—
41 (a) A child who
has attained the age of 1 year but who is
42 under the age of 5 years is eligible to enroll in the Medikids
43 program component of the Florida Kidcare program , if the child
44 is a member of a family that has a family income that which
45 exceeds the Medicaid applicable income level as specified in s.
46 409.903, but which is equal to or below 200 percent of the
47 current federal poverty level. In determining the eligibility of
48 such a child, an assets test is not required. A child who is
49 eligible for Medikids may elect to enroll in Florida Healthy
50 Kids coverage or employer-sponsored group coverage. However, a
51 child who is eligible for Medikids may participate in the
52 Florida Healthy Kids program only if the child has a sibling
53 participating in the Florida Healthy Kids program and the
54 child’s county of residence permits such enrollment.
55 (b) The provisions of s. 409.814(3)-(8) are 409.814 (3),
56 (4), (5), and (6) shall be applicable to the Medikids program.
57 Section 2. Section 409.814, Florida Statutes, is amended to
59 409.814 Eligibility.—A child who has not reached 19 years
60 of age whose family income is equal to or below 200 percent of
61 the federal poverty level is eligible for the Florida Kidcare
62 program as provided in this section. A child who is eligible
63 under this section must be offered the opportunity to be made
64 presumptively eligible. For enrollment in the Children’s Medical
65 Services Network, a complete application includes the medical or
66 behavioral health screening. If , subsequently, an enrolled
67 individual is determined to be ineligible for coverage, he or
68 she must be immediately be disenrolled from the respective
69 Florida Kidcare program component.
70 (1) A child who is eligible for Medicaid coverage under s.
71 409.903 or s. 409.904 must be enrolled in Medicaid and is not
72 eligible to receive health benefits under any other health
73 benefits coverage authorized under the Florida Kidcare program.
74 (2) A child who is not eligible for Medicaid, but who is
75 eligible for the Florida Kidcare program, may obtain health
76 benefits coverage under any of the other components listed in s.
77 409.813 if such coverage is approved and available in the county
78 in which the child resides.
79 (3) A Title XXI-funded child who is eligible for the
80 Florida Kidcare program and who is a child with special health
81 care needs, as determined through a medical or behavioral
82 screening instrument, is eligible for health benefits coverage
83 from and shall be assigned to and may opt out of the Children’s
84 Medical Services Network.
85 (4) A child who is eligible for a state-sponsored health
86 benefit plan through a family member or guardian employed by the
87 state and who meets the eligibility requirements for the
88 subsidized Florida Kidcare program may enroll in the subsidized
89 Florida Kidcare program, subject to an appropriation or the
90 availability of local contributions collected pursuant to s.
92 (5) A child who is an immigrant lawfully residing in the
93 United States and who meets the eligibility requirements for the
94 Florida Kidcare program may enroll in the program regardless of
95 the child’s date of entry.
96 (6) (4) The following children are not eligible to receive
97 Title XXI-funded premium assistance for health benefits coverage
98 under the Florida Kidcare program, except under Medicaid if the
99 child would have been eligible for Medicaid under s. 409.903 or
100 s. 409.904 as of June 1, 1997:
101 (a) A child who is eligible for coverage under a state
102 health benefit plan on the basis of a family member’s employment
103 with a public agency in the state.
104 (a) (b) A child who is covered under a family member’s group
105 health benefit plan or under other private or employer health
106 insurance coverage, if the cost of the child’s participation is
107 not greater than 5 percent of the family’s income. If a child is
108 otherwise eligible for a subsidy under the Florida Kidcare
109 program and the cost of the child’s participation in the family
110 member’s health insurance benefit plan is greater than 5 percent
111 of the family’s income, the child may enroll in the appropriate
112 subsidized Kidcare program.
113 (b) (c) A child who is seeking premium assistance for the
114 Florida Kidcare program through employer-sponsored group
115 coverage, if the child has been covered by the same employer’s
116 group coverage during the 60 days before the family submitted
117 prior to the family’s submitting an application for
118 determination of eligibility under the program.
119 (d) A child who is an alien, but who does not meet the
120 definition of qualified alien, in the United States.
121 (c) (e) A child who is an inmate of a public institution or
122 a patient in an institution for mental diseases.
