Caring for the Young

Health insurance is on a lot of people’s minds these days as America’s new Affordable Care Act continues to roll out. But even before the landmark legislation was conceived, Florida was taking steps to help insure its kids with a program that has been in place since 1998.

The Florida KidCare program is made up of four programs (Medicaid, MediKids, Healthy Kids and Children’s Medical Services Network) and currently provides affordable health and dental coverage to approximately 2.1 million Floridians age 18 and under.

In Highlands County, just more than 1,500 children are insured through the program.

Rich Robleto, executive director of Florida Healthy Kids, the administrative arm of Florida KidCare, said the original program was designed to fill a gap between poor children who qualified for Medicaid and children who were insured through a parent’s employer.

“There were a lot of people in the middle,” said Robleto. Many working families worked for small companies that did not offer health insurance benefits, yet they made too much money to qualify for Medicaid. “Florida turned out to be such a successful program that it turned out to be a model. About nine years later, the federal government modeled the Children’s Health Insurance Program after it,” Robleto said.

Indeed, according to the most recent data from the Center for Children and Families at Georgetown University, Florida is one of the top three states leading the nation in reducing the number of uninsured children, down from 16.7 percent to 11.9 percent in the past three years.

“We were number one last year,” said Robleto, who said he was not pleased with the numbers. “Any number of uninsured is one percent too many, but we are making progress,” he said.

The four programs under the Florida KidCare umbrella are as follows:

MediKids serves non-Medicaid children ages one to four and is administered by the state Agency for Health Care Administration.

Healthy Kids serves non-Medicaid children ages five to 18 and is administered by the Florida Healthy Kids Corporation.

Children’s Medical Services Network (CMSN) serves children with special health care needs. The administration for physical needs is handled by the Florida Department of Health; behavioral needs are handled by the Department of Children and Families.

Medicaid serves children under the age of 19. It is administered by the Agency for Health Care Administration, and eligibility is determined by the Department of Children and Families.

Infants in their first year of life are covered by Medicaid.

Enrollment for Florida KidCare is open year-round, and premium assistance is available for families making up to 200 percent of the federal poverty level. Using 2013 guidelines, that would be an annual income of up to $47,100 for a family of four. Most families who qualify pay $15 to $20 per month for the program (not per child). Families who don’t qualify for premium assistance can pay full monthly premiums of $196 for pre-school-aged children and $147 for school-aged children. Parents must renew every year.

And the coverage the kids receive under the program is extensive. Robleto said the Florida KidCare program was designed to make sure that children have access to health care services, including keeping those services affordable. While Medicaid services for children are free, MediKids and Healthy Kids programs may have small co-pays, for example $5 for an office visit. And most medical costs are covered, including physicals, prescriptions, hospital stays, emergency care and immunizations.

“We are committed to not have families’ costs exceed 5 percent of their annual income,” Robleto said. He referred to the designations being used to compare different insurance plans, such as bronze, silver, gold, and platinum. “Those different metal levels are designed to cover a percentage of a family’s medical costs,” explained Robleto. Bronze plans cover 60 percent, silver plans cover 70, gold covers 80 and platinum covers 90. “Our program is about 95 percent,” Robleto said.

He also said that while there is about a two-month waiting period for KidCare, and children must be uninsured to be eligible, there are multiple exceptions to ensure that kids who need medical care are able to quickly get on a plan and receive that care.

Premiums paid into the program go to commercial health plans from insurers like United Healthcare, and the program is funded through the families’ premiums and federal and state appropriations. The appropriations are a combination of general revenue, tobacco settlement and federal block grant funds, according to an email from Florida Healthy Kids Communication Specialist Christie Goss.

The Florida Healthy Kids Corporation is governed by a board of directors representing state agencies, including the Florida Department of Financial Services, the Department of Children and Families, the Agency for Health Care Administration, the Florida Department of Education, the Florida Pediatric Society, the Florida Dental Society, and other experts on children’s health policy and programs, the email stated.

While it isn’t difficult to find providers for medical care using the Florida KidCare program, Karen L. Neale Tedder shared on the Highlands Today Facebook page, “the only thing that is frustrating is trying to find dental and orthodontic locally.” She added, “It’s a wonderful program.”

As far as the effect of the Affordable Care Act on the program, Robleto said the new law is “still somewhat fluid” and it’s too early to tell if changes will affect current KidCare families, but families probably won’t notice any change. He did say families applying for insurance through the new health care exchanges who are eligible for premium assistance through Florida KidCare will be routed there.

For information on the Florida KidCare program, visit www.floridakidcare .org or call (888) 540-5437.

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