Florida Senate - 2023                       CS for CS for SB 246
       
       
        
       By the Committee on Fiscal Policy; the Appropriations Committee
       on Health and Human Services; and Senators Calatayud, Perry,
       Osgood, and Rodriguez
       
       
       
       594-04101-23                                           2023246c2
    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 threshold for coverage under
    5         the Medikids program component; amending s. 409.814,
    6         F.S.; increasing the income eligibility threshold for
    7         coverage under the Florida Kidcare program; requiring
    8         an applicant seeking coverage under the program to
    9         provide certain documentation if eligibility cannot be
   10         verified using reliable data sources; amending s.
   11         409.816, F.S.; requiring that premiums for certain
   12         enrollees under the Florida Kidcare program be based
   13         on a tiered system of uniform premiums; amending s.
   14         624.91, F.S.; conforming a provision to changes made
   15         by the act; providing effective dates.
   16          
   17  Be It Enacted by the Legislature of the State of Florida:
   18  
   19         Section 1. Effective January 1, 2024, paragraph (a) of
   20  subsection (6) of section 409.8132, Florida Statutes, is amended
   21  to read:
   22         409.8132 Medikids program component.—
   23         (6) ELIGIBILITY.—
   24         (a) A child who has attained the age of 1 year but who is
   25  under the age of 5 years is eligible to enroll in the Medikids
   26  program component of the Florida Kidcare program, if the child
   27  is a member of a family that has a family income which exceeds
   28  the Medicaid applicable income level as specified in s. 409.903,
   29  but which is equal to or below 300 200 percent of the current
   30  federal poverty level. In determining the eligibility of such a
   31  child, an assets test is not required. A child who is eligible
   32  for Medikids may elect to enroll in Florida Healthy Kids
   33  coverage or employer-sponsored group coverage. However, a child
   34  who is eligible for Medikids may participate in the Florida
   35  Healthy Kids program only if the child has a sibling
   36  participating in the Florida Healthy Kids program and the
   37  child’s county of residence permits such enrollment.
   38         Section 2. Effective January 1, 2024, section 409.814,
   39  Florida Statutes, is amended to read:
   40         409.814 Eligibility.—A child who has not reached 19 years
   41  of age whose family income is equal to or below 300 200 percent
   42  of the federal poverty level is eligible for the Florida Kidcare
   43  program as provided in this section. If an enrolled individual
   44  is determined to be ineligible for coverage, he or she must be
   45  immediately disenrolled from the respective Florida Kidcare
   46  program component.
   47         (1) A child who is eligible for Medicaid coverage under s.
   48  409.903 or s. 409.904 must be enrolled in Medicaid and is not
   49  eligible to receive health benefits under any other health
   50  benefits coverage authorized under the Florida Kidcare program.
   51         (2) A child who is not eligible for Medicaid, but who is
   52  eligible for the Florida Kidcare program, may obtain health
   53  benefits coverage under any of the other components listed in s.
   54  409.813 if such coverage is approved and available in the county
   55  in which the child resides.
   56         (3) A Title XXI-funded child who is eligible for the
   57  Florida Kidcare program who is a child with special health care
   58  needs, as determined through a medical or behavioral screening
   59  instrument, is eligible for health benefits coverage from and
   60  shall be assigned to and may opt out of the Children’s Medical
   61  Services Network.
   62         (4) A Title XXI-funded child who reaches 19 years of age is
   63  eligible for continued Title XXI-funded coverage for the
   64  duration of a pregnancy and the postpartum period consisting of
   65  the 12-month period beginning on the last day of a pregnancy, if
   66  such pregnancy or postpartum period begins prior to the child
   67  reaching 19 years of age, and if the child is ineligible for
   68  Medicaid.
   69         (5) 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         (6) 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 (5)(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         (7) 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 (5) 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         (8) 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         (9) 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         (10) In determining the eligibility of a child, an assets
  164  test is not required. If eligibility for the Florida Kidcare
  165  program cannot be verified using reliable data sources in
  166  accordance with federal requirements, each applicant must shall
  167  provide documentation during the application process and the
  168  redetermination process, including, but not limited to, the
  169  following:
  170         (a) Proof of family income, which must be verified
