A Primer on Florida's KidCare Partnership

In 1997, Congress enacted Title XXI of the Social Security Act, known as the State Children's Health Insurance Program (SCHIP). A year later, the Florida Legislature created the Florida KidCare Partnership, a health insurance program for uninsured children from birth to age 19 who meet certain income and eligibility requirements. Florida's program, which has earned praise as a national model, is composed of three state agencies and the Florida Healthy Kids Corp.

MediKids is for children ages 1-5 and is administered by the Agency for Health Care Administration (AHCA).

Florida Healthy Kids is for children ages 5-19 and is administered by the Florida Healthy Kids Corp.

Children's Medical Services Network is for children with special health-care needs. This program is administered by the Department of Health for physical health and the Department of Children and Families (DCF) for specialized behavioral health. Approximately three percent of Florida's uninsured children meet the Children's Medical Services Network clinical eligibility criteria for special health-care needs.

Medicaid for Children covers children from birth to age 19. AHCA administers the Medicaid program and DCF determines eligibility.

Florida KidCare Coordinating Council estimates that Florida's population will top 18.8 million this year, with individuals age 19 and younger comprising 24.4 percent of that total. According to the Kaiser Family Foundation, approximately 18 percent of Florida's children are uninsured, compared to 10.3 percent nationally.

KidCare Enrollment Criteria

To qualify for Florida's KidCare and premium assistance, in addition to meeting income and age eligibility the child must be a U.S. citizen or qualified non-citizen; not be eligible for Medicaid; not be a dependent of a state employee eligible for health insurance; and not be in a public institution.

There is no charge for Medicaid for Children. For the other programs, monthly premiums depend on household income and size. For most households, the cost is usually between $15 and $20 per month; health-care services and prescriptions may carry small charges or co-pays.

The Florida KidCare program is financed with a combination of federal and state funds and family contributions. Federal funding comes from two sources: Medicaid (Title XIX of the Social Security Act) and the Children's Health Insurance Program, or CHIP (Title XXI of the Social Security Act).

Tobacco settlement trust funds and general revenue comprise the state's share of funding. Family premium payments are another source of funding for the program. However, family premiums are not eligible for matching with federal Title XXI funds.

In fiscal year 2009-10, the Florida Legislature appropriated approximately $442 million in state and federal funds for the Title XXI-funded Florida KidCare program components, plus family contributions, to support a budgeted average monthly Title XXI-funded caseload of 235,422 children.

Full-Pay Options Available

Florida Healthy Kids also serves a small number of non-Title XXI eligible children with a combination of state and local funds and family contributions.

MediKids and Healthy Kids offer a full-pay option for children with family incomes above 200 percent of the federal poverty level. No state or federal funds are used for the full-pay population. Before 2008, there was a 10 percent limit on full-pay enrollment. The 2008 Florida Legislature removed the limit on full-pay enrollment, but required Florida Healthy Kids Corp. to prepare a report on premium impacts to the subsidized portion of the program from the inclusion of the full-pay program, including recommendations about how to mitigate these impacts.

According to the 2010 Florida KidCare Coordinating Council annual report, the per-child monthly premium rate is $159 for full-pay MediKids and $133 for full-pay Healthy Kids, including dental coverage. Currently, there is no full-pay option for infants up to age 1 with family incomes above 200 percent of the federal poverty level. There also is no separate full-pay option for the Children's Medical Services Network. Children with special health-care needs with family incomes above 200 percent of the federal poverty level may enroll in MediKids or Healthy Kids full pay, depending on the child's age.

Steve Israel is with South Florida Affiliated Health Insurers, Inc., in Boynton Beach. www.affiliated-health.com.

For related information, see Florida's Health Insurance Plans Tailored to Our One-Size-Does-Not-Fit-All Populace.