>
MediKids Eligibility
Covered Services
MediKids Program codes
Florida KidCare is the State of Florida’s health insurance program that covers children ages 0-18. The program is made up of Florida Healthy Kids, Medicaid, MediKids and Children’s Medical Services Network. Families can call 1-888-540-KIDS (5437) or complete an online application to begin the application process. All Florida KidCare programs are applied for with one application. Florida KidCare will place your child in the program that best meets your child’s needs. Florida KidCare is for children, not adults. To qualify for low-cost coverage, a child must be under age 19, must meet income eligibility requirements, must be a U.S. citizen or qualified non-citizen, and must not be in a public institution.
Premiums/Copays https://www.healthykids.org/cost/premiums/
Most Florida Healthy Kids families pay just $15 or $20 per month. Monthly premiums depend on your household’s size and income. If you do not qualify for subsidized coverage, you may be eligible for the full-pay option. The non-reduced monthly premium is $121/child without dental benefits and $133/child with dental benefits. You may have to pay small charges or co-payments for some services.
Florida Healthy Kids covers only children 5-18. If your children are older, younger, have special needs or have a lower income, your family may be served by other Florida KidCare partners (Medicaid, MediKids and Children’s Medical Services).
Enrollment in Florida KidCare and Medicaid closed when open enrollment for the federally facilitated marketplace (FFM) ended on March 31, 2014.
FACT: Enrollment in Florida KidCare and Medicaid is open all year. Enrollment in the FFM closed on March 31, 2014. However, if they get an application that looks like the person might qualify for Florida KidCare or Medicaid, the FFM will refer the application to Florida to determine eligibility, even if FFM enrollment is closed.
If eligible for Florida KidCare or Medicaid, the person can be enrolled at any time during the year.
The ACA created a “no wrong door” application process. There are multiple ways to apply:
1. Online at State Web Sites (Florida KidCare or the Department of Children & Families/DCF)
www.floridakidcare.org
2. Print a paper application from the state web sites or call Florida KidCare to request a paper application: 1-888-540-5437 (toll-free)
3. Online at Federal Web Site: https://www.healthcare.gov/ or call 1-800-318-2596 to apply by phone
Children’s Medical Services Managed Care Plan
The Children’s Medical Services (CMS) Plan is Florida’s Title V program for Children with Special Health Care Needs. Children enrolled in the CMS Plan have access to specialty providers, care coordination programs, early intervention services, and other medically necessary services that are essential for their
health care. The Florida Department of Health (DOH) operates the program, which is open to Title XIX and Title XXI-funded children with special health care needs who meet clinical eligibility requirements. CMS Plan enrollees with Title XXI premium assistance coverage are limited to ages one through 18, whereas
the Title XIX CMS Plan covers children from birth through 20 years of age. Infants under one year of age with family incomes between 186-200% of the Federal Poverty Level (FPL) are Title XXI-funded but receive services through the CMS Plan in the Medicaid managed care program. The CMS Plan covers Medicaid state plan services for its Title XIX- and Title XXI-funded enrollees and there are no copayments for services. CMS Plan Title XXI families pay a monthly family premium of $15 (for family income between 133% and 158% FPL) or $20 (for family income between 159% and 200% FPL). Title XXI CMS Plan enrollees between the ages 5 and 18 who meet the Department of Children and Families’ clinical eligibility for behavioral health services may be enrolled in the Behavioral Health Network (BNET) for their behavioral health services. The Florida Legislature created BNET in s.409.8135, F.S., for children ages 5 through 18 with serious behavioral or emotional conditions and is administered by the Department of Children and Families(DCF). For the current report, Title XIX CMS plan is one of the Managed Medical Assistance (MMA) plans and is reported with the MMA plan results and in the Title XIX MMA total; Title XXI CMS plan is
presented as a separate Florida KidCare program.
Florida Healthy Kids
Florida Healthy Kids is a statewide program for children ages five through 18 (inclusive) who are at or below 200% FPL and eligible for Title XXI premium assistance (see page 18). For each region, the Florida Healthy Kids Corporation selects two or more commercially licensed health plans through a competitive
bid process. In addition, Florida Healthy Kids selects at least two dental insurers to provide the dental benefits and form the provider networks. The dental benefit package is the same as Medicaid’s benefit package, with no cost-sharing or copayments. Title XXI enrollees do not pay any additional monthly family premiums for this dental coverage. Florida Healthy Kids families pay a monthly family premium of $15 (for family income between 133% and 158% FPL) or $20 (for family income between 159% and 200% FPL). Florida Healthy Kids has co-payments for certain services. Information on full-pay families is provided
below.
MediKids
MediKids is a Medicaid “look-alike” program for children ages one through four years, who are at or below 200% of the FPL and eligible for Title XXI premium assistance. MediKids offers the same benefit package as the Medicaid Program, with the exception of special waiver services that are available only to Medicaid recipients. State law provides that children in MediKids must receive their care through a managed care delivery system. MediKids children are enrolled in Statewide Medicaid MMA plans. MediKids families pay a monthly family premium of $15 (for family income between 133% and 158% FPL) or $20 (for family income between 159% and 200% FPL). Information on full-pay families is provided below.
Medicaid Renewal Information
To keep your benefits current, complete and return your renewal application by the requested date. That date is the fifth of the month your benefits are to end. If you turn in your renewal application on time and you are found eligible to continue receiving benefits there will be no gap in your coverage.
If you turn in your renewal application late, your Public Assistance office may not have time to process your renewal application before your benefit eligibility coverage period ends. This means your Medicaid benefits will be delayed. If you need to use benefits before you receive your card, contact your Public Assistance office or Denali KidCare (DKC). Statewide offices are listed in the back of this book. Your coupon can be issued by fax directly to your health care provider
Informative post.