Bill Text: FL S0510 | 2012 | Regular Session | Comm Sub
Bill Title: Florida Kidcare Program [Track Bill]
Status: 2012-03-09 - Died in Messages, companion bill(s) passed, see HB 5301 (Ch. [S0510 Detail]
Florida Senate - 2012 CS for SB 510 By the Committee on Health Regulation; and Senators Rich, Lynn, and Sobel 588-01852-12 2012510c1 1 A bill to be entitled 2 An act relating to the Florida Kidcare program; 3 amending s. 409.8132, F.S.; revising a cross 4 reference; amending s. 409.814, F.S.; deleting a 5 prohibition preventing children who are eligible for 6 coverage under a state health benefit plan from being 7 eligible for services provided through the subsidized 8 program; providing an effective date. 9 10 Be It Enacted by the Legislature of the State of Florida: 11 12 Section 1. Paragraph (b) of subsection (6) of section 13 409.8132, Florida Statutes, is amended to read: 14 409.8132 Medikids program component.— 15 (6) ELIGIBILITY.— 16 (b) The provisions of s. 409.814 apply
409.814 (3), (4),17 (5), and (6) shall be applicableto the Medikids program. 18 Section 2. Section 409.814, Florida Statutes, is amended to 19 read: 20 409.814 Eligibility.—A child who has not reached 19 years 21 of age whose family income is equal to or below 200 percent of 22 the federal poverty level is eligible for the Florida Kidcare 23 program as provided in this section. For enrollment in the24 Children’s Medical Services Network, a complete application25 includes the medical or behavioral health screening.If ,26 subsequently,an enrolled individual is determined to be 27 ineligible for coverage, he or she must be immediately be28 disenrolled from the respective Florida Kidcare program 29 component. 30 (1) A child who is eligible for Medicaid coverage under s. 31 409.903 or s. 409.904 must be enrolled in Medicaid and is not 32 eligible to receive health benefits under any other health 33 benefits coverage authorized under the Florida Kidcare program. 34 (2) A child who is not eligible for Medicaid, but who is 35 eligible for the Florida Kidcare program, may obtain health 36 benefits coverage under any of the other components listed in s. 37 409.813 if such coverage is approved and available in the county 38 in which the child resides. 39 (3) A Title XXI-funded child who is eligible for the 40 Florida Kidcare program who is a child with special health care 41 needs, as determined through a medical or behavioral screening 42 instrument, is eligible for health benefits coverage from and 43 shall be assigned to and may opt out of the Children’s Medical 44 Services Network. 45 (4) The following children are not eligible to receive 46 Title XXI-funded premium assistance for health benefits coverage 47 under the Florida Kidcare program, except under Medicaid if the 48 child would have been eligible for Medicaid under s. 409.903 or 49 s. 409.904 as of June 1, 1997: 50 (a) A child who is eligible for coverage under a state51 health benefit plan on the basis of a family member’s employment52 with a public agency in the state.53 (a) (b)A child who is covered under a family member’s group 54 health benefit plan or under other private or employer health 55 insurance coverage, if the cost of the child’s participation is 56 not greater than 5 percent of the family’s income. If a child is 57 otherwise eligible for a subsidy under the Florida Kidcare 58 program and the cost of the child’s participation in the family 59 member’s health insurance benefit plan is greater than 5 percent 60 of the family’s income, the child may enroll in the appropriate 61 subsidized Kidcare program. 62 (b) (c)A child who is seeking premium assistance for the 63 Florida Kidcare program through employer-sponsored group 64 coverage, if the child has been covered by the same employer’s 65 group coverage during the 60 days before the family submitted 66 prior to the family’s submittingan application for 67 determination of eligibility under the program. 68 (c) (d)A child who is an alien, but who does not meet the 69 definition of qualified alien, in the United States. 70 (d) (e)A child who is an inmate of a public institution or 71 a patient in an institution for mental diseases. 72 (e) (f)A child who is otherwise eligible for premium 73 assistance for the Florida Kidcare program and has had his or 74 her coverage in an employer-sponsored or private health benefit 75 plan voluntarily canceled in the last 60 days, except those 76 children whose coverage was voluntarily canceled for good cause, 77 including, but not limited to, the following circumstances: 78 1. The cost of participation in an employer-sponsored 79 health benefit plan is greater than 5 percent of the family’s 80 income; 81 2. The parent lost a job that provided an employer 82 sponsored health benefit plan for children; 83 3. The parent who had health benefits coverage for the 84 child is deceased; 85 4. The child has a medical condition that, without medical 86 care, would cause serious disability, loss of function, or 87 death; 88 5. The employer of the parent canceled health benefits 89 coverage for children; 90 6. The child’s health benefits coverage ended because the 91 child reached the maximum lifetime coverage amount; 92 7. The child has exhausted coverage under a COBRA 93 continuation provision; 94 8. The health benefits coverage does not cover the child’s 95 health care needs; or 96 9. Domestic violence led to loss of coverage. 