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Medicaid, SCHIP, & Federal Authority

  • Florida Medicaid Reform Waiver – In October 2005, Florida received approval for its Medicaid Reform waiver.  The waiver does not expand eligibility; however, it makes significant changes to the program. The Florida Medicaid Reform began in June 2006 in two counties and expanded to three additional counties in July 2007. The aim of the reform is to move the Medicaid program from being a defined benefit to a defined contribution program. The state provides a risk-adjusted payment to managed care plans. The increase in payments to the plans is capped at 8 percent per year. The program also created Enhanced Benefit Accounts, which reward beneficiaries for healthy behaviors (such as taking children to well-child checks or participating in a weight management program). The rewards can include up to $125 credit at a local pharmacy for health-related supplies such as bandaids or aspirin. In addition, beneficiaries can opt out of Medicaid and direct Medicaid premiums to employer-sponsored insurance. Individuals covered under the Medicaid Reform proposal have their choice of managed care plans and benefit packages.  As of February 2008, over 196,000 individuals were enrolled in Florida’s Medicaid Reform program.

    In May, 2008 the Florida legislature passed the Cover Florida Health Access Act which will allow children to buy into the KidCare Program regardless of income.

High-Risk Pools

  • Florida’s high-risk pool, the Florida Comprehensive Health Association has been closed to new enrollment since 1991. There are approximately 400 recipients remaining in the program which was originally established in 1983. The premium cap varies (between 200 percent and 250 percent of market rate for comparable coverage) and enrollees are grouped into one of three risk categories. The program is financed through premiums and assessments on insurers.


Limited-Benefit Plans

  • In 2002, the Florida legislature passed SB46E, which allowed a Health Flex Plan to be sold by insurers, HMOs, provider-sponsored organizations, and public or private community-based organizations as a pilot in areas of the state with high uninsured rates. In 2004, legislation was approved allowing Health Flex plans throughout the state. 

    Health Flex can limit/exclude benefits required by law, cap the total amount of claims paid per year, limit enrollment, or take any combination of these actions. Health Flex plans may enroll individuals with family incomes no greater than 200 percent FPL and who have been uninsured for the past 6 months and are not otherwise eligible for public programs.

Dependent Coverage

  • Legislation (Florida 627.6562) allows for young adults up to age 25 who are not married and either live with their parents or are financially dependent to remain on their parents’ health insurance. 

State Specific Strategies

  • In May, Governor Charlie Crist signed into law a bill (S.B. 2534) that creates a new health insurance option, the Cover Florida program, for Florida’s uninsured residents starting January 2009. The bill outlines a plan that allows private insurers to competitively negotiate with the state to provide benefit plans which should cost approximately $150 or less per month.[1]. Cover Florida sponsors must offer at least two plans: one with lower-level coverage, and one with catastrophic coverage. Nine carriers submitted proposals and six of those were selected by the state to participate in Cover Florida.[2] The benefit designs must focus on primary and preventive care in order to discourage people from using emergency rooms as their source of primary care. At minimum, all benefits plans must include:

    • Coverage for preventive services
    • Screenings
    • Office visits
    • Urgent care
    • Prescription drugs
    • Durable medical equipment
    • Diabetic supplies
    • Hospital care
    The higher level plan must also include catastrophic coverage. Generally speaking, only individuals who have been uninsured for at least six months will be eligible for the program.
    Health plans in the future may also competitively negotiate with the state to provide supplemental coverage, such as vision, dental, and cancer care.

    The legislation also creates the Florida Health Choices Corporation, described as a clearinghouse designed to promote health insurance choices for small business and help them fill out the necessary forms and paperwork.  Through the Corporation, small employers with 50 or fewer employees will be able to access coverage for their employees. Employees will have the ability to choose from a variety of health plans and services, including prepaid services, flexible savings accounts, and traditional insurance products. Employers will be required to establish Section 125 plans. The program will be administered by a 15-member board made up of appointees chosen by the Governor, the Senate president and the House speaker.[3]



    [1] Office of Florida Governor Charlie Crist, Governor Crist Signs Cover Florida Legislation to Provide Health Insurance Options to Florida’s 3.8 Million Uninsured, Press Release (May 21, 2008); and May Stateside
    [2] Kaiser Daily Health Policy Report, Nine Health Insurance Companies Submit Proposals for ‘Cover Florida’ Program (August 20, 2008).
    [3] Office of Florida Governor Charlie Crist, Governor Crist Signs Cover Florida Legislation to Provide Health Insurance Options to Florida’s 3.8 Million Uninsured, Press Release (May 21, 2008); and May Stateside