Florida Senate - 2012                                     SB 510
       By Senator Rich
       34-00042A-12                                           2012510__
    1                        A bill to be entitled                      
    2         An act relating to the Florida Kidcare program;
    3         amending s. 409.8132, F.S.; conforming cross
    4         references; amending s. 409.814, F.S.; providing that
    5         children who are eligible for a state-sponsored health
    6         benefit plan and the subsidized Kidcare program may
    7         enroll in the program; conforming provisions to
    8         changes made by the act; amending s. 409.816, F.S.;
    9         conforming a cross-reference; providing an effective
   10         date.
   12  Be It Enacted by the Legislature of the State of Florida:
   14         Section 1. Paragraph (b) of subsection (6) of section
   15  409.8132, Florida Statutes, is amended to read:
   16         409.8132 Medikids program component.—
   17         (6) ELIGIBILITY.—
   18         (b) The provisions of s. 409.814(3)-(7) apply 409.814(3),
   19  (4), (5), and (6) shall be applicable to the Medikids program.
   20         Section 2. Section 409.814, Florida Statutes, is amended to
   21  read:
   22         409.814 Eligibility.—A child who has not reached 19 years
   23  of age whose family income is equal to or below 200 percent of
   24  the federal poverty level is eligible for the Florida Kidcare
   25  program as provided in this section. For enrollment in the
   26  Children’s Medical Services Network, a complete application
   27  includes the medical or behavioral health screening. If,
   28  subsequently, an enrolled individual is determined to be
   29  ineligible for coverage, he or she must be immediately be
   30  disenrolled from the respective Florida Kidcare program
   31  component.
   32         (1) A child who is eligible for Medicaid coverage under s.
   33  409.903 or s. 409.904 must be enrolled in Medicaid and is not
   34  eligible to receive health benefits under any other health
   35  benefits coverage authorized under the Florida Kidcare program.
   36         (2) A child who is not eligible for Medicaid, but who is
   37  eligible for the Florida Kidcare program, may obtain health
   38  benefits coverage under any of the other components listed in s.
   39  409.813 if such coverage is approved and available in the county
   40  in which the child resides.
   41         (3) A Title XXI-funded child who is eligible for the
   42  Florida Kidcare program who is a child with special health care
   43  needs, as determined through a medical or behavioral screening
   44  instrument, is eligible for health benefits coverage from and
   45  shall be assigned to and may opt out of the Children’s Medical
   46  Services Network.
   47         (4)A child who is eligible for a state-sponsored health
   48  benefit plan through a family member or guardian employed by the
   49  state and who meets the eligibility requirements for the
   50  subsidized Florida Kidcare program may enroll in the subsidized
   51  Florida Kidcare program.
   52         (5)(4) The following children are not eligible to receive
   53  Title XXI-funded premium assistance for health benefits coverage
   54  under the Florida Kidcare program, except under Medicaid if the
   55  child would have been eligible for Medicaid under s. 409.903 or
   56  s. 409.904 as of June 1, 1997:
   57         (a) A child who is eligible for coverage under a state
   58  health benefit plan on the basis of a family member’s employment
   59  with a public agency in the state.
   60         (a)(b) A child who is covered under a family member’s group
   61  health benefit plan or under other private or employer health
   62  insurance coverage, if the cost of the child’s participation is
   63  not greater than 5 percent of the family’s income. If a child is
   64  otherwise eligible for a subsidy under the Florida Kidcare
   65  program and the cost of the child’s participation in the family
   66  member’s health insurance benefit plan is greater than 5 percent
   67  of the family’s income, the child may enroll in the appropriate
   68  subsidized Kidcare program.
   69         (b)(c) A child who is seeking premium assistance for the
   70  Florida Kidcare program through employer-sponsored group
   71  coverage, if the child has been covered by the same employer’s
   72  group coverage during the 60 days before the family submitted
   73  prior to the family’s submitting an application for
   74  determination of eligibility under the program.
   75         (c)(d) A child who is an alien, but who does not meet the
   76  definition of qualified alien, in the United States.
   77         (d)(e) A child who is an inmate of a public institution or
   78  a patient in an institution for mental diseases.
   79         (e)(f) A child who is otherwise eligible for premium
   80  assistance for the Florida Kidcare program and has had his or
   81  her coverage in an employer-sponsored or private health benefit
   82  plan voluntarily canceled in the last 60 days, except those
   83  children whose coverage was voluntarily canceled for good cause,
   84  including, but not limited to, the following circumstances:
   85         1. The cost of participation in an employer-sponsored
   86  health benefit plan is greater than 5 percent of the family’s
   87  income;
   88         2. The parent lost a job that provided an employer
   89  sponsored health benefit plan for children;
   90         3. The parent who had health benefits coverage for the
   91  child is deceased;
   92         4. The child has a medical condition that, without medical
   93  care, would cause serious disability, loss of function, or
   94  death;
   95         5. The employer of the parent canceled health benefits
   96  coverage for children;
   97         6. The child’s health benefits coverage ended because the
   98  child reached the maximum lifetime coverage amount;
   99         7. The child has exhausted coverage under a COBRA
  100  continuation provision;
  101         8. The health benefits coverage does not cover the child’s
  102  health care needs; or
  103         9. Domestic violence led to loss of coverage.
  104         (6)(5) A child who is otherwise eligible for the Florida
  105  Kidcare program and who has a preexisting condition that
  106  prevents coverage under another insurance plan as described in
  107  paragraph (5)(a) (4)(b) which would have disqualified the child
  108  for the Florida Kidcare program if the child were able to enroll
  109  in the plan is shall be eligible for Florida Kidcare coverage
  110  when enrollment is possible.
