Florida Senate - 2021                                    SB 1244
       By Senator Book
       32-01087A-21                                          20211244__
    1                        A bill to be entitled                      
    2         An act relating to Florida Kidcare program
    3         eligibility; amending s. 409.8132, F.S.; increasing
    4         the income eligibility limit for coverage under the
    5         Florida Kidcare program; amending s. 409.814, F.S.;
    6         increasing the income eligibility limit for coverage
    7         under the Florida Kidcare program; requiring
    8         applicants to provide specified documentation if the
    9         Florida Kidcare program is unable to verify
   10         eligibility according to federal requirements;
   11         amending s. 624.91, F.S.; increasing the income
   12         eligibility limit for coverage under the Florida
   13         Kidcare program; authorizing the Agency for Health
   14         Care Administration to seek federal waiver approval or
   15         submit state plan amendments as necessary; requiring
   16         the agency to examine graduated family contribution
   17         rates for newly qualifying families under the Kidcare
   18         program; providing guidelines for such rates;
   19         providing legislative intent; requiring the agency to
   20         increase the income eligibility limit for coverage
   21         under the Kidcare program each fiscal year until
   22         meeting a specified income limit; providing an
   23         effective date.
   25  Be It Enacted by the Legislature of the State of Florida:
   27         Section 1. Paragraph (a) of subsection (6) of section
   28  409.8132, Florida Statutes, is amended to read:
   29         409.8132 Medikids program component.—
   30         (6) ELIGIBILITY.—
   31         (a) A child who has attained the age of 1 year but who is
   32  under the age of 5 years is eligible to enroll in the Medikids
   33  program component of the Florida Kidcare program, if the child
   34  is a member of a family that has a family income which exceeds
   35  the Medicaid applicable income level as specified in s. 409.903,
   36  but which is equal to or below 300 200 percent of the current
   37  federal poverty level. In determining the eligibility of such a
   38  child, an assets test is not required. A child who is eligible
   39  for Medikids may elect to enroll in Florida Healthy Kids
   40  coverage or employer-sponsored group coverage. However, a child
   41  who is eligible for Medikids may participate in the Florida
   42  Healthy Kids program only if the child has a sibling
   43  participating in the Florida Healthy Kids program and the
   44  child’s county of residence permits such enrollment.
   45         Section 2. Section 409.814, Florida Statutes, is amended to
   46  read:
   47         409.814 Eligibility.—A child who has not reached 19 years
   48  of age whose family income is equal to or below 300 200 percent
   49  of the federal poverty level is eligible for the Florida Kidcare
   50  program as provided in this section. If an enrolled individual
   51  is determined to be ineligible for coverage, he or she must be
   52  immediately disenrolled from the respective Florida Kidcare
   53  program component.
   54         (1) A child who is eligible for Medicaid coverage under s.
   55  409.903 or s. 409.904 must be enrolled in Medicaid and is not
   56  eligible to receive health benefits under any other health
   57  benefits coverage authorized under the Florida Kidcare program.
   58         (2) A child who is not eligible for Medicaid, but who is
   59  eligible for the Florida Kidcare program, may obtain health
   60  benefits coverage under any of the other components listed in s.
   61  409.813 if such coverage is approved and available in the county
   62  in which the child resides.
   63         (3) A Title XXI-funded child who is eligible for the
   64  Florida Kidcare program who is a child with special health care
   65  needs, as determined through a medical or behavioral screening
   66  instrument, is eligible for health benefits coverage from and
   67  shall be assigned to and may opt out of the Children’s Medical
   68  Services Network.
   69         (4) The following children are not eligible to receive
   70  Title XXI-funded premium assistance for health benefits coverage
   71  under the Florida Kidcare program, except under Medicaid if the
   72  child would have been eligible for Medicaid under s. 409.903 or
   73  s. 409.904 as of June 1, 1997:
   74         (a) A child who is covered under a family member’s group
   75  health benefit plan or under other private or employer health
   76  insurance coverage, if the cost of the child’s participation is
   77  not greater than 5 percent of the family’s income. If a child is
   78  otherwise eligible for a subsidy under the Florida Kidcare
   79  program and the cost of the child’s participation in the family
   80  member’s health insurance benefit plan is greater than 5 percent
   81  of the family’s income, the child may enroll in the appropriate
   82  subsidized Kidcare program.
   83         (b) A child who is seeking premium assistance for the
   84  Florida Kidcare program through employer-sponsored group
   85  coverage, if the child has been covered by the same employer’s
   86  group coverage during the 60 days before the family submitted an
   87  application for determination of eligibility under the program.
