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Www.floridakidcare.org 1-888-540-5437 This presentation was produced by Florida Healthy Kids, a Florida KidCare partner. The State of Florida’s high-quality,

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Presentation on theme: "Www.floridakidcare.org 1-888-540-5437 This presentation was produced by Florida Healthy Kids, a Florida KidCare partner. The State of Florida’s high-quality,"— Presentation transcript:

1 This presentation was produced by Florida Healthy Kids, a Florida KidCare partner. The State of Florida’s high-quality, low-cost health insurance for children from birth through age 18 The State of Florida’s high-quality, low-cost health insurance for children from birth through age 18 An Overview of the Florida KidCare Program 1

2 Before we get started…  Download the Florida KidCare app on your iPhone or Android  Search for ‘FL KidCare’  We will explore its features together later on in this presentation 2

3 State of Florida’s Uninsured Child Population 2011 Census information indicates: State’s number of uninsured children is approximately 475,112 or 11.9%. Overall U.S. child uninsurance rate is 7.5%. Florida ranks 48th in nation for percentage of uninsured and 49th for number of uninsured. Florida ranked first in the country for reducing the uninsured child rate from 2008 – 2010 and third from 2009 –

4 By the Numbers 2.1 million Florida children are covered by Florida KidCare, including 1.8 million through Medicaid. Many KidCare families pay $15 or $20/month, but most pay nothing at all. 4

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6 CHIP Enrollment 6

7 Why do kids need insurance? Insured kids have more fun! 7 Healthy kids perform better in the classroom and on the recital stage and baseball field.

8 Benefits Package Florida KidCare offers a comprehensive benefits package that provides access to preventive services, regular medical care and protection from catastrophic financial expenses. It includes: Doctor visits Check-ups Shots Hospitalization and emergencies Surgeries Prescriptions Dental Vision and hearing Behavioral health 8

9 Back to the Beginning In 1997, Congress created the State Children’s Health Insurance Program (SCHIP), also known as Title XXI of the Social Security Act Program designed to provide affordable coverage to working families who did not qualify for Medicaid

10 What is Florida KidCare? The Florida KidCare Program was created by the 1998 Florida Legislature as the “combination” option in response to SCHIP legislation The Florida KidCare Program includes: o Children’s Medicaid o Healthy Kids o Children’s Medical Services Network (CMSN) o MediKids 10

11 Florida KidCare Funding 11 Medicaid is an Entitlement Program Feds match each state $1.00 with $1.42 Program is funded 41.33% state and % federal CHIP is a Block Grant Program Feds match each state $1.00 with $2.48 Program is funded 28.85% state and 71.15% federal Families contribute premium of $15 or $20 per month

12 Eligibility Chart 12

13 Eligibility Chart 13 MediKids Full Pay > 200% Florida Healthy Kids Full Pay > 200%

14 Florida KidCare Premium Costs $20 per family per month $15 per family per month

15 Program 1: Children’s Medicaid For children from birth through age 18 Eligibility determined by the Department of Children and Families (DCF) Program Administered by Agency for Health Care Administration (AHCA) Eligibility is based on child’s age, household size, income and citizenship Comprehensive benefits package, including medical and dental coverage 15

16 More on Children’s Medicaid A child can be covered by other insurance and still be eligible for Children’s Medicaid. A child found eligible for the Children’s Medicaid program can only enroll in Children’s Medicaid. A parent cannot refuse Children’s Medicaid to select another Florida KidCare program. No premiums and no other cost sharing under Children’s Medicaid. Children’s Medicaid is provided through Medicaid managed-care providers (HMO, PSN and MediPass). 16

17 Program 2: MediKids For children ages 1 through 4 Administered by the Agency for Health Care Administration Same benefits as provided under Medicaid (except waiver services) Services delivered through managed care plans (HMO, PSN and MediPass). MediKids Helpline: o o Monday through Friday: 8:00 a.m. - 6:00 p.m. (EST) 17

