Training Two Navigating: Avery Slyker, Ph.D. Outreach Coordinator Florida Covering Kids and Families Lawton and Rhea Chiles Center University of South Florida

Of the uninsured children in Florida most may be eligible for health care coverage through

But … Many parents do not realize their children are eligible!

Florida KidCare Medicaid CMSN MediKids Healthy Kids

Florida KidCare Anyone can get coverage in Florida KidCare It is what you pay that varies from family to family

Financial Eligibility

Income Documentation Tax return W2 Form Pay stub/Wage Statement Employer Letter Wages & Salaries Business Ledger Receipts Tax Statement SSN # Self Employment Income

Child Support Received Social Security Benefits Disability Benefits Unemployment Pensions Workers’ Compensation Veteran's Benefits Unearned Income Income Documentation

Voluntary Cancellation of Benefits Cost of insurance was more than 5% of family’s income Lost of job that provided insurance Employer canceled insurance Canceled COBRA coverage or COBRA reached legal limit Non-custodial parent canceled coverage Subsidized premium assistance:

Voluntary Cancellation of Benefits Child has a medical condition that without medical care could cause serious disability, loss of function, or death Insurance does not cover health care needs Coverage ended due to child reaching maximum lifetime limit or annual benefit Domestic violence led to loss of coverage Subsidized premium assistance:

Voluntary Cancellation of Benefits If insurance was cancelled in the last two months but the family does NOT qualify for subsidized premium assistance, family can still apply for Full Pay Coverage.

Citizenship Social Security Information Child’s social security number is required-Not parents Parents need to provide SSN application date A SSN application confirmation letter Immigration Status Florida KidCare does not ask about parent’s immigration status Non-Citizen Children Qualified Non-citizens

Children with lawful permanent residence (5 years) Human trafficking victims Refugees Asylees Cuban and Haitian entrants Amerasians Canadian Indians Dependent children of active duty U.S. military

Children’s Medical Services - CMSN A managed system of care for children enrolled in Medicaid or Florida KidCare A family-centered and coordinated, statewide managed system of care Links community-based health care with multidisciplinary, regional, and tertiary pediatric care Children with special needs No insurance Under insured for their condition

CMSN Clinical Eligibility Medical, behavioral or development condition that has lasted or is expected to last at least 12 months Congenital, genetic, chronic or catastrophic conditions such as: ◦ADD/ADHD ◦Brain & Spinal Cord Injuries ◦Cancer ◦Cystic Fibrosis ◦Diabetes ◦Hemophilia ◦Sickle Cell Anemia ◦Spina Bifida

CMSN Subsided Eligibility General Eligibility ◦Medicaid eligible (Title XIX) ◦Florida KidCare SCHIP (Title XXI) ◦CSHCN with family incomes over 200% FPL with spend-down to Medicaid levels ◦High-risk pregnant female eligible for Medicaid

CMSN Benefits Full range of care ◦Prevention ◦Early Intervention ◦Primary ◦Specialty Care ◦Long Term Care Medically Necessary Services ◦Respite ◦Genetic Testing ◦Genetic & Nutritional Counseling ◦Parent Support

CMSN Services A private/public partnership A network of private sector providers ◦Physicians ◦Multidisciplinary health care providers ◦Hospitals ◦Medical schools ◦Regional health clinics.

CMSN Coverage Cancelations-Dec *Regular file for upcoming month is received middle of current month. Supplemental file is received during the first week of the coverage month. Eligible children are reinstated. CMS Network accepts Title 21 eligible children throughout the coverage month.

Children’s Medicaid Provides medical coverage for children from birth through 18 Needs to meet low-income eligibility requirement The Agency for Health Care Administration administers program The Department of Children and Family Services determines eligibility

Medicaid Eligibility Florida Resident Under age 19 Live with Adult Caregiver Disclose 3 rd Party Insurance Citizenship Proof of SSN application U.S. citizen or Qualified Non-Citizen Parent or caretaker's citizenship does not apply Income Children under age 1 household gross income <200% FPL Children ages 1-5 household gross < 133% FPL Children ages 6-18 household gross income <100% of

Medicaid Eligibility If children do not qualify for Medicaid due to family income, the application will be sent electronically to Florida Healthy Kids (FHK).

Children’s Medicaid Mandatory Benefits Child Health Check-UpLicensed Midwife Services Family Planning ServicesHome Health Services Physician ServicesHospital Services Portable X-Ray ServicesIndependent Laboratory Services Rural Health Clinic ServicesAdvanced Registered Nurse Practitioner Services Transportation Services

Children’s Medicaid Optional Benefits Ambulatory Surgical CentersState Mental Health Hospital Services Medical Foster Care ServicesHearing Services Assistive Care ServicesHospice Services Mental Health Targeted Case ManagementTransplant Services – Organ and Bone Marrow Birth Center ServicesHearing Services-Newborn Screening Optometric ServicesVisual Services Child Health Services Targeted Case ManagementIntermediate Care Facility Services for the Developmentally Disabled Physician Assistant ServicesTherapy Services – Occupational, Physical, Respiratory, Speech/Language Pathology Chiropractic ServicesRegistered Nurse First Assistant Services Podiatry ServicesDurable Medical Equipment and Medical Supplies Community Mental Health ServicesSchool-Based Services Programs Prescribed Drug ServicesEarly Intervention Services - School District Program County Health Department Clinic ServicesFederally Qualified Health Centers - County Health Department Program Prescribed Pediatric Extended Care ServicesFreestanding Dialysis Center Services Dental Services

