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 Fiscal Policy
BILL: CS/CS/SB 246
INTRODUCER: Fiscal Policy Committee; Appropriations Committee on Health and Human Services;
Senator Calatayud and others
SUBJECT: Florida Kidcare Program Eligibility
DATE: April 21, 2023 REVISED:
ANALYST STAFF DIRECTOR REFERENCE ACTION
1. Stovall Brown HP Favorable
2. McKnight Money AHS Fav/CS
3. Stovall Yeatman FP Fav/CS
Please see Section IX. for Additional Information:
COMMITTEE SUBSTITUTE - Substantial Changes
I. Summary:
CS/CS/SB 246 raises the income eligibility limits for the subsidized MediKids, Florida Healthy
Kids, and Children’s Medical Services Network programs within the Florida Kidcare program
from 200 percent to 300 percent of the federal poverty level (FPL), effective January 1, 2024.
The bill requires the Florida Healthy Kids Corporation to establish new monthly premiums for
enrollees in households over 150 percent of the FPL and develop a minimum of three, but not
more than six, income-based tiers.
The bill has a significant negative fiscal impact to the Florida KidCare program. See Section V
of this analysis.
The bill takes effect upon becoming a law, except as otherwise expressly provided in the bill.
II. Present Situation:
The Florida KidCare (KidCare) program was established in 1998 as a combination of Medicaid
delivery systems and public and private partnerships, with a wrap-around delivery system
serving children with special health care needs.1 The KidCare program, codified in ss. 409.810
through 409.821, F.S., encompasses four government-sponsored health insurance programs
1
Chapter 1998-288, Laws of Fla.
BILL: CS/CS/SB 246 Page 2
serving Florida’s children: MediKids, Florida Healthy Kids (Healthy Kids), Children’s Medical
Services (CMS) Network, and Medicaid for children.2
Three of the four programs, MediKids, Healthy Kids, and CMS, directly receive federal
Children’s Health Insurance Program (CHIP) funding and constitute Florida’s CHIP program.
The CHIP was designed as a federal and state partnership, similar to Medicaid, with the goal of
expanding health insurance to children whose families earn too much income to be eligible for
Medicaid, but not enough money to purchase private, comprehensive health insurance. The
federal CHIP is authorized and funded through Fiscal Year 2029.3
CHIP funding is also used to enhance the match rate for some children in Medicaid. More
specifically:
 MediKids is a Medicaid “look-alike” program administered by the Agency for Health Care
Administration (AHCA) for children ages 1 through 4 who are at or below 200 percent of the
federal poverty level (FPL).4 Families whose income exceeds 200 percent of the FPL can
elect to participate in the MediKids full-pay premium option.5
 Healthy Kids is for children ages 5 through 18 and administered by the Florida Healthy Kids
Corporation (FHKC). Children in families with income between 133 percent and 200 percent
of the FPL ($33,383 and $50,200 for a family of four) are eligible for subsidized coverage
through the Healthy Kids program.6 Families whose income exceeds 200 percent of the FPL
can elect to participate in the Healthy Kids full-pay option.7
 Children’s Medical Services (CMS) Network is a program for children from birth through age
18 with special health care needs.8 The Department of Health (DOH) operates the program
which is open to all children who meet the clinical eligibility criteria that are Medicaid or
Title XXI eligible.9
 Medicaid eligibility is determined by the Department of Children and Families (DCF) and
provides Title XIX coverage to infants from birth to age 1 who are at or below 200 percent of
the FPL and children ages 1 through 18 who are at or below 133 percent of the FPL.10
Families who receive Medicaid are not responsible for paying premiums or co-payments.
Families with children that qualify for other KidCare program components are responsible for
paying monthly premiums and co-payments for certain services. The Healthy Kids program11
2
Florida KidCare, available at https://www.floridakidcare.org/ (last visited Mar. 13, 2023).
3
Consolidated Appropriations Act, 2023, Public Law No. 117-328 (2022).
4
Section 409.8132(6), F.S.
5
Agency for Health Care Administration, Florida KidCare, Welcome to MediKids,
https://ahca.myflorida.com/medicaid/Policy_and_Quality/Policy/program_policy/FLKidCare/PDF/FLORIDA_MEDIKIDS_I
NFORMATION_2019.pdf (last visited Mar. 13, 2023).
6
Florida Healthy Kids Corporation, Subsidized Premiums/Copays, https://www.healthykids.org/cost/subsidized/ (last visited
Mar. 13, 2023).
7
Id.
8
See ch. 391, F.S.
9
Id.