18 Program 3: Healthy Kids For children ages 5 through 18 Administered by the Florida Healthy Kids Corporation Created by statute Managed by prescribed board Comprehensive medical and dental benefits Services delivered by managed care plans (HMOs and EPO) and dental plans, competitively bid Small co-payments for certain services 18

19 Program 4: Children’s Medical Services Network (CMSN) For children from birth through age 18 Administered by the Florida Department of Health For children with special health care needs, including behavioral health (BNet) Children must be found clinically and financially eligible for CMSN Utilizes a specialized network of physicians and providers 19

20 Enrollment is Always Open! Enrollment is open year-round in all Florida KidCare programs. 20

21 Who Can Apply for Florida KidCare? Children birth through 18 residing in Florida Applicants with unborn children may also apply for the future child. Many non-citizens are eligible (Florida KidCare does not share information about applicants with U.S. Citizenship and Immigration Services ) Children with pre-existing health conditions 21

22 Eligibility For subsidized CHIP program coverage, a child must meet these general guidelines: Reside in the home of the applicant o Uninsured o Not be the inmate of a public institution o Be a U.S. citizen or qualified non-citizen for five years o Depending upon household size and family income, pay premium 22

23 How Do Families Apply? Families can apply for all Florida KidCare programs with just one application (available in English, Spanish and Creole) using any of the following: Online application: Download and print an application from the web Application by fax: (toll-free) Call the Florida KidCare Information Line and request a mailed application: (toll-free) If a child was previously enrolled in Florida KidCare, parents may not need to complete a new application. 23

24 Florida KidCare App Available for iPhone and Androids! Features: program information, application assistance location finder, success stories and photos, easy access to payments 24

25 Application Assistance Florida KidCare application assistance is now at the fingertips of families! Simply enter contact information and the nearest application assister with get in touch with the requester to help them through the process. Use the ‘locations’ tab to locate the nearest application assistance location (and get directions delivered straight to your phone!)

26 Adventures of KidCare The ‘Adventures of KidCare’ tab has multiple comic strips of the Florida KidCare superhero mascot Let’s peruse the comics together…

27 Required Documentation State law requires families to report all current sources of earned and unearned household income Eligibility processors will electronically verify income, if possible If no electronic verification is possible, applicants should submit legible copies of documents with parent’s name and social security number clearly printed on each copy 27

28 After Applying, What Happens? All applications are: o Acknowledged by letter once received and a request for missing information is sent, if needed o Screened for Children’s Medicaid eligibility. If eligible, the child must enroll in Children’s Medicaid. If referred to DCF, a referral letter to the family is mailed. o If an applicant indicates their child has special health care needs they are screened for CMSN 28

29 Next Steps If eligible for MediKids, Healthy Kids or CMSN: o Coverage begins the first day of the month following eligibility determination AND receipt of full-premium payment. If eligible for Children’s Medicaid: o Coverage may begin in the month the application was received. o If there are any unpaid medical bills from the three months before application, Children’s Medicaid may be able to pay them. 29

30 Premium Payment Options Premium payments are due on the 1 st of month for the next month’s coverage. If payment is not received and posted by the end of the month, coverage for the following month is cancelled for non- payment. New state law passed in 2009 requires a minimum 30-day wait for reinstatement if cancelled for non-payment of premium If payment is not received by the due date families will receive reminder notices: First late notice sent on the 7th of the month Cancellation notice sent around the 21st of the month 5 easy ways to pay! 1. Mail Payments should be either check or money order and should include the family account number. 2. Phone: By text 4. Online at Reoccurring payment plans are available Through a third-party company, there is a convenience fee of $1.50 per transaction charge for phone and online payment options. 5. Cash 30

31 Renewal Options Premium payments are due on the 1 st of month for the next month’s coverage. If payment is not received and posted by the end of the month, coverage for the following month is cancelled for non- payment. New state law passed in 2009 requires a minimum 30-day wait for reinstatement if cancelled for non-payment of premium If payment is not received by the due date families will receive reminder notices: First late notice sent on the 7th of the month Cancellation notice sent around the 21st of the month Enrollees must renew their coverage once every 12 months (determined by date of enrollment) Pre-populated notices and forms are sent 60 days in advance of the child’s renewal date Online account renewal and renewal forms are also available online at: Current income documentation is also required with completed renewal form; 2009 Legislative Session called for new electronic verification of income. Account must be updated during this renewal period or risk interruption of coverage 31

