3.1 Family Co-payments

Lead Agencies must establish and periodically revise a sliding-fee scale for families receiving CCDF services that varies based on income and the size of the family to determine each family’s contribution (i.e., co-payment) and does not create a barrier to receiving CCDF assistance. In addition to income and the size of the family, the Lead Agency may use other factors as appropriate when determining family contributions/co-payments. Lead Agencies may not use price of care or amount of subsidy payment in determining co-payments. Lead Agencies must ensure that the total payment to a child care provider is not reduced because of family’s lowered or waived co-payment. 3.1.1 Family co-payment Lead Agencies may not charge any family more than 7% of a family’s gross income, regardless of the number of children participating in CCDF. a. What is the maximum percent of a family’s gross income any family could be charged as a co-payment? Currently, DEL requires co-pays to be no more than 10% of a family’s income. The DEL is working to establish co-payment policies for families receiving CCDF assistance to be no more than 7% of family income to help ensure family co-payments are not a barrier to accessing child care. b. Does the Lead Agency certify that their sliding fee scales are always based on income and family size (regardless of how many different scales they may use)? [x] Yes. [ ] No. If no, describe: 3.1.2 Sliding fee scale Provide the CCDF co-payments for eligible families in the table(s) below according to family size for one child in care. a. Is the sliding fee scale set statewide? [ ] Yes. [x] No. If no, describe how the sliding fee scale is set: The DEL requires ELCs and RCMA to develop sliding fee scales based on the most current release of the Federal Poverty Guidelines and SMI. This information is provided in each ELC's and RCMA's SR Plan and subject to the DEL’s approval. Most, but not all ELCs allow for a discounted fee for two or more children. Recent legislation from the 2024 legislative session moved the authority of setting copayments to the state instead of at the ELC level. DEL will be revising copayments in the upcoming year. b. Complete the table below. If the sliding fee scale is not set statewide, complete the table for the most populous locality: -- A B C D E F Family Size Lowest monthly income at initial eligibility where the family is first charged a co-pay (greater than $0). What is the monthly co-payment for a family of this size based on the income level in (A)? What percentage of income is the co- payment in (B)? Highest monthly income at initial eligibility where a family is charged a co-pay before a family is no longer eligible. What is the monthly co- payment for a family of this size based on the income level in (D)? What percentage of income is this co- payment in (E)? 1 0.01 17.33 2.90 3073.75 294.67 9.60 2 0.01 17.33 2.10 4019.58 294.67 7.30 3 0.01 17.33 1.70 4965.33 294.67 5.90 4 0.01 17.33 1.40 5911.17 294.67 5.00 5 0.01 17.33 1.20 6859.92 294.67 4.30 c. What is the effective date of the sliding-fee scale(s)? July 1, 2024 d. Provide the link(s) to the sliding-fee scale(s): https://www.elcmdm.org/Content/Uploads/elcmdm.org/files/contracts/Copy%20of%202 024-2025%20Sliding%20Fee%20Schedule%20template.pdf. e. Does the Lead Agency allow providers to charge families additional amounts above the required co-payment in instances where the provider’s price exceeds the subsidy payment? [ ] No. [x] Yes. If yes: i. Provide the rationale for the Lead Agency’s policy to allow providers to charge families additional amounts above the required co-payment, including a demonstration of how the policy does not provide a barrier and promotes affordability and access for families: Providers have different practices on what they charge parents. This has not hindered access to a large variety of care. All contracted SR providers must inform parents prior to enrollment of any amount the provider charges in addition to the co-payment. Providers must also indicate in their statewide contract if they charge parents the difference between the reimbursement rate and the private pay rate. ii. Provide data (including data on the size and frequency of such amounts) on the extent to which CCDF providers charge additional amounts to families: Florida does not currently collect data on the size and frequency of the additional amounts charged to families above the required co-payment. Providers are required to indicate if they charge a differential to the families based on the private pay rate and the reimbursement rate. Of the 6,827 total CCDF providers, 5,679 (83 percent) providers charge a differential to families.