The Florida Senate
BILL ANALYSIS AND FISCAL IMPACT STATEMENT
(This document is based on the provisions contained in the legislation as of the latest date listed below.)
Prepared By: The Professional Staff of the Committee on Appropriations
BILL: CS/SB 1526
INTRODUCER: Children, Families, and Elder Affairs Committee and Senator Garcia
SUBJECT: Medicaid Coverage for Former Foster Youth
DATE: April 14, 2021 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Preston Cox CF Fav/CS
2. Sneed Kidd AHS Recommend: Favorable
3. Sneed Sadberry AP Favorable
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/SB 1526 makes a number of changes to the law relating to Medicaid coverage for young
adults who have aged out of foster care. The bill requires the Department of Children and
Families (DCF) to develop a program to facilitate enrollment of young adults formerly in out-of-
home care in Medicaid.
The bill authorizes the DCF to coordinate with a community-based care lead agency in
implementing the program and requires specified outreach services that must be included in the
program.
The bill revises eligibility for Medicaid coverage for specified young adults formerly eligible for
foster care to provide that a young adult who as a child was eligible under Title IV-E of the
Social Security Act for foster care or state-provided foster care and was living in out-of-home
care in Florida on his or her 18th birthday remains eligible until the young adult reaches 26 years
of age. There is no income, resource, or categorical limit for eligibility that is otherwise required
to be in compliance with federal law.
The bill may have an indeterminate negative fiscal impact on state government. See Section V.
Fiscal Impact Statement.
The bill takes effect July 1, 2021.
BILL: CS/SB 1526 Page 2
II. Present Situation:
Medicaid
Medicaid, authorized in Title XIX of the Social Security Act (SSA), is a state administered
federal program that jointly finances medical and related services to a diverse low-income
population.1 To be eligible for Medicaid, individuals must meet both categorical2 and financial3
criteria in addition to requirements regarding residency, immigration status, and U.S.
citizenship.4 For some eligibility groups or pathways, state coverage is mandatory, while for
others it is optional. States and territories must submit a state plan to the federal government to
describe how they will carry out their Medicaid programs within the federal statute’s
framework.5
As the Medicaid agency for the state, as provided under federal law, Medicaid services in Florida
are administered by the Agency for Health Care Administration (AHCA). Medicaid eligibility in
Florida is determined by either the Department of Children and Families (DCF) or the Social
Security Administration for Supplemental Security Income (SSI)6 recipients. The DCF
determines Medicaid eligibility for:
Parents and caretaker relatives of children;
Children;
Pregnant women;
Former Foster Care Individuals;
Non-citizens with medical emergencies; and
Aged or disabled individuals not currently receiving SSI.7
Children in Out-of-Home Care
The Foster Care, Prevention, and Permanency program, authorized in Title IV-E of the SSA, is a
federal-state program that, among other things, jointly finances foster care for children who a
state determines cannot safely remain in their homes and who meet federal eligibility rules
related to being removed from a low-income household and other factors. The program also
provides some support for services to assist older children in foster care and those who age out of
foster care in making a successful transition to adulthood. The Administration for Children and
Families (ACF) at the U.S. Department of Health and Human Services (HHS) administers the
Title IV-E program.8
1
Medicaid.gov, Medicaid, available at https://www.medicaid.gov/medicaid/index.html (last visited March 6, 2021).
2
Categories include the elderly, children, or pregnant women.
3
These include income and assets.
4
Medicaid.gov, Eligibility, available at https://www.medicaid.gov/medicaid/eligibility/index.html (last visited March 6,
2021).
5
Congressional Research Service, Medicaid Coverage for Former Foster Youth Up to Age 26, October 26, 2018, available at
https://fas.org/sgp/crs/misc/IF11010.pdf (last visited March 5, 2021) (hereinafter cited as “CRS Medicaid for Foster Youth”).
6
Supplemental Security Income (SSI) is a federal income supplement program funded by general tax revenues (not Social
Security taxes). The program is designed to help aged, blind, and disabled people, who have little or no income and it
provides cash to meet basic needs for food, clothing, and shelter.
7
The DCF, ACCESS Program, Medicaid, available at https://www.myflfamilies.com/service-
programs/access/medicaid.shtml (last visited March 5, 2021).
8
CRS Medicaid for Foster Youth.
BILL: CS/SB 1526 Page 3
While in foster care, nearly all children are eligible for Medicaid under mandatory eligibility
pathways. This means that states must provide coverage because these children receive
assistance under the Title IV-E foster care program, are disabled, or meet other eligibility
criteria. Under the Title IV-E program, states are required to inform foster youth within 90 days
prior to emancipation about their future options for health care. Title IV-E also directs states to
provide these youth with health information and official documentation that they were previously
in care. Such documentation may be necessary to determine eligibility for some former foster
youth who later apply for Medicaid.9
Current law requires the AHCA to make payments for medical assistance and related services on
behalf of individuals who the department, or the Social Security Administration by contract with
the DCF, determines to be eligible, subject to the income, assets, and categorical eligibility tests
set forth in federal and state law. Payment on behalf of these Medicaid eligible persons is subject
to the availability of moneys and any limitations established by the General Appropriations Act
or ch. 216, F.S.10 These individuals include a child who is eligible under Title IV-E of the Social
Security Act for subsidized board payments, foster care, or adoption subsidies, and a child for
whom the state has assumed temporary or permanent responsibility and who does not qualify for
Title IV-E assistance but is in foster care, shelter or emergency shelter care, or subsidized
adoption. This category includes:
A young adult who is eligible to receive services under s. 409.1451, F.S., until the young
adult reaches 21 years of age, without regard to any income, resource, or categorical
eligibility test that is otherwise required.