   88         (c) A child who is an alien but who does not meet the
   89  definition of a lawfully residing child. This paragraph does not
   90  extend eligibility for the Florida Kidcare program to an
   91  undocumented immigrant.
   92         (d) A child who is an inmate of a public institution or a
   93  patient in an institution for mental diseases.
   94         (e) A child who is otherwise eligible for premium
   95  assistance for the Florida Kidcare program and has had his or
   96  her coverage in an employer-sponsored or private health benefit
   97  plan voluntarily canceled in the last 60 days, except those
   98  children whose coverage was voluntarily canceled for good cause,
   99  including, but not limited to, the following circumstances:
  100         1. The cost of participation in an employer-sponsored
  101  health benefit plan is greater than 5 percent of the family’s
  102  income;
  103         2. The parent lost a job that provided an employer
  104  sponsored health benefit plan for children;
  105         3. The parent who had health benefits coverage for the
  106  child is deceased;
  107         4. The child has a medical condition that, without medical
  108  care, would cause serious disability, loss of function, or
  109  death;
  110         5. The employer of the parent canceled health benefits
  111  coverage for children;
  112         6. The child’s health benefits coverage ended because the
  113  child reached the maximum lifetime coverage amount;
  114         7. The child has exhausted coverage under a COBRA
  115  continuation provision;
  116         8. The health benefits coverage does not cover the child’s
  117  health care needs; or
  118         9. Domestic violence led to loss of coverage.
  119         (5) A child who is otherwise eligible for the Florida
  120  Kidcare program and who has a preexisting condition that
  121  prevents coverage under another insurance plan as described in
  122  paragraph (4)(a) which would have disqualified the child for the
  123  Florida Kidcare program if the child were able to enroll in the
  124  plan is eligible for Florida Kidcare coverage when enrollment is
  125  possible.
  126         (6) A child whose family income is above 300 200 percent of
  127  the federal poverty level or a child who is excluded under the
  128  provisions of subsection (4) may participate in the Florida
  129  Kidcare program as provided in s. 409.8132 or, if the child is
  130  ineligible for Medikids by reason of age, in the Florida Healthy
  131  Kids program, subject to the following:
  132         (a) The family is not eligible for premium assistance
  133  payments and must pay the full cost of the premium, including
  134  any administrative costs.
  135         (b) The board of directors of the Florida Healthy Kids
  136  Corporation may offer a reduced benefit package to these
  137  children in order to limit program costs for such families.
  138         (7) Once a child is enrolled in the Florida Kidcare
  139  program, the child is eligible for coverage for 12 months
  140  without a redetermination or reverification of eligibility, if
  141  the family continues to pay the applicable premium. Eligibility
  142  for program components funded through Title XXI of the Social
  143  Security Act terminates when a child attains the age of 19. A
  144  child who has not attained the age of 5 and who has been
  145  determined eligible for the Medicaid program is eligible for
  146  coverage for 12 months without a redetermination or
  147  reverification of eligibility.
  148         (8) When determining or reviewing a child’s eligibility
  149  under the Florida Kidcare program, the applicant shall be
  150  provided with reasonable notice of changes in eligibility which
  151  may affect enrollment in one or more of the program components.
  152  If a transition from one program component to another is
  153  authorized, there shall be cooperation between the program
  154  components and the affected family which promotes continuity of
  155  health care coverage. Any authorized transfers must be managed
  156  within the program’s overall appropriated or authorized levels
  157  of funding. Each component of the program shall establish a
  158  reserve to ensure that transfers between components will be
  159  accomplished within current year appropriations. These reserves
  160  shall be reviewed by each convening of the Social Services
  161  Estimating Conference to determine the adequacy of such reserves
  162  to meet actual experience.
  163         (9) In determining the eligibility of a child, an assets
  164  test is not required. If the Florida Kidcare program is unable
  165  to verify eligibility through reliable data sources according to
  166  federal requirements, each applicant shall provide documentation
  167  during the application process and the redetermination process,
  168  including, but not limited to, the following:
  169         (a) Proof of family income, which must be verified
  170  electronically to determine financial eligibility for the
  171  Florida Kidcare program. Written documentation, which may
  172  include wages and earnings statements or pay stubs, W-2 forms,
  173  or a copy of the applicant’s most recent federal income tax
  174  return, is required only if the electronic verification is not
  175  available or does not substantiate the applicant’s income.