10
Florida Healthy Kids, Florida KidCare Health and Dental Insurance Program Eligibility Overview,
https://www.floridakidcare.org/_docs/Florida_KidCare_Income_Guidelines.pdf (last visited Mar. 13, 2023).
11
Chapter 2019-115, Laws of Fla., Specific Appropriation 178.
BILL: CS/CS/SB 246 Page 3
and the MediKids program12 both utilize a combined-risk premium model of Title XXI-
subsidized and full-pay enrollments for medical insurance payments.
The total monthly family payment for CHIP enrollees is $15 or $20 for families with incomes
between 133 percent and 200 percent of the FPL.13 The per-child monthly premium rate is
$210.18 for full-pay MediKids coverage and $259.50 for full-pay Healthy Kids coverage,
including dental coverage.14
As of March 2023, 4,883 children are enrolled in subsidized MediKids; 3,280 children are
enrolled in MediKids under the full-pay option; 76,340 children are enrolled in subsidized
Healthy Kids; 21,650 children are enrolled in Healthy Kids under the full-pay option; 6,575
children are enrolled in CMS; and 2,466,597 children are enrolled in the Medicaid program.15, 16
The following chart provides an eligibility overview of the KidCare program.17
12
Chapter 2020-111, Laws of Fla., Specific Appropriation 185.
13
Florida Healthy Kids Corporation, Florida KidCare Health and Dental Insurance Program Eligibility Overview,
https://www.floridakidcare.org/_docs/Florida_KidCare_Income_Guidelines.pdf (last visited Mar. 13, 2023).
14
Id.
15
Agency for Health Care Administration, Florida KidCare, Florida KidCare Enrollment Report, March 2023 (on file with
the Senate Appropriations Committee on Health and Human Services).
16
Florida KidCare program enrollment has been affected by federal Medicaid maintenance of effort (MOE) requirements
outlined in the Families First Coronavirus Response Act (Public Law No. 116-127). The Act provided for states to receive a
6.2% enhancement to the customary Medicaid Federal Medical Assistance Percentage (FMAP) for the duration of the federal
public health emergency (PHE). In return, states are required to provide continuous eligibility to Medicaid enrollees. This
Medicaid MOE requirement has resulted in a sharp enrollment decline in the Title XXI, KidCare programs. Children that
might have otherwise transferred to KidCare programs are required to remain in Medicaid. The Title XXI enrollment decline
is expected to reverse after the PHE ends and the MOE expires.
17
Florida KidCare, Program Eligibility Overview, available at
https://www.floridakidcare.org/_docs/Florida_KidCare_Income_Guidelines.pdf (last visited Mar. 29, 2023).
BILL: CS/CS/SB 246 Page 4
The KidCare program is jointly administered by the Agency for Health Care Administration, the
Florida Health Kids Corporation, the Department of Health, the Department of Children and
Families, and the Office of Insurance Regulation. The general KidCare program responsibilities
of each agency are outlined in the following table:
Entity Responsibilities
Agency for Health  Administration of the state Medicaid program that serves
Care Administration18 individuals eligible for Medicaid under Title XIX.
 Administration of the MediKids program that serves Title XXI
children from age 1 through age 4.
 The Title XXI state contact with the federal Centers for
Medicare & Medicaid Services.
 Distribution of federal funds for Title XXI programs.
 Management of the contract with the FHKC.
 Development and maintenance of the Title XXI Florida KidCare
State Plan.
Department of Children  Processing Medicaid applications and determining children’s
and Families19 eligibility for Medicaid.
Department of Health20  Administration of the CMSN that offers a range of services to
Title XIX and XXI children from birth through age 18 who have
special health care needs.
 Chair of the Florida KidCare Coordinating Council.
 In consultation with the FHKC and the DCF, establishment of a
toll-free telephone line to assist families with questions about the
program.
Florida Healthy Kids  Under a contract with the AHCA, perform the administrative
Corporation21 KidCare functions including eligibility determination, premium
billing and collection, refunds, and customer service.
 Administration of the Florida Healthy Kids program for Title
XXI children from age 5 through age 18.
Office of Insurance  Certification that health benefits coverage plans seeking to
Regulation22 provide services under the KidCare program, aside from services
provided under Healthy Kids and CMSN, meet, exceed, or are
equivalent to the benchmark benefit plan and that the health
insurance plans will be offered at an approved rate.
III. Effect of Proposed Changes:
Section 1 amends s. 409.8132, F.S., relating to eligibility for MediKids (age 1-4), to increase the
eligibility threshold from 200 percent to 300 percent of the Federal Poverty Limit (FPL),
effective January 1, 2024.
