Florida Senate - 2012 COMMITTEE AMENDMENT
Bill No. SB 510
Senate . House
Comm: RCS .
The Committee on Health Regulation (Fasano) recommended the
1 Senate Amendment (with title amendment)
3 Delete everything after the enacting clause
4 and insert:
5 Section 1. Paragraph (b) of subsection (6) of section
6 409.8132, Florida Statutes, is amended to read:
7 409.8132 Medikids program component.—
8 (6) ELIGIBILITY.—
9 (b) The provisions of s. 409.814 apply
409.814 (3), (4),
10 (5), and (6) shall be applicable to the Medikids program.
11 Section 2. Section 409.814, Florida Statutes, is amended to
13 409.814 Eligibility.—A child who has not reached 19 years
14 of age whose family income is equal to or below 200 percent of
15 the federal poverty level is eligible for the Florida Kidcare
16 program as provided in this section. For enrollment in the
17 Children’s Medical Services Network, a complete application
18 includes the medical or behavioral health screening. If ,
19 subsequently, an enrolled individual is determined to be
20 ineligible for coverage, he or she must be immediately be
21 disenrolled from the respective Florida Kidcare program
23 (1) A child who is eligible for Medicaid coverage under s.
24 409.903 or s. 409.904 must be enrolled in Medicaid and is not
25 eligible to receive health benefits under any other health
26 benefits coverage authorized under the Florida Kidcare program.
27 (2) A child who is not eligible for Medicaid, but who is
28 eligible for the Florida Kidcare program, may obtain health
29 benefits coverage under any of the other components listed in s.
30 409.813 if such coverage is approved and available in the county
31 in which the child resides.
32 (3) A Title XXI-funded child who is eligible for the
33 Florida Kidcare program who is a child with special health care
34 needs, as determined through a medical or behavioral screening
35 instrument, is eligible for health benefits coverage from and
36 shall be assigned to and may opt out of the Children’s Medical
37 Services Network.
38 (4) The following children are not eligible to receive
39 Title XXI-funded premium assistance for health benefits coverage
40 under the Florida Kidcare program, except under Medicaid if the
41 child would have been eligible for Medicaid under s. 409.903 or
42 s. 409.904 as of June 1, 1997:
43 (a) A child who is eligible for coverage under a state
44 health benefit plan on the basis of a family member’s employment
45 with a public agency in the state.
46 (a) (b) A child who is covered under a family member’s group
47 health benefit plan or under other private or employer health
48 insurance coverage, if the cost of the child’s participation is
49 not greater than 5 percent of the family’s income. If a child is
50 otherwise eligible for a subsidy under the Florida Kidcare
51 program and the cost of the child’s participation in the family
52 member’s health insurance benefit plan is greater than 5 percent
53 of the family’s income, the child may enroll in the appropriate
54 subsidized Kidcare program.
55 (b) (c) A child who is seeking premium assistance for the
56 Florida Kidcare program through employer-sponsored group
57 coverage, if the child has been covered by the same employer’s
58 group coverage during the 60 days before the family submitted
59 prior to the family’s submitting an application for
60 determination of eligibility under the program.
61 (c) (d) A child who is an alien, but who does not meet the
62 definition of qualified alien, in the United States.
63 (d) (e) A child who is an inmate of a public institution or
64 a patient in an institution for mental diseases.
65 (e) (f) A child who is otherwise eligible for premium
66 assistance for the Florida Kidcare program and has had his or
67 her coverage in an employer-sponsored or private health benefit
68 plan voluntarily canceled in the last 60 days, except those
69 children whose coverage was voluntarily canceled for good cause,
70 including, but not limited to, the following circumstances:
71 1. The cost of participation in an employer-sponsored
72 health benefit plan is greater than 5 percent of the family’s
74 2. The parent lost a job that provided an employer
75 sponsored health benefit plan for children;
76 3. The parent who had health benefits coverage for the
77 child is deceased;
78 4. The child has a medical condition that, without medical
79 care, would cause serious disability, loss of function, or
81 5. The employer of the parent canceled health benefits
82 coverage for children;
83 6. The child’s health benefits coverage ended because the
84 child reached the maximum lifetime coverage amount;
85 7. The child has exhausted coverage under a COBRA
86 continuation provision;
87 8. The health benefits coverage does not cover the child’s
88 health care needs; or
89 9. Domestic violence led to loss of coverage.
90 (5) A child who is otherwise eligible for the Florida
91 Kidcare program and who has a preexisting condition that
92 prevents coverage under another insurance plan as described in
93 paragraph (4)(a) (4)(b) which would have disqualified the child
94 for the Florida Kidcare program if the child were able to enroll
95 in the plan is shall be eligible for Florida Kidcare coverage
96 when enrollment is possible.
