F L O R I D A H O U S E O F R E P R E S E N T A T I V E S
HB 1245 2023
1 A bill to be entitled
2 An act relating to Florida Kidcare program income
3 eligibility; creating s. 409.8141, F.S.; establishing
4 a tiered system of family premiums for Title-XXI
5 coverage under the Florida Kidcare program beginning
6 on a specified date; authorizing the Agency for Health
7 Care Administration to seek federal waiver approval or
8 submit any state plan amendments as necessary;
9 amending ss. 409.8132, 409.814, and 624.91, F.S.;
10 increasing the income eligibility threshold for
11 coverage under the program to conform to changes made
12 by the act; providing that specified amendments are
13 subject to federal approval; requiring the agency to
14 notify the Division of Law Revision within a specifie d
15 timeframe after receiving federal approval through a
16 waiver or state plan amendment; providing an effective
17 date.
18
19 Be It Enacted by the Legislature of the State of Florida:
20
21 Section 1. Section 409.8141, Florida Statutes, is created
22 to read:
23 409.8141 Tiered system of family premiums for Title-XXI
24 coverage under the Florida Kidcare program.—
25 (1) Beginning January 1, 2024, and subject to federal
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26 approval through a waiver or a state plan amendment, the
27 following tiered system of family premiums for Title-XXI
28 coverage under the Florida Kidcare program shall apply:
29 (a) For a child whose family has an income from 200.01
30 through 240 percent of the federal poverty level, a uniform
31 premium calculated by using the average household size in this
32 state multiplied by 1 percent of the highest potential income
33 within this range.
34 (b) For a child whose family has an income from 240.01
35 through 280 percent of the federal poverty level, a uniform
36 premium calculated by using the average household size in this
37 state multiplied by 1.5 percent of the highest potential income
38 within this range.
39 (c) For a child whose family has an income from 280.01
40 through 320 percent of the federal poverty level, a uniform
41 premium calculated by using the average household size in this
42 state multiplied by 2 percent of the highest potential income
43 within this range.
44 (d) For a child whose family has an income from 320.01
45 through 360 percent of the federal poverty level, a uniform
46 premium calculated by using the average household size in this
47 state multiplied by 2.5 percent of the highest potential income
48 within this range.
49 (e) For a child whose family has an income from 360.01
50 through 400 percent of the federal poverty level, a uniform
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51 premium calculated by using the average household size in this
52 state multiplied by 3 percent of the highest potential income
53 within this range.
54 (2) The agency may seek federal waiver approval or submit
55 any state plan amendments necessary to implement this section.
56 Section 2. Paragraph (a) of subsection (6) of section
57 409.8132, Florida Statutes, is amended to read:
58 409.8132 Medikids program component.—
59 (6) ELIGIBILITY.—
60 (a) A child who has attained the age of 1 year but who is
61 under the age of 5 years is eligible to enroll in the Medikids
62 program component of the Florida Kidcare program, if the child
63 is a member of a family that has a family income which exceeds
64 the Medicaid applicable income level as specified in s. 409.903,
65 but which is equal to or below 400 200 percent of the current
66 federal poverty level. In determining the eligibility of such a
67 child, an assets test is not required. A child who is eligible
68 for Medikids may elect to enroll in Florida Healthy Kids
69 coverage or employer-sponsored group coverage. However, a child
70 who is eligible for Medikids may participate in the Florida
71 Healthy Kids program only if the child has a sibling
72 participating in the Florida Healthy Kids program and the
73 child's county of residence permits such enrollment.
74 Section 3. Section 409.814, Florida Statutes, is amended
75 to read:
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76 409.814 Eligibility.—A child who has not reached 19 years
77 of age whose family income is equal to or below 400 200 percent
78 of the federal poverty level is eligible for the Florida Kidcare
79 program as provided in this section. If an enrolled individual
80 is determined to be ineligible for coverage, he or she must be
81 immediately disenrolled from the respective Florida Kidcare
82 program component.
83 (1) A child who is eligible for Medicaid coverage under s.
84 409.903 or s. 409.904 must be enrolled in Medicaid and is not
85 eligible to receive health benefits under any other health
86 benefits coverage authorized under the Florida Kidcare program.
87 (2) A child who is not eligible for Medicaid, but who is
88 eligible for the Florida Kidcare program, may obtain health
89 benefits coverage under any of the other components listed in s.
90 409.813 if such coverage is approved and available in the county
91 in which the child resides.
92 (3) A Title XXI-funded child who is eligible for the
93 Florida Kidcare program who is a child with special health care
94 needs, as determined through a medical or behavioral screening
95 instrument, is eligible for health benefits coverage from and
96 shall be assigned to and may opt out of the Children's Medical
97 Services Network.
98 (4) A Title XXI-funded child who reaches 19 years of age
99 is eligible for continued Title XXI-funded coverage for the
100 duration of a pregnancy and the postpartum period consisting of
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101 the 12-month period beginning on the last day of a pregnancy, if
102 such pregnancy or postpartum period begins prior to the child
103 reaching 19 years of age, and if the child is ineligible for
104 Medicaid.
105 (5) The following children are not eligible to receive
106 Title XXI-funded premium assistance for health benefits coverage
107 under the Florida Kidcare program, except under Medicaid if the
108 child would have been eligible for Medicaid under s. 409.903 or
109 s. 409.904 as of June 1, 1997:
110 (a) A child who is covered under a family member's group
111 health benefit plan or under other private or employer health
112 insurance coverage, if the cost of the child's participation is
113 not greater than 5 percent of the family's income. If a child is
114 otherwise eligible for a subsidy under the Florida Kidcare
115 program and the cost of the child's participation in the family
116 member's health insurance benefit plan is greater than 5 percent
117 of the family's income, the child may enroll in the appropriate
118 subsidized Kidcare program.
