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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 1 Table of Contents

Section 1 General Description and Purpose of the State Child Health Plans and State

Child Health Plan Requirements ....................................................................... 4 Section 2 General Background and Description of State Approach to Child Health

Coverage and Coordination............................................................................. 10 Section 3 Methods of Delivery and Utilization Controls ................................................ 32 Section 4 Eligibility Standards and Methodology .......................................................... 41 Section 5 Outreach .......................................................................................................... 67 Section 6 Coverage Requirements for Children’s Health Insurance .............................. 78 Section 7 Quality and Appropriateness of Care .............................................................. 90 Section 8 Cost Sharing and Payment .............................................................................. 98 Section 9 Strategic Objectives and Performance Goals and Plan Administration……..109 Section 10 Annual Reports and Evaluations…………………………………………….122 Section 11 Program Integrity…………………………………………………………....123 Section 12 Applicant and Enrollee Protections………………………………………….124 Tables and Charts Florida KidCare Eligibility ....................................................................................................... 5 Florida Medicaid Child Eligibility .......................................................................................... 18 Overview of FHKC Administrative Functions ....................................................................... 23 Florida KidCare Application Process ..................................................................................... 28 Florida Medicaid/MediKids Managed Care Coverage ........................................................... 32 Title XXI Transfer Policy…………………………………………………………………………………...60