123 (d) (f) A child who is otherwise eligible for premium
124 assistance for the Florida Kidcare program and has had his or
125 her coverage in an employer-sponsored or private health benefit
126 plan voluntarily canceled in the last 60 days, except those
127 children whose coverage was voluntarily canceled for good cause,
128 including, but not limited to, the following circumstances:
129 1. The cost of participation in an employer-sponsored
130 health benefit plan is greater than 5 percent of the family’s
132 2. The parent lost a job that provided an employer
133 sponsored health benefit plan for children;
134 3. The parent who had health benefits coverage for the
135 child is deceased;
136 4. The child has a medical condition that, without medical
137 care, would cause serious disability, loss of function, or
139 5. The employer of the parent canceled health benefits
140 coverage for children;
141 6. The child’s health benefits coverage ended because the
142 child reached the maximum lifetime coverage amount;
143 7. The child has exhausted coverage under a COBRA
144 continuation provision;
145 8. The health benefits coverage does not cover the child’s
146 health care needs; or
147 9. Domestic violence led to loss of coverage.
148 (7) (5) A child who is otherwise eligible for the Florida
149 Kidcare program and who has a preexisting condition that
150 prevents coverage under another insurance plan as described in
151 paragraph (6)(a) (4)(b) which would have disqualified the child
152 for the Florida Kidcare program if the child were able to enroll
153 in the plan is shall be eligible for Florida Kidcare coverage
154 when enrollment is possible.
155 (8) (6) A child whose family income is above 200 percent of
156 the federal poverty level or a child who is excluded under the
157 provisions of subsection (6) (4) may participate in the Florida
158 Kidcare program as provided in s. 409.8132 or, if the child is
159 ineligible for Medikids by reason of age, in the Florida Healthy
160 Kids program, subject to the following provisions:
161 (a) The family is not eligible for premium assistance
162 payments and must pay the full cost of the premium, including
163 any administrative costs.
164 (b) The board of directors of the Florida Healthy Kids
165 Corporation may offer a reduced benefit package to these
166 children in order to limit program costs for such families.
167 (9) (7) Once a child is enrolled in the Florida Kidcare
168 program, the child is eligible for coverage under the program
169 for 12 months without a redetermination or reverification of
170 eligibility , if the family continues to pay the applicable
171 premium. Eligibility for program components funded through Title
172 XXI of the Social Security Act shall terminate when a child
173 attains the age of 19. A child who has not attained the age of 5
174 and who has been determined eligible for the Medicaid program is
175 eligible for coverage for 12 months without a redetermination or
176 reverification of eligibility.
177 (10) (8) When determining or reviewing a child’s eligibility
178 under the Florida Kidcare program, the applicant shall be
179 provided with reasonable notice of changes in eligibility which
180 may affect enrollment in one or more of the program components.
181 If When a transition from one program component to another is
182 authorized, there shall be cooperation between the program
183 components and the affected family which promotes continuity of
184 health care coverage. Any authorized transfers must be managed
185 within the program’s overall appropriated or authorized levels
186 of funding. Each component of the program shall establish a
187 reserve to ensure that transfers between components will be
188 accomplished within current year appropriations. These reserves
189 shall be reviewed by each convening of the Social Services
190 Estimating Conference to determine the adequacy of such reserves
191 to meet actual experience.
192 (11) (9) In determining the eligibility of a child, an
193 assets test is not required. Each applicant shall provide
194 documentation during the application process and the
195 redetermination process, including, but not limited to, the
197 (a) Each applicant’s Proof of family income, which must
198 sh all be verified electronically to determine financial
199 eligibility for the Florida Kidcare program. Written
200 documentation, which may include wages and earnings statements
201 or pay stubs, W-2 forms, or a copy of the applicant’s most
202 recent federal income tax return, are shall be required only if
203 the electronic verification is not available or does not
204 substantiate the applicant’s income.
205 (b) Each applicant shall provide A statement from all
206 applicable, employed family members that :
207 1. Their employers do not sponsor health benefit plans for
209 2. the potential enrollee is not covered by an employer
210 sponsored health benefit plan ; or
211 3. The potential enrollee is covered by an employer
212 sponsored health benefit plan and the cost of the employer
213 sponsored health benefit plan is more than 5 percent of the
214 family’s income.
215 (12) (10) Subject to paragraph (6)(a) (4)(b), the Florida
216 Kidcare program shall withhold benefits from an enrollee if the
217 program obtains evidence that the enrollee is no longer
218 eligible, submitted incorrect or fraudulent information in order
219 to establish eligibility, or failed to provide verification of
220 eligibility. The applicant or enrollee shall be notified that
221 because of such evidence program benefits will be withheld
222 unless the applicant or enrollee contacts a designated
223 representative of the program by a specified date, which must be
224 within 10 working days after the date of notice, to discuss and
225 resolve the matter. The program shall make every effort to
226 resolve the matter within a timeframe that will not cause
227 benefits to be withheld from an eligible enrollee.