119 (b) A child who is seeking premium assistance for the
120 Florida Kidcare program through employer-sponsored group
121 coverage, if the child has been covered by the same employer's
122 group coverage during the 60 days before the family submitted an
123 application for determination of eligibility under the program.
124 (c) A child who is an alien but who does not meet the
125 definition of a lawfully residing child. This paragraph does not
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126 extend eligibility for the Florida Kidcare program to an
127 undocumented immigrant.
128 (d) A child who is an inmate of a public institution or a
129 patient in an institution for mental diseases.
130 (e) A child who is otherwise eligible for premium
131 assistance for the Florida Kidcare program and has had his or
132 her coverage in an employer-sponsored or private health benefit
133 plan voluntarily canceled in the last 60 days, except those
134 children whose coverage was voluntarily canceled for good cause,
135 including, but not limited to, the following circumstances:
136 1. The cost of participation in an employer-sponsored
137 health benefit plan is greater than 5 percent of the family's
138 income;
139 2. The parent lost a job that provided an employer -
140 sponsored health benefit plan for children;
141 3. The parent who had health benefits coverage for the
142 child is deceased;
143 4. The child has a medical condition that, without medical
144 care, would cause serious disability, loss of function, or
145 death;
146 5. The employer of the parent canceled health benefits
147 coverage for children;
148 6. The child's health benefits coverage ended because the
149 child reached the maximum lifetime coverage amount;
150 7. The child has exhausted coverage under a COBRA
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151 continuation provision;
152 8. The health benefits coverage does not cover the child's
153 health care needs; or
154 9. Domestic violence led to loss of coverage.
155 (6) A child who is otherwise eligible for the Florida
156 Kidcare program and who has a preexisting condition that
157 prevents coverage under another insurance plan as described in
158 paragraph (5)(a) which would have disqualified the child for the
159 Florida Kidcare program if the child were able to enroll in the
160 plan is eligible for Florida Kidcare coverage when enrollment is
161 possible.
162 (7) A child whose family income is above 400 200 percent
163 of the federal poverty level or a child who is excluded under
164 the provisions of subsection (5) may participate in the Florida
165 Kidcare program as provided in s. 409.8132 or, if the child is
166 ineligible for Medikids by reason of age, in the Florida Healthy
167 Kids program, subject to the following:
168 (a) The family is not eligible for premium assistance
169 payments and must pay the full cost of the premium, including
170 any administrative costs.
171 (b) The board of directors of the Florida Healthy Kids
172 Corporation may offer a reduced benefit package to these
173 children in order to limit program costs for such families.
174 (8) Once a child is enrolled in the Florida Kidcare
175 program, the child is eligible for coverage for 12 months
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176 without a redetermination or reverification of eligibility, if
177 the family continues to pay the applicable premium. Eligibility
178 for program components funded through Title XXI of the Social
179 Security Act terminates when a child attains the age of 19. A
180 child who has not attained the age of 5 and who has been
181 determined eligible for the Medicaid program is eligible for
182 coverage for 12 months without a redetermination or
183 reverification of eligibility.
184 (9) When determining or reviewing a child's eligibility
185 under the Florida Kidcare program, the applicant shall be
186 provided with reasonable notice of changes in eligibility which
187 may affect enrollment in one or more of the program components.
188 If a transition from one program component to another is
189 authorized, there shall be cooperation between the program
190 components and the affected family which promotes continuity of
191 health care coverage. Any authorized transfers must be managed
192 within the program's overall appropriated or authorized levels
193 of funding. Each component of the program shall establish a
194 reserve to ensure that transfers between components will be
195 accomplished within current year appropriations. These reserves
196 shall be reviewed by each convening of the Social Services
197 Estimating Conference to determine the adequacy of such reserves
198 to meet actual experience.
199 (10) In determining the eligibility of a child, an assets
200 test is not required. Each applicant shall provide documentation
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201 during the application process and the redetermination process,
202 including, but not limited to, the following:
203 (a) Proof of family income, which must be verified
204 electronically to determine financial eligibility for the
205 Florida Kidcare program. Written documentation, which may
206 include wages and earnings statements or pay stubs, W -2 forms,
207 or a copy of the applicant's most recent federal income tax
208 return, is required only if the electronic verification is not
209 available or does not substantiate the applicant's income.
210 (b) A statement from all applicable, employed family
211 members that:
212 1. Their employers do not sponsor health benefit plans for
213 employees;
214 2. The potential enrollee is not covered by an employer -
215 sponsored health benefit plan; or
216 3. The potential enrollee is