32 Confidentiality Premium payments are due on the 1 st of month for the next month’s coverage. If payment is not received and posted by the end of the month, coverage for the following month is cancelled for non- payment. New state law passed in 2009 requires a minimum 30-day wait for reinstatement if cancelled for non-payment of premium If payment is not received by the due date families will receive reminder notices: First late notice sent on the 7th of the month Cancellation notice sent around the 21st of the month Information regarding a Florida KidCare account can only be released to a parent or guardian listed on the application; this is state and federal law. Written authorization forms are required for Florida KidCare account access by third parties other than program providers. o Must use the Florida KidCare Authorization to Release Information form for each child o Selected health and dental plans may require a separate authorization to release information. Parent should verify with plan. Authorization forms are not valid for more than one year from date of signature. 32

33 Notable Recent Events New CHIP Third Party Administrator selected  MAXIMUS  October 2013 implementation date DCF directed to develop eligibility determination capability (Medicaid, CHIP and link to Federal hub). Marketing campaign “Kids Oughta Be Covered!”

34 Affordable Care Act Early Provisions Early Provisions  Created interim high risk pool  Mandated child policy guaranteed policy issue 2014 Provisions 2014 Provisions  Coverage mandate (delayed for employers to 2015)  All policies guaranteed issue  No policy maximums

35 Affordable Care Act  Expansion of Medicaid up to 133% of the FPL  Child policies Medicaid expansion upheld by Supreme Court  Adult policy expansion optional  Individual and small business exchanges established  States can opt in, partner with Feds or opt out  Small business delayed until 2015  State chose to defer to federal government

36 Medicaid Expansion Adults and children: 0-133% FPL in Medicaid  Children funded at current match  Other family members federally funded at 100% initially Children: % FPL in CHIP  Funded at current match Adults: 133 – 400% FPL and children >200% FPL eligible for subsidy in Exchange OR

37 Subsidized Health Care Eligibility Levels

38 More on Medicaid Expansion Adults < 100% - No Medicaid Expansion Children ≤ 133% - Medicaid Children > 133% - 200% - CHIP Adults > 100% - 400% - Marketplace Children > 200% - Marketplace OR

39 2014 Subsidized Health Care Eligibility Levels

40 Contact Information Premium payments are due on the 1 st of month for the next month’s coverage. If payment is not received and posted by the end of the month, coverage for the following month is cancelled for non- payment. New state law passed in 2009 requires a minimum 30-day wait for reinstatement if cancelled for non-payment of premium If payment is not received by the due date families will receive reminder notices: First late notice sent on the 7th of the month Cancellation notice sent around the 21st of the month Florida KidCare Web site: general program information, downloadable application, links to the online application, and links to Florida KidCare partner sites/informational sites: o Florida KidCare Information Line: general information o (Monday-Friday, 7:30 a.m.-7:30 p.m. ET) Florida KidCare Customer Service Line provides account information for those that have submitted an application or currently enrolled: o (Monday-Friday, 7:30 a.m.-7:30 p.m. ET) Children’s Medicaid Hotline provides account information for those that have been referred to Medicaid or currently enrolled: o (Monday-Friday, 8:00 a.m.-4:30 p.m. ET) 40

41 Thanks! Premium payments are due on the 1 st of month for the next month’s coverage. If payment is not received and posted by the end of the month, coverage for the following month is cancelled for non- payment. New state law passed in 2009 requires a minimum 30-day wait for reinstatement if cancelled for non-payment of premium If payment is not received by the due date families will receive reminder notices: First late notice sent on the 7th of the month Cancellation notice sent around the 21st of the month Rich Robleto Executive Director Florida Healthy Kids Corporation (850)


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