MediKids The Agency for Health Care Administration (AHCA) manages the program Low-cost health insurance for children ages 1 through 4 Child is not eligible for Medicaid Child is uninsured The MediKids program is similar to Children’s Medicaid ◦Children enrolled in MediKids receive Medicaid benefits and medical services from Medicaid providers

Medikids Benefits What’s Covered Ambulance Lab & X-Ray Services Hospital Inpatient Services Dental Services Hospital Outpatient & Ambulatory Surgical Services Durable Medial Equipment Medical Services from Primary Care Provider Speech, Physical, Respiratory & Occupational Therapy Medical Services from Specialist Private Duty Nursing Vision Services, including Eyeglasses Mental Health Services Hearing Services, including Hearing Aids Home Health Services Prescription Drugs What’s Not Covered Cosmetic Procedures Home & Community-Based Services Custodial Care Impatient Psychiatric Services in Specialty Hospitals Diapers, Incontinence Supplies & Other Over the Counter Medical Supplies Respite Services Experimental Services

Florida Healthy Kids Florida Healthy Kids manages the program Low-cost health insurance for children ages 5 through 18 Child is not eligible for Medicaid Child is uninsured Focuses on preventive care in an effort to promote children's health and learning Coverage Full Pay Subsided/Lower Premium

Florida Healthy Kids Benefits Office visits for Minor Illness, Accident Care (Primary Care Provider)$5 Co-Pay Well Child CareNo Co-Pay Routine Vision and Hearing Screening (Primary Care Provider)No Co-Pay Specialist Office Visit (Referred)$5 Co-Pay Behavioral Health Services (Pre-authorized, Outpatient - 40 visits per year, Inpatient/Residential - 30 days per year) $5 Co-Pay Substance Abuse Rehabilitation and Treatment (Pre-authorized, 40 outpatient visits, 7 inpatient days for detox, 30 residential days) No Co-Pay Diagnostic Testing (Laboratory, X-rays, etc.)No Co-Pay Emergency Services$10 Co-Pay Emergency Ambulance Services$10 Co-Pay Hospital Inpatient Medical and Surgical Care (Pre-Authorized, includes 15 day rehabilitation stay for non-acute confinement) No Co-Pay Semi-private room Surgeon Fees (Pre-authorized)No Co-Pay Maternity Services and DeliveryNo Co-Pay Anesthesia ServicesNo Co-Pay

Florida Healthy Kids Benefits Organ Transplants (Non-experimental, when authorized by Insurer at Insurer approved facility) No Co-Pay Pharmacy (Medicaid formulary, Generic)$5 Co-Pay Durable Medical Equipment and Prosthetic Devices (Pre-Authorized)No Co-Pay Refractions/Corrective Lenses (After failing vision screening - 1 pair every 2 years or when head size or prescription changes warrant) $10 Co-Pay Hearing AidsNo Co-Pay Outpatient PT, OT and Speech Therapy (Up to 24 sessions within 60 day period)$5 Co-Pay Home Health Services (Skilled Nursing Only)$5 Co-Pay Hospice Services$5 Co-Pay Skilled Nursing Facility (Pre-Authorized, 100 days per year)No Co-Pay

When the family finishes the online application…. Print documents to send in Keep a copy of the application & documentation for their records Write their application confirmation number or family account number each document they send Do not send original documents, but send readable copies Send documents one of two ways: 1. By Fax 2. By Mail Completed Applications

On-line account review Need ACCOUNT NUMBER and PARENT’S SSN Call 800/821-KIDS (800/ ) for questions regarding: Status of an application Existing Florida KidCare account Additional Information

Family Assistance Sites Help families understand what can they expect: ◦ Explain Application Options and Process ◦ Explain How to use the Online Application Provide Customer Service Number and Contact Information: For questions about an application’s status: call (the call is free) or visit For questions about an existing Florida KidCare Account, call

Monthly Premium Payments 24 hours a day, 7 days a week Visa, MasterCard and Discover accepted Direct from checking or savings account Fee may be charged Internet & Telephone Mail a check or money order with payment coupon to Florida KidCare Write your family account number on check or money order Mail Not making a payment will result in a cancellation of coverage Nonpayment cancelation: Cannot reapply for coverage for one month (30 Days) Enrollees have 10 working days to request a dispute resolution & benefits reinstated Non-Payment

Renewal 12 Month Renewal Pre-populated forms to review Need to update income verifications Notification Letter in mail 2 months prior to renewal date Important to respond ASAP to letter Family Check List Your family's most recent tax return (Form 1040) Your Wage and Earning Statement (W- 2 Form) Current Pay Stubs (covering the last 4 weeks) Employer Insurance Costs Florida KidCare Insurance Access Statement Non-renewal of coverage means the loss of health insurance benefits!

Importance of Renewal

Florida’s Children’s Hospitals Assistance Local Coalition Collaboration Community Resource List for Computer Access Computer Labs

Florida Covering Kids and Families: Jodi Ray, M.A. Principle Investigator, Program Director (813) ; Avery Slyker, Ph.D. Coordinator, Corporate Outreach & Training (813) ; Florida Association of Children’s Hospitals: Melanie Hall, Florida Association of Children’s Hospitals (813) Information Web Sites: If you have questions or would like further information about Florida Covering Kids and Families or Florida KidCare outreach activities contact: For more information