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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 28 Florida KidCare Application Process Initially Developed 12/14/98. Revised 2/12/99, 12/7/99,4/12/04 and 6/21/05. Families who leave TANF due to earned income may be eligible for KidCare or Medicaid Applications brought into Children & Families service centers Applications mailed to Florida Healthy Kids Corporation (FHKC) Unopened applications sent overnight to TPA and scanned by TPA and date stamped Uninsured children may be eligible for KidCare, including Medicaid Receipt of application acknowledged. Missing information letters sent to applicants if critical information is omitted Applications screened for potential Medicaid eligibility. Applications that may be CMS eligible are sent to CMS for medical eligibility determination concurrently with referrals to Children & Families for Medicaid eligibility determination. TPA processes other applications for Healthy Kids or MediKids Application status letters are sent to families Potentially Medicaid Eligible Electronically transmitted applications are sent to Tallahassee Children & Families KidCare/Medicaid application processing unit. Information from complete applications is entered into the FLORIDA system. Applications are distributed to one of the central processing units. Children & Families eligibility specialists use the simplified eligibility process to determine Medicaid eligibility Eligible for Medicaid Medicaid approvals authorized with code “144” to signify use of KidCare application Applications receive case numbers and transferred to local Children & Families service centers Post application verification of income occurs New eligibility determination occurs at the end of 6 or 12 months depending on the child’s age Potentially KidCare Eligible TPA conducts Medicaid and state employee matches Child is enrolled in Healthy Kids, the CMS Network, MediKids or denied Case status for applications received at FHKC only are communicated to TPA. Process must be completed within 45 days Ineligible for Medicaid Open enrollment Non-open enrollment period Letter sent - reapply at open enrollment