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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 51 inmate of a public institution or a patient in an institution for mental diseases; (8) be a Florida resident; and (9) be age-eligible. Families will be required to provide proof of income if not available electronically. Effective July 1, 2009, access to employer-sponsored coverage is no longer a factor of eligibility based on changes to state law. No face-to-face interviews are required. The Department of Children and Families will use its access to other state computer systems to verify income statements on the application form for the Medicaid eligibility determination process. If the child is not a U.S. citizen, additional information may be required from the family in order to determine whether the child meets the criteria to be considered a qualified alien for Title XXI coverage. An automated matching system will also verify that no applicant is currently enrolled in the Medicaid program prior to enrollment in a non-Medicaid component of the Florida KidCare program. A Third Party Administrator (TPA) under contract with FHKC conducts the determination of eligibility for non-Medicaid components of the Florida KidCare program. The TPA is responsible for the following services: system development; application processing; account maintenance; customer service and eligibility determination. The Title XXI and Title XIX programs use the same income disregards and family income definitions to determine eligibility to the extent shown in Attachment A, the Medicaid Screening Tool. As part of the application process, applicants will be required to provide a social security number for each child beginning with the distribution of the new KidCare application in the first quarter of 2003. For those children who do not yet have a social security number, processes are in place to address those situations, to avoid any lag in processing time. An automated matching system has been established with Medicaid, the TPA, and the Florida State Employees Payroll System. Electronic matches are conducted on at least a monthly basis, if not more frequently, to identify the following conditions which may affect continued participation in the Florida KidCare program: (1) enrollment in Medicaid, and (2) the parent’s employment with a state agency. If the match indicates enrollment in Medicaid, the child’s coverage will be cancelled or the child’s application will be denied, whichever is appropriate. Starting April 1, 2006, all applications are matched weekly with the Florida State Employees Payroll System. This ensures that any child of a state employee will be identified before the eligibility determination is complete.