97 (6) A child whose family income is above 200 percent of the
98 federal poverty level or a child who is excluded under the
99 provisions of subsection (4) may participate in the Florida
100 Kidcare program as provided in s. 409.8132 or, if the child is
101 ineligible for Medikids by reason of age, in the Florida Healthy
102 Kids program, subject to the following provisions:
103 (a) The family is not eligible for premium assistance
104 payments and must pay the full cost of the premium, including
105 any administrative costs.
106 (b) The board of directors of the Florida Healthy Kids
107 Corporation may offer a reduced benefit package to these
108 children in order to limit program costs for such families.
109 (7) Once a child is enrolled in the Florida Kidcare
110 program, the child is eligible for coverage under the program
111 for 12 months without a redetermination or reverification of
112 eligibility , if the family continues to pay the applicable
113 premium. Eligibility for program components funded through Title
114 XXI of the Social Security Act terminates shall terminate when a
115 child attains the age of 19. A child who has not attained the
116 age of 5 and who has been determined eligible for the Medicaid
117 program is eligible for coverage for 12 months without a
118 redetermination or reverification of eligibility.
119 (8) When determining or reviewing a child’s eligibility
120 under the Florida Kidcare program, the applicant shall be
121 provided with reasonable notice of changes in eligibility which
122 may affect enrollment in one or more of the program components.
123 If When a transition from one program component to another is
124 authorized, there shall be cooperation between the program
125 components and the affected family which promotes continuity of
126 health care coverage. Any authorized transfers must be managed
127 within the program’s overall appropriated or authorized levels
128 of funding. Each component of the program shall establish a
129 reserve to ensure that transfers between components will be
130 accomplished within current year appropriations. These reserves
131 shall be reviewed by each convening of the Social Services
132 Estimating Conference to determine the adequacy of such reserves
133 to meet actual experience.
134 (9) In determining the eligibility of a child, an assets
135 test is not required. Each applicant shall provide documentation
136 during the application process and the redetermination process,
137 including, but not limited to, the following:
138 (a) Each applicant’s Proof of family income, which must
139 shall be verified electronically to determine financial
140 eligibility for the Florida Kidcare program. Written
141 documentation, which may include wages and earnings statements
142 or pay stubs, W-2 forms, or a copy of the applicant’s most
143 recent federal income tax return, is shall be required only if
144 the electronic verification is not available or does not
145 substantiate the applicant’s income.
146 (b) Each applicant shall provide A statement from all
147 applicable, employed family members that:
148 1. Their employers do not sponsor health benefit plans for
150 2. The potential enrollee is not covered by an employer
151 sponsored health benefit plan; or
152 3. The potential enrollee is covered by an employer
153 sponsored health benefit plan and the cost of the employer
154 sponsored health benefit plan is more than 5 percent of the
155 family’s income.
156 (c) To enroll in the Children’s Medical Services Network, a
157 completed application, including a clinical screening.
158 (10) Subject to paragraph (4)(a) (4)(b), the Florida
159 Kidcare program shall withhold benefits from an enrollee if the
160 program obtains evidence that the enrollee is no longer
161 eligible, submitted incorrect or fraudulent information in order
162 to establish eligibility, or failed to provide verification of
163 eligibility. The applicant or enrollee shall be notified that
164 because of such evidence program benefits will be withheld
165 unless the applicant or enrollee contacts a designated
166 representative of the program by a specified date, which must be
167 within 10 working days after the date of notice, to discuss and
168 resolve the matter. The program shall make every effort to
169 resolve the matter within a timeframe that will not cause
170 benefits to be withheld from an eligible enrollee.
171 (11) The following individuals may be subject to
172 prosecution in accordance with s. 414.39:
173 (a) An applicant obtaining or attempting to obtain benefits
174 for a potential enrollee under the Florida Kidcare program if
175 when the applicant knows or should have known that the potential
176 enrollee does not qualify for the Florida Kidcare program.
177 (b) An individual who assists an applicant in obtaining or
178 attempting to obtain benefits for a potential enrollee under the
179 Florida Kidcare program if when the individual knows or should
180 have known that the potential enrollee does not qualify for the
181 Florida Kidcare program.
182 Section 3. This act shall take effect July 1, 2012.
184 ================= T I T L E A M E N D M E N T ================
185 And the title is amended as follows:
186 Delete everything before the enacting clause
187 and insert:
188 A bill to be entitled
189 An act relating to the Florida Kidcare program;
190 amending s. 409.8132, F.S.; revising a cross
191 reference; amending s. 409.814, F.S.; deleting a
192 prohibition preventing children who are eligible for
193 coverage under a state health benefit plan from being
194 eligible for services provided through the subsidized
195 program; providing an effective date.