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State Children’s Health Insurance Program

Phase 1 Effective Date: April 1, 1998

Revised: 1/26/98, 2/19/98, 3/3/98, 3/6/98 Phase 2 Effective Date: July 1, 1998

Revised: 8/20/98, 8/24/98, 10/1/99, 7/28/00, 1/31/01, 7/02/02, 7/22/02, 1/3/03, 2/13/04, 9/27/04, 11/15/04, 8/11/05, 10/1/06, 7/1/09, 7/1/10, 7/1/11, 7/1/12 103 MediKids and CMSN The maximum annual out-of-pocket premium expenditure per household for these components of the KidCare program does not exceed $180 for families with incomes at or below 150% of the federal poverty level, or $240 for families with incomes above 150% of the federal poverty level. No co-payments or other cost sharing is charged. These amounts are below the 5% threshold. Healthy Kids Upon enrollment in KidCare families receive notification of their rights to a maximum cost-sharing allowance of 5% of their annual income. Families are instructed to keep receipts of all cost sharing incurred for their children’s health care. In the unlikely instance that a family’s out-of-pocket expenses meet the 5% annual income maximum, the family will be instructed to mail a copy of all receipts to FHKC. FHKC will produce a letter to the family indicating that it would no longer be responsible for any provider co-payments for the remainder of the year. The family can show this letter to providers to ensure that they are not charged or otherwise obligated to make any co- payment. FHKC would also ensure that health plans participating in Healthy Kids are made aware of this procedure and instructed to notify their providers of this. In addition, once it has been determined that a family has met its cost-sharing limit, Healthy Kids would no longer require the family to submit a monthly premium payment for the rest of the year. 42 CFR 457.560(b) requires informing the enrollee’s family in writing of their individual cumulative cost-sharing maximum amount at the time of enrollment and reenrollment. Effective October 2011, in order to comply with 42 CFR 457.560(b), families will receive notice of their 5% maximum cost sharing amount. This information will be included in their coverage approval letter, renewal notice and other times when an income change would affect the family’s 5% maximum calculation. Describe the procedures the state will use to ensure American Indian (as defined by the Indian Health Care Improvement Act of 1976) and Alaska Native children will be excluded from cost sharing. (Section 2103(b)(3)(D)) (42CFR 457.535) In preparing for the development of a process to identify and notify qualified American Indian tribal members of the Florida KidCare cost-sharing exemption process, the interagency partners of the Florida KidCare Program held an American Indian Cost-Sharing Exemption Workshop. The goal of the meeting was to glean critical input from KidCare partners and from representatives of the tribes on how to develop the most sensitive and effective course of action. Mr. Joe Quetone, appointed by the Governor to serve as the American Indian representative on the Florida KidCare Coordinating Council, was a critical and most valuable participant in that