18
See part II of ch. 409, F.S.
19
Section 409.818(1), F.S.
20
See ch. 391 and s. 409.818(2), F.S.
21
Section 624.91, F.S.
22
Section 409.818(4), F.S.
BILL: CS/CS/SB 246 Page 5
Section 2 amends s. 409.814, F.S., relating to eligibility for Healthy Kids (age 5-18) and the
Children’s Medical Services Network (children with special health care needs), to increase the
eligibility threshold from 200 percent to 300 percent of the FPL, effective January 1, 2024.
The bill also provides that if the eligibility determination and redetermination for the KidCare
program cannot be verified using reliable data sources in accordance with federal requirements,
then the applicant must provide secondary sources of information.
Section 3 amends s. 409.816, F.S., relating to limitations on premiums and cost sharing in the
KidCare program to require that enrollment fees, premiums, copayments, deductibles,
coinsurance, or similar charges must be based on a minimum of three, but no more than six, tiers
of uniform premiums scaled to the FPL, by tier. This provision takes effect January 1, 2024.
Section 4 amends s. 624.91, F.S., relating to the Florida Healthy Kids Corporation, to conform
the increased eligibility thresholds to 300 percent of the FPL and is effective January 1, 2024.
Section 5 provides the bill takes effect upon becoming a law, except as otherwise expressly
provided in the bill.
IV. Constitutional Issues:
A. Municipality/County Mandates Restrictions:
None.
B. Public Records/Open Meetings Issues:
None.
C. Trust Funds Restrictions:
None.
D. State Tax or Fee Increases:
None.
E. Other Constitutional Issues:
None.
V. Fiscal Impact Statement:
A. Tax/Fee Issues:
None.
BILL: CS/CS/SB 246 Page 6
B. Private Sector Impact:
Increasing the eligibility threshold to 300 percent of the federal poverty level (FPL) will
convert a portion of current full-pay enrollees to the Children’s Health Insurance Program
(CHIP) subsidized payment category. Current CHIP full-pay enrollees with household
incomes between 200 to 300 percent FPL will experience lower monthly premium costs,
and new potential enrollees may find coverage less expensive compared to the current
CHIP full-pay structure and cost.
The bill amends the structure of household premiums for CHIP-subsidized KidCare.
Currently, the premium is $15 a month, per household, for households with incomes
between 133 to 158 percent FPL, and $20, per household, for households with incomes
between 158 to 200 percent FPL. Current law caps premiums for households with
incomes between 150 to 200 percent FPL to no more than five percent of the household’s
annual income.
The bill requires the Florida Healthy Kids Corporation (FHKC) to establish premium
tiers based on household income for all enrollees with household incomes over 150
percent FPL. The bill’s requirement applies both to current enrollees at 150 to 200
percent FPL and to the new eligibility group at 200 to 300 percent FPL. The FHKC must
establish at least three, but no more than six, tiers of premiums.
The bill does not address copays for the new eligibility group or amend them for existing
eligibility groups.
According to the 2021 U.S. Census Report, 68,455 Florida children have household
incomes between 200.01 to 300 percent of the FPL and have no health insurance
coverage.23
C. Government Sector Impact:
Mercer Government Human Services Consulting (Mercer) conducted an actuarial
analysis dated March 22, 2023, on behalf of the Florida Healthy Kids Corporation
(FHKC), to support discussion of increasing the KidCare program’s income eligibility
upper income limit for the CHIP program.24
For Fiscal Year 2023-2024, the bill is estimated to increase state expenditures by $22.2
million, of which $6.5 million is from general revenue funds. The Florida Healthy Kids
Corporation (FHKC) projects 18,575 additional children will enroll.25
 Mercer estimates that the bill’s implementation will result in recurring expenditures
to the Florida KidCare program of $19.4 million, of which $5.7 million is from
23
Florida Healthy Kids Corporation, SB 246 Bill Analysis (Mar. 7, 2023) (on file with the Senate Appropriations Committee
on Health and Human Services).
24
Email from Florida Healthy Kids Corporation to the Senate Appropriations Committee on Health and Human Services
(Apr. 10, 2023) (on file with the Senate Appropriations Committee on Health and Human Services).
25
Id.
BILL: CS/CS/SB 246 Page 7
general revenue funds. Recurring expenditures are projected to increase in out years,
as more eligible children obtain coverage in the KidCare program.26
 The Florida KidCare eligibility system’s third-party administrator has estimated the
programming changes required to comply with the provisions of the bill will result in
$800,000 one-year nonrecurring expenditures, of which approximately $235,424 is
from