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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 47 child’s primary care physician must certify that the child’s condition could result in death prior to the age of 21 years and that the child/family/caregiver could benefit from PIC support services.

Possible diagnoses for children entering the PIC program may include: brain and spinal cord malformations, central nervous system degeneration and disease, infantile cerebral palsy, epilepsy, muscular dystrophies and myopathies, heart and great vessel malformations, cardiomyopathies, conduction disorders and dysrhythmias, respiratory malformations, chronic respiratory disease, cystic fibrosis, congenital anomalies, chronic renal failure, congenital liver disease and cirrhosis, inflammatory bowel disease, sickle cell anemias, hereditary anemias, hereditary immunodeficiency, human immunodeficiency virus disease, amino acid metabolism, carbohydrate metabolism, lipid metabolism, storage disorders, other metabolic disorders, chromosomal anomalies, bone and joint anomalies, diaphragm and abdominal wall anomalies, and other congenital anomalies.

4.1.7.  Access to or coverage under other health coverage:

A child must be uninsured at the time of application for the Florida KidCare program. Effective July 1, 2009, a child will not be eligible if employer- sponsored or private health care coverage was voluntarily canceled within 60 days prior to applying for Title XXI coverage. Claiming a good cause exception will be based on the parents’ attestation. Good cause exceptions to the 60 day wait are including, but not limited to, the following situations: 1. The cost of participation in an employer-sponsored health benefit plan is greater than 5 percent of the family’s gross income; 2. The parent lost a job that provided an employer-sponsored health benefit plan for children; 3. The parent who had health benefits coverage for the child is