97 (5) A child who is otherwise eligible for the Florida 98 Kidcare program and who has a preexisting condition that 99 prevents coverage under another insurance plan as described in 100 paragraph (4)(a) (4)(b)which would have disqualified the child 101 for the Florida Kidcare program if the child were able to enroll 102 in the plan is shall beeligible for Florida Kidcare coverage 103 when enrollment is possible. 104 (6) A child whose family income is above 200 percent of the 105 federal poverty level or a child who is excluded under the 106 provisions of subsection (4) may participate in the Florida 107 Kidcare program as provided in s. 409.8132 or, if the child is 108 ineligible for Medikids by reason of age, in the Florida Healthy 109 Kids program, subject to the following provisions: 110 (a) The family is not eligible for premium assistance 111 payments and must pay the full cost of the premium, including 112 any administrative costs. 113 (b) The board of directors of the Florida Healthy Kids 114 Corporation may offer a reduced benefit package to these 115 children in order to limit program costs for such families. 116 (7) Once a child is enrolled in the Florida Kidcare 117 program, the child is eligible for coverage under the program118 for 12 months without a redetermination or reverification of 119 eligibility ,if the family continues to pay the applicable 120 premium. Eligibility for program components funded through Title 121 XXI of the Social Security Act terminates shall terminatewhen a 122 child attains the age of 19. A child who has not attained the 123 age of 5 and who has been determined eligible for the Medicaid 124 program is eligible for coverage for 12 months without a 125 redetermination or reverification of eligibility. 126 (8) When determining or reviewing a child’s eligibility 127 under the Florida Kidcare program, the applicant shall be 128 provided with reasonable notice of changes in eligibility which 129 may affect enrollment in one or more of the program components. 130 If Whena transition from one program component to another is 131 authorized, there shall be cooperation between the program 132 components and the affected family which promotes continuity of 133 health care coverage. Any authorized transfers must be managed 134 within the program’s overall appropriated or authorized levels 135 of funding. Each component of the program shall establish a 136 reserve to ensure that transfers between components will be 137 accomplished within current year appropriations. These reserves 138 shall be reviewed by each convening of the Social Services 139 Estimating Conference to determine the adequacy of such reserves 140 to meet actual experience. 141 (9) In determining the eligibility of a child, an assets 142 test is not required. Each applicant shall provide documentation 143 during the application process and the redetermination process, 144 including, but not limited to, the following: 145 (a) Each applicant’sProof of family income, which must 146 shallbe verified electronically to determine financial 147 eligibility for the Florida Kidcare program. Written 148 documentation, which may include wages and earnings statements 149 or pay stubs, W-2 forms, or a copy of the applicant’s most 150 recent federal income tax return, is shall berequired only if 151 theelectronic verification is not available or does not 152 substantiate the applicant’s income. 153 (b) Each applicant shall provideA statement from all 154 applicable, employed family members that: 155 1. Their employers do not sponsor health benefit plans for 156 employees; 157 2. The potential enrollee is not covered by an employer 158 sponsored health benefit plan; or 159 3. The potential enrollee is covered by an employer 160 sponsored health benefit plan and the cost of the employer 161 sponsored health benefit plan is more than 5 percent of the 162 family’s income. 163 (c) To enroll in the Children’s Medical Services Network, a 164 completed application, including a clinical screening. 165 (10) Subject to paragraph (4)(a) (4)(b), the Florida 166 Kidcare program shall withhold benefits from an enrollee if the 167 program obtains evidence that the enrollee is no longer 168 eligible, submitted incorrect or fraudulent information in order 169 to establish eligibility, or failed to provide verification of 170 eligibility. The applicant or enrollee shall be notified that 171 because of such evidence program benefits will be withheld 172 unless the applicant or enrollee contacts a designated 173 representative of the program by a specified date, which must be 174 within 10 working days after the date of notice, to discuss and 175 resolve the matter. The program shall make every effort to 176 resolve the matter within a timeframe that will not cause 177 benefits to be withheld from an eligible enrollee. 178 (11) The following individuals may be subject to 179 prosecution in accordance with s. 414.39: 180 (a) An applicant obtaining or attempting to obtain benefits 181 for a potential enrollee under the Florida Kidcare program if 182 whenthe applicant knows or should have known that the potential 183 enrollee does not qualify for the Florida Kidcareprogram. 184 (b) An individual who assists an applicant in obtaining or 185 attempting to obtain benefits for a potential enrollee under the 186 Florida Kidcare program if whenthe individual knows or should 187 have known that the potential enrollee does not qualify for the 188 Florida Kidcareprogram. 189 Section 3. This act shall take effect July 1, 2012.