  171  electronically to determine financial eligibility for the
  172  Florida Kidcare program. Written documentation, which may
  173  include wages and earnings statements or pay stubs, W-2 forms,
  174  or a copy of the applicant’s most recent federal income tax
  175  return, is required only if the electronic verification is not
  176  available or does not substantiate the applicant’s income.
  177         (b) A statement from all applicable, employed family
  178  members that:
  179         1. Their employers do not sponsor health benefit plans for
  180  employees;
  181         2. The potential enrollee is not covered by an employer
  182  sponsored health benefit plan; or
  183         3. The potential enrollee is covered by an employer
  184  sponsored health benefit plan and the cost of the employer
  185  sponsored health benefit plan is more than 5 percent of the
  186  family’s income.
  187         (c) To enroll in the Children’s Medical Services Network, a
  188  completed application, including a clinical screening.
  189         (11) Subject to paragraph (5)(a), the Florida Kidcare
  190  program shall withhold benefits from an enrollee if the program
  191  obtains evidence that the enrollee is no longer eligible,
  192  submitted incorrect or fraudulent information in order to
  193  establish eligibility, or failed to provide verification of
  194  eligibility. The applicant or enrollee must shall be notified
  195  that because of such evidence program benefits will be withheld
  196  unless the applicant or enrollee contacts a designated
  197  representative of the program by a specified date, which must be
  198  within 10 working days after the date of notice, to discuss and
  199  resolve the matter. The program shall make every effort to
  200  resolve the matter within a timeframe that will not cause
  201  benefits to be withheld from an eligible enrollee.
  202         (12) The following individuals may be subject to
  203  prosecution in accordance with s. 414.39:
  204         (a) An applicant obtaining or attempting to obtain benefits
  205  for a potential enrollee under the Florida Kidcare program when
  206  the applicant knows or should have known the potential enrollee
  207  does not qualify for the Florida Kidcare program.
  208         (b) An individual who assists an applicant in obtaining or
  209  attempting to obtain benefits for a potential enrollee under the
  210  Florida Kidcare program when the individual knows or should have
  211  known the potential enrollee does not qualify for the Florida
  212  Kidcare program.
  213         Section 3. Effective January 1, 2024, subsection (3) of
  214  section 409.816, Florida Statutes, is amended to read:
  215         409.816 Limitations on premiums and cost sharing.—The
  216  following limitations on premiums and cost sharing are
  217  established for the program.
  218         (3) Enrollees in families with a family income above 150
  219  percent of the federal poverty level who are not receiving
  220  coverage under the Medicaid program or who are not eligible
  221  under s. 409.814(7) may be required to pay enrollment fees,
  222  premiums, copayments, deductibles, coinsurance, or similar
  223  charges on a sliding scale related to income, except that the
  224  total annual aggregate cost sharing with respect to all children
  225  in a family may not exceed 5 percent of the family’s income.
  226  However, copayments, deductibles, coinsurance, or similar
  227  charges may not be imposed for preventive services, including
  228  well-baby and well-child care, age-appropriate immunizations,
  229  and routine hearing and vision screenings. Premiums for
  230  enrollees who are paying enrollment fees, premiums, copayments,
  231  deductibles, coinsurance, or similar charges as provided in this
  232  subsection must be based on at least three but no more than six
  233  tiers of uniform premiums that increase with each tier as a
  234  percentage of the applicable threshold amount of the federal
  235  poverty level, by tier.
  236         Section 4. Effective January 1, 2024, paragraph (b) of
  237  subsection (2) of section 624.91, Florida Statutes, is amended
  238  to read:
  239         624.91 The Florida Healthy Kids Corporation Act.—
  240         (2) LEGISLATIVE INTENT.—
  241         (b) It is the intent of the Legislature that the Florida
  242  Healthy Kids Corporation serve as one of several providers of
  243  services to children eligible for medical assistance under Title
  244  XXI of the Social Security Act. Although the corporation may
  245  serve other children, the Legislature intends the primary
  246  recipients of services provided through the corporation be
  247  school-age children with a family income equal to or below 300
  248  200 percent of the federal poverty level, who do not qualify for
  249  Medicaid. It is also the intent of the Legislature that state
  250  and local government Florida Healthy Kids funds be used to
  251  continue coverage, subject to specific appropriations in the
  252  General Appropriations Act, to children not eligible for federal
  253  matching funds under Title XXI.
  254         Section 5. Except as otherwise expressly provided in this
  255  act, this act shall take effect upon becoming a law.