  111         (7)(6) A child whose family income is above 200 percent of
  112  the federal poverty level or a child who is excluded under the
  113  provisions of subsection (5) (4) may participate in the Florida
  114  Kidcare program as provided in s. 409.8132 or, if the child is
  115  ineligible for Medikids by reason of age, in the Florida Healthy
  116  Kids program, subject to the following provisions:
  117         (a) The family is not eligible for premium assistance
  118  payments and must pay the full cost of the premium, including
  119  any administrative costs.
  120         (b) The board of directors of the Florida Healthy Kids
  121  Corporation may offer a reduced benefit package to these
  122  children in order to limit program costs for such families.
  123         (8)(7) Once a child is enrolled in the Florida Kidcare
  124  program, the child is eligible for coverage under the program
  125  for 12 months without a redetermination or reverification of
  126  eligibility, if the family continues to pay the applicable
  127  premium. Eligibility for program components funded through Title
  128  XXI of the Social Security Act terminates shall terminate when a
  129  child attains the age of 19. A child who has not attained the
  130  age of 5 and who has been determined eligible for the Medicaid
  131  program is eligible for coverage for 12 months without a
  132  redetermination or reverification of eligibility.
  133         (9)(8) When determining or reviewing a child’s eligibility
  134  under the Florida Kidcare program, the applicant shall be
  135  provided with reasonable notice of changes in eligibility which
  136  may affect enrollment in one or more of the program components.
  137  If When a transition from one program component to another is
  138  authorized, there shall be cooperation between the program
  139  components and the affected family which promotes continuity of
  140  health care coverage. Any authorized transfers must be managed
  141  within the program’s overall appropriated or authorized levels
  142  of funding. Each component of the program shall establish a
  143  reserve to ensure that transfers between components will be
  144  accomplished within current year appropriations. These reserves
  145  shall be reviewed by each convening of the Social Services
  146  Estimating Conference to determine the adequacy of such reserves
  147  to meet actual experience.
  148         (10)(9) In determining the eligibility of a child, an
  149  assets test is not required. Each applicant shall provide
  150  documentation during the application process and the
  151  redetermination process, including, but not limited to, the
  152  following:
  153         (a) Each applicant’s Proof of family income, which must
  154  shall be verified electronically to determine financial
  155  eligibility for the Florida Kidcare program. Written
  156  documentation, which may include wages and earnings statements
  157  or pay stubs, W-2 forms, or a copy of the applicant’s most
  158  recent federal income tax return, is shall be required only if
  159  the electronic verification is not available or does not
  160  substantiate the applicant’s income.
  161         (b) Each applicant shall provide A statement from all
  162  applicable, employed family members that:
  163         1. Their employers do not sponsor health benefit plans for
  164  employees;
  165         2. The potential enrollee is not covered by an employer
  166  sponsored health benefit plan; or
  167         3. The potential enrollee is covered by an employer
  168  sponsored health benefit plan and the cost of the employer
  169  sponsored health benefit plan is more than 5 percent of the
  170  family’s income.
  171         (11)(10) Subject to paragraph (5)(a) (4)(b), the Florida
  172  Kidcare program shall withhold benefits from an enrollee if the
  173  program obtains evidence that the enrollee is no longer
  174  eligible, submitted incorrect or fraudulent information in order
  175  to establish eligibility, or failed to provide verification of
  176  eligibility. The applicant or enrollee shall be notified that
  177  because of such evidence program benefits will be withheld
  178  unless the applicant or enrollee contacts a designated
  179  representative of the program by a specified date, which must be
  180  within 10 working days after the date of notice, to discuss and
  181  resolve the matter. The program shall make every effort to
  182  resolve the matter within a timeframe that will not cause
  183  benefits to be withheld from an eligible enrollee.
  184         (12)(11) The following individuals may be subject to
  185  prosecution in accordance with s. 414.39:
  186         (a) An applicant obtaining or attempting to obtain benefits
  187  for a potential enrollee under the Florida Kidcare program if
  188  when the applicant knows or should have known that the potential
  189  enrollee does not qualify for the Florida Kidcare program.
  190         (b) An individual who assists an applicant in obtaining or
  191  attempting to obtain benefits for a potential enrollee under the
  192  Florida Kidcare program if when the individual knows or should
  193  have known that the potential enrollee does not qualify for the
  194  Florida Kidcare program.
  195         Section 3. Subsection (3) of section 409.816, Florida
  196  Statutes, is amended to read:
  197         409.816 Limitations on premiums and cost-sharing.—The
  198  following limitations on premiums and cost-sharing are
  199  established for the program.
  200         (3) Enrollees in families with a family income above 150
  201  percent of the federal poverty level who are not receiving
  202  coverage under the Medicaid program or who are not eligible
  203  under s. 409.814(7) 409.814(6) may be required to pay enrollment
  204  fees, premiums, copayments, deductibles, coinsurance, or similar
  205  charges on a sliding scale related to income, except that the
  206  total annual aggregate cost-sharing with respect to all children
  207  in a family may not exceed 5 percent of the family’s income.
  208  However, copayments, deductibles, coinsurance, or similar
  209  charges may not be imposed for preventive services, including
  210  well-baby and well-child care, age-appropriate immunizations,
  211  and routine hearing and vision screenings.
  212         Section 4. This act shall take effect July 1, 2012.