Memorandum from Rep. Ausley to Rep. Gelber on KidCare Reform

TO: Representative Dan Gelber

FROM: Representative Loranne Ausley 

RE: Florida Kidcare Legislation

DATE: Monday, May 07, 2007 

As you are aware, the Florida legislature adjourned last week without passing legislation to streamline the Florida KidCare program.  The bill that passed out of the Florida House was truly a bi-partisan effort representing the consensus of children's advocates and stakeholders.  

It is unfortunate that this critical issue of children's health insurance was not addressed during the regular session, but the children of Florida can not wait until the spring of 2008, and it is my hope that we can address the major issues during the June Special Session.   The timing is particularly important as Congress is currently discussing the reauthorization of the S-CHIP program that provides the federal match for our state dollars at the ratio of 3:1, enabling us to stretch our state dollars and cover more children.  

For years, we have been leaving federal dollars on the table, allowing other states to take advantage of these resources that have been allocated for Florida.   If we do not act now to streamline and simplify the enrollment and eligibility process, these dollars could be limited in future years. 

I have broken the issues relating to the program into three categories: 

NON-CONTROVERSIAL, AGREED UPON ISSUES

• Eliminate different program names, creating one seamless program to be marketed as KidCare and KidCare Plus (for children with special health care needs); 

• Give clear and broad rule-making authority to the Agency for Health Care Administration with direction to develop the rules in consultation with the Florida KidCare partners.

• Make family income the sole determinant for eligibility rather than age and income determinations.  All children in families below 133% of poverty will be in Title XIX financed program, those above 133% will be in Title XXI financed program;

• Require that family income  be verified electronically during the application and re-determination process, with written documentation required if necessary; 

• Notify a child's health plan when the child will transition to a new program so they can assist the family in the transition and retain coverage;

• Reduce waiting periods for children to receive coverage; 

• Reduce penalty periods for late payment of premiums;

• Provide presumptive and continuous eligibility for all children in the KidCare program; 

• Eliminate the 10% limit on the number of children allowed to be in the full pay program;

• Remove income verification requirements for full pay participants; 

• Allow families of children with Special Health Care needs to opt out of CMS if they wish to have a different provider;

• Require the Department of Health in consultation with the Agency for Health Care Administration to develop standards regarding quality of care; 

ISSUES NOT AGREED UPON, BUT IMPORTANT TO DISCUSS

• Program Governance/Consolidation
  
  The major difference between the House and Senate versions of the bill is the issue of governance or consolidation.   The advocates and apparently the policy makers are split on where the Kidcare program should be housed.  At the outset, there was agreement that all program elements should be transferred to the Department of Health, and by the end of the session the prevailing sentiment was to transfer all elements to ACHA.  The House bill created a compromise position which was an independent study which would thoroughly examine the various program elements and provide a recommendation to the Speaker of the House, the Senate President and the Governor before the next legislative session. 

ISSUES TO BE DISCUSSED IN THE INTERIM

• Offer a KidCare program with all  health benefits equivalent to the pediatric Medicaid benefit package;

• Reinstate coverage for children of state employee's and immigrants who are barred from receiving federal matching dollars;

• Direct AHCA to submit a state plan amendment to the Center for Medicare and Medicaid Services to increase the maximum income threshold to 235% of the poverty level, subject to appropriation; 

• Require the  Department of Health,  in consultation with the KidCare Coordinating Council, to develop and implement a plan to publicize the program, and to maintain public awareness and outreach for the program; 

• Provide funding for statewide, coordinated, culturally appropriate marketing and education;

• Reinstitute marketing and information dissemination to childcare providers around the state; 

• Provide all children who qualify for the free and reduced lunch program with information about the program.; explore possibility of presumptive eligibility if family qualifies for free or reduced lunch with opt out provision;

• Raise the income eligibility level for pregnant women to receive prenatal care to 200% of the Federal Poverty Level or whatever the level is that the newborn is eligible; 

• Review the viability of ensuring that Medipass remains an option throughout the state;

• Review equalizing the reimbursement rates for Medicaid and Title XXI.

I am working closely with CFO Alex Sink, Representatives Galvano, Bean and Garcia as well as the advocacy community to maintain the level of communication and consensus that has gotten us to this point.  Please let me know if you have questions or if you need additional information.