228 (13) (11) The following individuals may be subject to
229 prosecution in accordance with s. 414.39:
230 (a) An applicant obtaining or attempting to obtain benefits
231 for a potential enrollee under the Florida Kidcare program if
232 when the applicant knows or should have known that the potential
233 enrollee does not qualify for the Florida Kidcare program.
234 (b) An individual who assists an applicant in obtaining or
235 attempting to obtain benefits for a potential enrollee under the
236 Florida Kidcare program if when the individual knows or should
237 have known that the potential enrollee does not qualify for the
238 Florida Kidcare program.
239 Section 3. Paragraph (f) of subsection (2) of section
240 409.815, Florida Statutes, is amended to read:
241 409.815 Health benefits coverage; limitations.—
242 (2) BENCHMARK BENEFITS.—In order for health benefits
243 coverage to qualify for premium assistance payments for an
244 eligible child under ss. 409.810-409.821, the health benefits
245 coverage, except for coverage under Medicaid and Medikids, must
246 include the following minimum benefits, as medically necessary.
247 (f) Outpatient services.—Covered services include
248 preventive, diagnostic, therapeutic, palliative care, and other
249 services authorized by the enrollee’s health benefits coverage
250 provider and provided to an enrollee in the outpatient portion
251 of a health facility licensed under chapter 395 , except for the
252 following limitations:
253 1. Services must be authorized by the enrollee’s health
254 benefits coverage provider ; and
255 2. Treatment for temporomandibular joint disease (TMJ) is
256 specifically excluded.
257 Section 4. Subsection (3) of section 409.816, Florida
258 Statutes, is amended to read:
259 409.816 Limitations on premiums and cost-sharing.—The
260 following limitations on premiums and cost-sharing are
261 established for the program.
262 (3) Enrollees in families with a family income above 150
263 percent of the federal poverty level who are not receiving
264 coverage under the Medicaid program or who are not eligible
265 under s. 409.814(8) 409.814 (7) may be required to pay enrollment
266 fees, premiums, copayments, deductibles, coinsurance, or similar
267 charges on a sliding scale related to income, except that the
268 total annual aggregate cost-sharing with respect to all children
269 in a family may not exceed 5 percent of the family’s income.
270 However, copayments, deductibles, coinsurance, or similar
271 charges may not be imposed for preventive services, including
272 well-baby and well-child care, age-appropriate immunizations,
273 and routine hearing and vision screenings.
274 Section 5. Paragraph (b) of subsection (1) of section
275 409.818, Florida Statutes, is amended to read:
276 409.818 Administration.—In order to implement ss. 409.810
277 409.821, the following agencies shall have the following duties:
278 (1) The Department of Children and Family Services shall:
279 (b) Establish and maintain the eligibility determination
280 process under the program except as specified in subsection (5).
281 The department shall directly, or through the services of a
282 contracted third-party administrator, establish and maintain a
283 process for determining eligibility of children for coverage
284 under the program. The eligibility determination process must be
285 used solely for determining eligibility of applicants for health
286 benefits coverage under the program. The eligibility
287 determination process must include an initial determination of
288 eligibility for any coverage offered under the program, as well
289 as a redetermination or reverification of eligibility each
290 subsequent 6 months. Effective January 1, 1999, a child who has
291 not attained the age of 5 and who has been determined eligible
292 for the Medicaid program is eligible for coverage for 12 months
293 without a redetermination or reverification of eligibility. In
294 conducting an eligibility determination, the department shall
295 determine if the child has special health care needs. The
296 department, in consultation with the Agency for Health Care
297 Administration and the Florida Healthy Kids Corporation, shall
298 develop procedures for redetermining eligibility which enable a
299 family to easily update any change in circumstances which could
300 affect eligibility. The department may accept changes in a
301 family’s status as reported to the department by the Florida
302 Healthy Kids Corporation without requiring a new application
303 from the family. Redetermination of a child’s eligibility for
304 Medicaid may not be linked to a child’s eligibility
305 determination for other programs.