  176         (b) A statement from all applicable, employed family
  177  members that:
  178         1. Their employers do not sponsor health benefit plans for
  179  employees;
  180         2. The potential enrollee is not covered by an employer
  181  sponsored health benefit plan; or
  182         3. The potential enrollee is covered by an employer
  183  sponsored health benefit plan and the cost of the employer
  184  sponsored health benefit plan is more than 5 percent of the
  185  family’s income.
  186         (c) To enroll in the Children’s Medical Services Network, a
  187  completed application, including a clinical screening.
  188         (10) Subject to paragraph (4)(a), the Florida Kidcare
  189  program shall withhold benefits from an enrollee if the program
  190  obtains evidence that the enrollee is no longer eligible,
  191  submitted incorrect or fraudulent information in order to
  192  establish eligibility, or failed to provide verification of
  193  eligibility. The applicant or enrollee shall be notified that
  194  because of such evidence program benefits will be withheld
  195  unless the applicant or enrollee contacts a designated
  196  representative of the program by a specified date, which must be
  197  within 10 working days after the date of notice, to discuss and
  198  resolve the matter. The program shall make every effort to
  199  resolve the matter within a timeframe that will not cause
  200  benefits to be withheld from an eligible enrollee.
  201         (11) The following individuals may be subject to
  202  prosecution in accordance with s. 414.39:
  203         (a) An applicant obtaining or attempting to obtain benefits
  204  for a potential enrollee under the Florida Kidcare program when
  205  the applicant knows or should have known the potential enrollee
  206  does not qualify for the Florida Kidcare program.
  207         (b) An individual who assists an applicant in obtaining or
  208  attempting to obtain benefits for a potential enrollee under the
  209  Florida Kidcare program when the individual knows or should have
  210  known the potential enrollee does not qualify for the Florida
  211  Kidcare program.
  212         Section 3. Paragraph (b) of subsection (2) of section
  213  624.91, Florida Statutes, is amended to read:
  214         624.91 The Florida Healthy Kids Corporation Act.—
  215         (2) LEGISLATIVE INTENT.—
  216         (b) It is the intent of the Legislature that the Florida
  217  Healthy Kids Corporation serve as one of several providers of
  218  services to children eligible for medical assistance under Title
  219  XXI of the Social Security Act. Although the corporation may
  220  serve other children, the Legislature intends the primary
  221  recipients of services provided through the corporation be
  222  school-age children with a family income below 300 200 percent
  223  of the federal poverty level, who do not qualify for Medicaid.
  224  It is also the intent of the Legislature that state and local
  225  government Florida Healthy Kids funds be used to continue
  226  coverage, subject to specific appropriations in the General
  227  Appropriations Act, to children not eligible for federal
  228  matching funds under Title XXI.
  229         Section 4. (1)The Agency for Health Care Administration
  230  may seek federal waiver approval or submit any state plan
  231  amendments necessary to implement this act.
  232         (2)Subject to federal waiver approval and in accordance
  233  with the cost containment goals for the Florida Kidcare program
  234  and for the state, the agency shall examine graduated family
  235  contribution rates for newly qualifying families under the
  236  Florida Kidcare program which are consistent with the existing
  237  standard established under the Children’s Health Insurance
  238  Program (CHIP) as follows:
  239         (a)For a child or children whose family has an income
  240  between 200 and 250 percent of the federal poverty level, a
  241  contribution rate of at least $30 per month per family.
  242         (b)For a child or children whose family has an income
  243  between 250 and 300 percent of the federal poverty level, a
  244  contribution rate of at least $40 per month per family.
  245         (3)The Legislature intends for the graduated family
  246  contribution rates provided in subsection (2) to be in addition
  247  to the existing contribution rates of $15 per month per family
  248  for a child whose family has an income between 138 and 158
  249  percent of the federal poverty level and $20 per month per
  250  family for a child whose family has an income between 158 and
  251  215 percent of the federal poverty level, allowing the state to
  252  attain additional cost savings for the expansion of the Florida
  253  Kidcare program and to attain the federal Centers for Medicare
  254  and Medicaid Services’ stated goals for CHIP to expand coverage
  255  and health care access for uninsured or underinsured children.
  256         (4)Subject to federal waiver approval, the agency shall
  257  increase the income eligibility limit for coverage under the
  258  Florida Kidcare program to 220 percent of the federal poverty
  259  level for the 2021-2022 fiscal year, and shall increase the
  260  income eligibility limit by 20 percent each fiscal year
  261  thereafter until meeting an income eligibility limit of 300
  262  percent of the federal poverty level as required by this act.
  263         Section 5. This act shall take effect July 1, 2021.