A person who as a child was eligible under Title IV-E of the Social Security Act for foster
care or the state-provided foster care and who is a participant in the Road-to-Independence
Program.
A child who is eligible for the Guardianship Assistance Program as provided in s. 39.6225,
F.S.11
Young Adults Formerly in Out-of-Home Care
The Medicaid pathway for former foster youth is intended to provide necessary health supports
in the years immediately after leaving foster care.12 The Patient Protection and Affordable Care
Act (ACA)13 authorizes Medicaid for an individual up to age 26 if they were in foster care and
receiving Medicaid when they aged out of foster care at the age of 18 or older. It parallels
another ACA requirement that health insurance companies provide coverage of children up to
age 26 under their parents’ private health care plans. There is no income limit for eligibility and
the young adult must not be eligible for another Medicaid coverage type. However, the
individual must apply for this coverage through the DCF’s ACCESS Florida.14
9
Id.
10
Section 409.903, F.S.
11
Section 409.903(4), F.S.
12
CRS Medicaid for Foster Youth.
13
See Pub. L. 111-148.
14
The DCF, CFOP 170-15, Chapter 2 Medicaid, 2-9.a., available at
https://www.myflfamilies.com/admin/publications/cfops/CFOP%20170-xx%20Child%20Welfare/CFOP%20170-
BILL: CS/SB 1526 Page 4
Prior to reaching age 21, if the young adult has an open supervision case or upon request of a
young adult, child welfare staff must:15
Assist the young adult in applying for Medicaid under this coverage group.
Ensure that the young adult retains continuity of medical care and has a Medicaid card.
A review of continued Medicaid eligibility must be completed at least once every 12 months, or
sooner if the child’s circumstances change. The criteria for recertification remain the same as for
the initial Medicaid eligibility determination. In all cases, Medicaid for non-Title IV-E eligible
children must be authorized for 12 months. All factors relating to eligibility are reevaluated at
each recertification.16
III. Effect of Proposed Changes:
Currently, the DCF or the community-based lead agency is required to document that young
adults who were formerly in out-of-home care are enrolled in Medicaid under s. 409.903(4),
F.S.17 The bill directs the DCF to develop a program to facilitate enrollment of these young
adults into the Medicaid program. The DCF is required to provide outreach and technical
assistance that includes:
Notifying eligible or prospectively eligible young adults, caregivers, group homes, and
residential programs about the eligibility and options for enrollment.
Providing technical assistance to eligible young adults in enrolling.
Publicizing options for Medicaid enrollment for young adults who have lived in foster care.
The bill also amends s. 409.903(4), F.S., to conform the statute to federal law and existing
Florida Medicaid rules, which require state Medicaid programs to extend eligibility for former
foster care youth to the age of 26, without regard to any income, resource, or categorical
eligibility test that is otherwise required in order to be in compliance with federal law.
The bill takes effect July 1, 2021.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
15%20%20Federal%20and%20State%20Funding%20Eligibility/CFOP%20170-
15,%20%20Chapter%2002,%20Medicaid.pdf (last visited March 6, 2021).
15
Id. Medicaid 2-9 b.
16
The DCF, CFOP 170-15, Chapter 2 Medicaid, 2-14 a.
17
Section 409.1451(10), F.S.
BILL: CS/SB 1526 Page 5
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None identified.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
B. Private Sector Impact:
None.
C. Government Sector Impact:
CS/SB 1526 has an indeterminate negative fiscal impact on state government.
The DCF projects one-time costs to make the necessary technological updates to the
Florida Safe Families Network (FSFN) and ACCESS Florida systems. 18 However,
because the costs are projected to be minimal, the DCF would likely be able to absorb the
costs within existing department resources.
The ACHA states that the bill poses no operational costs for the department.19 The
AHCA also provides that since former foster care youth are currently eligible for
Medicaid coverage until age 26 as mandated by federal law, the bill codifies in statute to
align with what is currently covered under Florida Medicaid. However, the AHCA states
that the program to assist enrollment of former foster youth in Medicaid may result in an
indeterminate increase in the number of Medicaid enrollees.20
VI. Technical Deficiencies:
None.
18
DCF, 2021 Agency Legislative Bill Analysis, SB 1526 (on file with the Senate Appropriations Subcommittee on Health and
Human Services).
19
ACHA, 2021 Agency Legislative Bill Analysis, SB 1526 (on file with the Senate Committee on Children, Families, and
Elder Affairs).
20
Id.
BILL: CS/SB 1526 Page 6
VII. Related Issues:
None.
VIII. Statutes Affected:
This bill substantially amends the following sections of the Florida Statutes: 409.1451 and
409.903.
IX. Additional Information:
A. Committee Substitute – Statement of Substantial Changes:
(Summarizing differences between the Committee Substitute and the prior version of the bill.)
CS by Children, Families, and Elder Affairs on March 9, 2021:
The committee substitute revises eligibility for Medicaid coverage for specified young
adults formerly eligible for foster care and who was living in out-of-home care in Florida
on his or her 18th birthday remains eligible until the young adult reaches 26 years of age,
without regard to any income, resource, or categorical eligibility test that is otherwise
required in order to be in compliance with federal law.
B. Amendments:
None.
This Senate Bill Analysis does not reflect the intent or official position of the bill’s introducer or the Florida Senate.
Statutes affected: S 1526 Filed: 409.1451, 409.903
S 1526 c1: 409.1451, 409.903