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. 24 25 Be It Enacted by the Legislature of the State of Florida: 26 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
200percent 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 200percent 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 200percent 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 200percent 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.