306 Section 6. Subsections (6) and (7) of section 409.904,
307 Florida Statutes, are amended to read:
308 409.904 Optional payments for eligible persons.—The agency
309 may make payments for medical assistance and related services on
310 behalf of the following persons who are determined to be
311 eligible subject to the income, assets, and categorical
312 eligibility tests set forth in federal and state law. Payment on
313 behalf of these Medicaid eligible persons is subject to the
314 availability of moneys and any limitations established by the
315 General Appropriations Act or chapter 216.
316 (6) A child who has not attained the age of 19 who has been
317 determined eligible for the Medicaid program is deemed to be
318 eligible for a total of 6 months, regardless of changes in
319 circumstances other than attainment of the maximum age.
320 Effective January 1, 1999, a child who has not attained the age
321 of 5 and who has been determined eligible for the Medicaid
322 program is deemed to be eligible for a total of 12 months
323 regardless of changes in circumstances other than attainment of
324 the maximum age. Subject to federal regulations, a child who is
325 eligible under this subsection must be offered the opportunity
326 to be made presumptively eligible.
327 (7) A pregnant woman for the duration of her pregnancy and
328 for the postpartum period as defined in federal law and rule, or
329 a child under 1 year of age who lives in a family that has an
330 income above 185 percent of the most recently published federal
331 poverty level, but which is at or below 200 percent of such
332 poverty level. In determining the eligibility of such child, an
333 assets test is not required. An individual A child who is
334 eligible for Medicaid under this subsection must be offered the
335 opportunity, subject to federal rules, to be made presumptively
337 Section 7. Subsection (3), paragraph (b) of subsection (5),
338 and paragraph (a) of subsection (6) of section 624.91, Florida
339 Statutes, are amended to read:
340 624.91 The Florida Healthy Kids Corporation Act.—
341 (3) ELIGIBILITY FOR STATE-FUNDED ASSISTANCE.—Only the
342 following individuals are eligible for state-funded assistance
343 in paying Florida Healthy Kids premiums:
344 (a) Residents of this state who are eligible for the
345 Florida Kidcare program pursuant to s. 409.814.
346 (b) Notwithstanding s. 409.814 , Legal aliens who are
347 enrolled in the Florida Healthy Kids program as of January 31,
348 2004, who do not qualify for Title XXI federal funds because
349 they are not qualified aliens as defined in s. 409.811.
350 (5) CORPORATION AUTHORIZATION, DUTIES, POWERS.—
351 (b) The Florida Healthy Kids Corporation shall:
352 1. Arrange for the collection of any family, local
353 contributions, or employer payment or premium, in an amount to
354 be determined by the board of directors, to provide for payment
355 of premiums for comprehensive insurance coverage and for the
356 actual or estimated administrative expenses.
357 2. Arrange for the collection of any voluntary
358 contributions to provide for payment of Florida Kidcare program
359 premiums for children who are not eligible for medical
360 assistance under Title XIX or Title XXI of the Social Security
362 3. Subject to the provisions of s. 409.8134, accept
363 voluntary supplemental local match contributions that comply
364 with the requirements of Title XXI of the Social Security Act
365 for the purpose of providing additional Florida Kidcare coverage
366 in contributing counties under Title XXI.
367 4. Establish the administrative and accounting procedures
368 for the operation of the corporation.
369 5. Establish, with consultation from appropriate
370 professional organizations, standards for preventive health
371 services and providers and comprehensive insurance benefits
372 appropriate to children if , provided that such standards for
373 rural areas do shall not limit primary care providers to board
374 certified pediatricians.
375 6. Determine eligibility for children seeking to
376 participate in the Title XXI-funded components of the Florida
377 Kidcare program consistent with the requirements specified in s.
378 409.814 , as well as the non-Title-XXI-eligible children as
379 provided in subsection (3).
380 7. Establish procedures under which providers of local
381 match to, applicants to, and participants in the program may
382 have grievances reviewed by an impartial body and reported to
383 the board of directors of the corporation.
384 8. Establish participation criteria and, if appropriate,
385 contract with an authorized insurer, health maintenance
386 organization, or third-party administrator to provide
387 administrative services to the corporation.
388 9. Establish enrollment criteria that include penalties or
389 30-day waiting periods of 30 days for reinstatement of coverage
390 upon voluntary cancellation for nonpayment of family premiums.
