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President Office — Press Release


March 5, 2015

CONTACT: Katie Betta, (850) 487-5229

MEMO: Florida Health Insurance Affordability Exchange Program


All Senators


Andy Gardiner, President


Florida Health Insurance Affordability Exchange Program


March 5, 2015



Florida is at an important crossroads in the Medicaid program.  Nearly $2 billion of Low Income Pool (LIP) funding is in jeopardy.  LIP funding is a critical source of support for hospitals that provide essential services to Medicaid patients as well as the uninsured.  Some of our safety net hospitals struggle to remain solvent even with the supplemental payments provided through LIP.  Our communities depend on the services supported by LIP payments and loss of these funds poses a significant threat. 


At the same time, more than 800,000 uninsured Floridians can qualify for Medicaid if we decide to expand coverage.  Extra federal funds will enable more of our friends and neighbors to obtain health coverage.  Not surprisingly, the federal money comes with strings attached.  Some say Florida should not expand the existing Medicaid program and I agree.  But we have the obligation to make coverage affordable and the opportunity to develop a consumer-driven approach—one that provides access to high-quality, affordable health care coverage while promoting personal responsibility.  We should develop options that uniquely suit the needs of Floridians.  We should examine the opportunity for expansion and determine the best way to put in place conservative, free market guardrails that will control the cost and growth of the Medicaid program for Florida’s taxpayers.


This week, the Health Policy Committee conducted a workshop and panel discussion on health care coverage options.  The committee received a presentation on the Healthy Indiana Plan 2.0 (HIP 2.0), Indiana’s recently expanded health insurance program.  HIP 2.0 is an alternative to traditional Medicaid expansion.  Indiana’s waiver is different than other Medicaid expansion waivers approved by the federal government to date in that it allows new flexibility to the state.  Additionally, senators heard from the AHCA regarding the capacity of the agency to add the new group of eligible enrollees under the existing Medicaid managed care program. 


During the workshop, members discussed ideas with experts and listened to constituents from across the state.  As a result, the Health Policy Committee, under the leadership of Chair Bean, has developed Proposed Committee Bill 7044.  PCB 7044 creates a state-operated marketplace for low-income Floridians to access health care coverage, services and products.  Under the proposed legislation, enrollment will begin July 1, 2015 and will utilize a phased transition to ensure continuity of care.  A summary of the proposed legislation is attached.  I encourage you to review this information and become familiar with the challenges facing Florida’s Medicaid program.  I look forward to working with all of you to find the best way to meet the healthcare needs of our state.




PCB 7044 relating to Access to Health Coverage


Establishment of the Florida Health Insurance Affordability Exchange (FHIX) Program:

The FHIX program is a consumer-driven approach to providing access to high-quality, affordable health care coverage while promoting personal responsibility.  FHIX participants will have access to a state-operated marketplace to shop and select coverage, services and products.  The FHIX program will have a start date of July 1, 2015 and offer existing Medicaid Managed Care Plans immediately. 


Coverage Population & Eligibility Requirements:

  • The FHIX program will extend coverage to an estimated 800,000 low-income Floridians.

  • The expanded population will include individuals earning less than 138% of the Federal Poverty Level (FPL), who are not currently eligible under section 409.902, Florida Statutes.Individuals who earn an annual income of up to approximately $16,000 or parents who earn up to approximately $33,000 for a family of 4 will now be eligible.

  • Must be a Florida resident.


Products and Services:

  • All Florida Health Choices Program products and services.

  • All Medicaid Managed Care plans.

  • All products offered by Florida Healthy Kids Corporation.

  • Employer sponsored plans.


Cost-Sharing Principles:

  • Participants may be charged for inappropriate use of emergency room visits, $8 for the first visit and up to $25 for subsequent visits.

  • Participants will be assessed mandatory monthly premiums based on their modified adjusted gross income as follows:

    • Less than 22% of the FPL: $3

    • Between 22.01%-50% of the FPL: $8

    • Between 50.01%-75% of the FPL: $15

    • Between 75.01%-100% of the FPL: $20

    • Between 100.01%-138% of the FPL: $25

  • If a full premium payment is not received after a 30-day grace period, the premium assistance will be suspended and the participant may not re-activate coverage for a minimum of 6 months.


Employment Requirements:

  • Participants are required to complete an initial application for coverage which includes proof of employment, on-the-job training or placement activities, or pursuit of educational opportunities at a minimum hourly level as follows:

    • Parents with children under the age of 18: Minimum requirement of 20 hours per week.

    • Childless adults (disabled adults or caregivers of disabled children or adults may submit exceptions): Minimum requirement of 30 hours per week.

  • Participants must maintain the above work or educational requirements and will submit a renewal annually.



There will be a 3-phased approach to eligibility and enrollment that uses existing resources:

  • Phase One - Extend eligibility to the newly eligible with the Medicaid Managed Care Plans while seeking approval for Phase 2;
  • Phase Two - Transition participants to the Florida Health Choices marketplace to select plans, services and products using premium credits based on a risk adjusted rate beginning January 1, 2016; and
  • Phase Three - Fold Florida Healthy Kids enrollees into the marketplace starting July 1, 2016.
  • A Transition Workgroup will oversee the process and make recommendations to the Agency for Health Care Administration (AHCA).
  • The AHCA, as the single state agency for Medicaid, will make the ultimate decision on whether or not a region or phase is ready to “go live”.



  • The Department of Children and Families will continue to determine eligibility.
  • The Agency for Health Care Administration will administer Phase One, is the recipient and distributor of federal funds, chairs the FHIX Workgroup and has overall responsibility for the program.
  • The Florida Healthy Kids Corporation will provide customer support, financial services and retain its other responsibilities until Phase Three.
  • Florida Health Choices, Inc., will implement and operate the FHIX marketplace.


Participant Responsibilities:

  • Apply for coverage.
  • Execute participant contract to acknowledge program limitations, including possible non-funding, participant responsibilities for payments and work or education, and disenrollment consequences.
  • Make monthly premium payments based on income and work or educational requirements that begin in Phase Two.
  • Assume cost sharing for services based on products selected in the marketplace.
  • Renew eligibility annually.


Participant Rights:

  • Access the FHIX marketplace to shop and select coverage, services and products.
  • Avoid disruption of coverage through portability and continuity of coverage when eligibility changes.
  • Retain premium credits earned despite changes in circumstances in a health reimbursement or health savings account.
  • Select more than one plan or product on the FHIX marketplace.
  • Choose from at least two plans on the FHIX marketplace that are compliant with the Patient Protection and Affordable Care Act.