391 10. Contract with authorized insurers or providers any
392 provider of health care services, who meet meeting standards
393 established by the corporation, for the provision of
394 comprehensive insurance coverage to participants. Such standards
395 must shall include criteria under which the corporation may
396 contract with more than one provider of health care services in
397 program sites. Health plans shall be selected through a
398 competitive bid process. The Florida Healthy Kids Corporation
399 shall purchase goods and services in the most cost-effective
400 manner consistent with the delivery of quality medical care. The
401 maximum administrative cost for a Florida Healthy Kids
402 Corporation contract is shall be 15 percent. For health care
403 contracts, the minimum medical loss ratio for a Florida Healthy
404 Kids Corporation contract is shall be 85 percent. For dental
405 contracts, the remaining compensation to be paid to the
406 authorized insurer or provider must be at least under a Florida
407 Healthy Kids Corporation contract shall be no less than an
408 amount which is 85 percent of the premium; to the extent any
409 contract provision does not provide for this minimum
410 compensation, this section prevails shall prevail. The health
411 plan selection criteria and scoring system, and the scoring
412 results, must shall be available upon request for inspection
413 after the bids have been awarded.
414 11. Establish disenrollment criteria if in the event local
415 matching funds are insufficient to cover enrollments.
416 12. Develop and implement a plan to publicize the Florida
417 Kidcare program, the eligibility requirements of the program,
418 and the procedures for enrollment in the program and to maintain
419 public awareness of the corporation and the program.
420 13. Secure staff necessary to properly administer the
421 corporation. Staff costs shall be funded from state and local
422 matching funds and such other private or public funds as become
423 available. The board of directors shall determine the number of
424 staff members necessary to administer the corporation.
425 14. In consultation with the partner agencies, provide a
426 report on the Florida Kidcare program annually to the Governor,
427 the Chief Financial Officer, the Commissioner of Education, the
428 President of the Senate, the Speaker of the House of
429 Representatives, and the Minority Leaders of the Senate and the
430 House of Representatives.
431 15. Provide information on a quarterly basis to the
432 Legislature and the Governor which compares the costs and
433 utilization of the full-pay enrolled population and the Title
434 XXI-subsidized enrolled population in the Florida Kidcare
435 program. The information, At a minimum, the information must
437 a. The monthly enrollment and expenditure for full-pay
438 enrollees in the Medikids and Florida Healthy Kids programs
439 compared to the Title XXI-subsidized enrolled population; and
440 b. The costs and utilization by service of the full-pay
441 enrollees in the Medikids and Florida Healthy Kids programs and
442 the Title XXI-subsidized enrolled population.
444 By February 1, 2010, the Florida Healthy Kids Corporation shall
445 provide a study to the Legislature and the Governor on premium
446 impacts to the subsidized portion of the program from the
447 inclusion of the full-pay program, which must shall include
448 recommendations on how to eliminate or mitigate possible impacts
449 to the subsidized premiums.
450 16. Establish benefit packages that conform to the
451 provisions of the Florida Kidcare program, as created in ss.
453 (6) BOARD OF DIRECTORS.—
454 (a) The Florida Healthy Kids Corporation is shall operate
455 subject to the supervision and approval of a board of directors
456 chaired by the Chief Financial Officer or her or his designee,
457 and composed of 12 11 other members selected for 3-year terms of
458 office as follows:
459 1. The Secretary of Health Care Administration, or his or
460 her designee.
461 2. One member appointed by the Commissioner of Education
462 from the Office of School Health Programs of the Florida
463 Department of Education.
464 3. One member appointed by the Chief Financial Officer from
465 among three members nominated by the Florida Pediatric Society.
466 4. One member, appointed by the Governor, who represents
467 the Children’s Medical Services Program.
468 5. One member appointed by the Chief Financial Officer from
469 among three members nominated by the Florida Hospital
471 6. One member, appointed by the Governor, who is an expert
472 on child health policy.
473 7. One member, appointed by the Chief Financial Officer,
474 from among three members nominated by the Florida Academy of
475 Family Physicians.
476 8. One member, appointed by the Governor, who represents
477 the state Medicaid program.
478 9. One member, appointed by the Chief Financial Officer,
479 from among three members nominated by the Florida Association of
481 10. The State Health Officer, or her or his designee.
482 11. The Secretary of Children and Family Services, or his
483 or her designee.
484 12. One member, appointed by the Governor, from among three
485 members nominated by the Florida Dental Association.
486 Section 8. Subject to appropriation, the Agency for Health
487 Care Administration shall implement the federal Family
488 Opportunity Act, ss. 6062-6071 of the Deficit Reduction Act of
489 2005, to allow families whose income is up to 300 percent of the
490 federal poverty level to buy Medicaid coverage for their
491 disabled children.
492 Section 9. This act shall take effect October 1, 2010.