OPPAGA text logo with graphic of FL historic capitol
OPPAGA text logo with graphic of FL historic capitol

Agency for Health Care Administration

Florida KidCare

What is the purpose of the program?

Florida KidCare provides low or no-cost health insurance for children from birth through age 18 whose family incomes are too low to afford health insurance coverage for their children. Florida KidCare consists of four programs: Children's Medicaid, MediKids, Healthy Kids, and Children's Medical Services.

How is the program administered?

Florida KidCare is a partnership among the Agency for Health Care Administration, the Department of Children and Families, the Department of Health, and the Florida Healthy Kids Corporation to administer Florida's Children's Health Insurance Program (CHIP). The Agency for Health Care Administration, as the lead state agency for federal Medicaid and CHIP funds, contracts with the Healthy Kids Corporation to perform major administrative functions for the Florida KidCare Program. These functions include processing applications, screening for Medicaid eligibility, determining eligibility for the CHIP components of Florida KidCare, and billing and collecting premiums.

Who is eligible for Florida KidCare?

Children are eligible for Florida KidCare if they do not have health insurance, are under age 19, are U.S. citizens or qualified non-citizens, and meet income eligibility requirements. Additional eligibility rules vary by program as described below.
  • Children's Medicaid serves children from birth through age 18 from income-eligible families.Infants in families with earnings between 185% and 200% of the federal poverty level are financed with CHIP funds; other age groups and income levels are financed by Medicaid funds. This Florida KidCare component is administered by the Agency for Health Care Administration. Eligibility determination is conducted by the Department of Children and Families or the Social Security Administration.There are no premium or co-payment requirements under Children's Medicaid. CHIP funds are used to finance Children's Medicaid recipients in families.
  • MediKids serves children ages 1 through 4. This Florida KidCare component is financed by CHIP funds and is administered by the Agency for Health Care Administration. Eligibility determination and premium collection are conducted by the Florida Healthy Kids Corporation. Families pay a monthly premium of no more than $20 depending on income, and there are no co-payment requirements under MediKids.
  • Florida Healthy Kids serves children ages 5 through 18 who are not Medicaid eligible.This program component is financed by CHIP, general revenue, and local funds, as well as by families that pay the full premium amount. The Florida Healthy Kids Corporation administers this program component and is governed by a board of directors representing each Florida KidCare component, including the Department of Children and Families, the Agency for Healthcare administration, the Department of Health, and the Department of Financial Services. Premiums and co-payments are required under Healthy Kids. For children in most families with incomes between 133% and 200% of the federal poverty level coverage costs no more than $20 a month. Families with incomes above 200% of the federal poverty level, or those with children who have been legal permanent residents for less than five years, pay the entire premium amount, or what is referred to as the full-pay monthly premium.
  • Children's Medical Services operates the CMS Managed Care Plan, a statewide specialty plan for children from birth to 21 years of age who have serious and chronic physical, developmental, behavioral or emotional conditions. Children who are clinically eligible can choose the CMS Network as a benefit plan option if they meet income eligibility requirements for Medicaid or CHIP. This component of Florida KidCare is financed by Medicaid, CHIP, and general revenue funds. Financial eligibility determination is conducted either by the Department of Children and Families (Medicaid) or the Healthy Kids Corporation. The Healthy Kids Corporation collects premium payments for the CHIP component.  Clinical eligibility for the program is determined by the Department of Health or upon receipt of a treating physician's attestation for clinical eligibility. Behavioral health eligibility is determined by the Department of Children and Families which also administers the behavioral health network component of Children's Medical Services. Premiums are required for CHIP-funded enrollees, but there are no co-payment requirements.

How many children were enrolled in KidCare?

At the end of calendar year 2018, a total of 2,361,682 children were enrolled the Florida KidCare program. This is a decrease of 2.0% from the previous calendar year, mainly from Medicaid, which experienced a decrease of 3.8%.

How satisfied are families with the health plan provided to them through Florida KidCare?

For Fiscal Year 2018-19, 93.1% of families enrolled in Florida KidCare reported they were satisfied with the care provided under the program, a satisfaction level just below the agency's 95% satisfaction goal. In addition, 94.96% of all KidCare eligible enrollees successfully renewed KidCare coverage, above the approved standard of 90.0%.

In its December 2019 report on Florida Kidcare, researchers at the Institute for Child Health Policy found that in Calendar Year 2018, Medicaid MMA plans utilizing the Children with Chronic Conditions Questions met or exceeded the national Medicaid benchmarks 10 out of the 13 times that a national Medicaid benchmark was available.  And MediKids met or exceeded the national CHIP benchmarks four out of eight times where there was a CHIP benchmark.  Overall, 89% of Florida KidCare families reported positive experiences with getting care quickly, just below the national Medicaid (90%) and CHIP (91%) benchmarks. Most Florida KidCare families (75%) rated their primary care provider as a '9' or '10' with 72% rating their specialty care provider seen most often as a '9' or a '10.' When rating their overall experiences, 71% of the Florida KidCare families rated their health as a '9' or '10,' and nearly 70% rated their health plan experience as a '9' or '10.'

How are these activities funded?

Florida KidCare is funded through federal and state revenues.  For Children's Medicaid, the federal share is funded through Title XIX of the Social Security Act; during Federal Fiscal Year 2020, Florida's match rate for Title XIX Medicaid would have been 61.47% except for the Families First Coronavirus Response Act of 2020.  The act provides a temporary 6.2% increase to the FMAP for each calendar quarter beginning on the first day of the  public health emergency period. Because the coronavirus was declared a public health emergency on January 27, the increase in funding to the FMAP began January 1, 2020 which raised Florida's FMAP.  For Federal Fiscal year 2020, the total Federal match for Florida's CHIP is 67.67% federal funding to 32.33% state funding. The state also receives Title XXI (CHIP) funds to provide health care services for certain children not covered by Medicaid or through the non-Medicaid-funded components of Florida KidCare. Florida's Federal Fiscal Year 2020 match rate for Florida CHIP would have been 73.03% except for two occurances: the Healthy Kids Act that enhanced the existing CHIP federal matching rate by 11.5% for the time period beginning October 1,2019 and ending September 30, 2020; and the Families First Coronavirus Response Act of 2020. Because the Families First Coronnavirus Response Act of 2020 increase is calculated based on the Title XIX funding, the enhanced Title XXI is not as high as the Title XIX increase.  The increase in funding raised Florida's CHIP for Federal Fiscal Year 2020 by another 4.34%. As a result, the total Federal match for Florida's CHIP is 88.87%.  The Legislature does not authorize positions for the Florida KidCare Program. 

Fiscal Year: 2020-21
Fund Salary Rate/ Position General Revenue Trust Funds
SPECIAL CATEGORIES
GRANTS AND AIDS - FLORIDA HEALTHY KIDS CORPORATION
FROM GENERAL REVENUE FUND
FROM MEDICAL CARE TRUST FUND
SPECIAL CATEGORIES
CONTRACTED SERVICES
FROM GENERAL REVENUE FUND
FROM GRANTS AND DONATIONS TRUST FUND
FROM MEDICAL CARE TRUST FUND
SPECIAL CATEGORIES
GRANTS AND AIDS - CONTRACTED SERVICES - FLORIDA HEALTHY KIDS ADMINISTRATION
FROM GENERAL REVENUE FUND
FROM MEDICAL CARE TRUST FUND
SPECIAL CATEGORIES
GRANTS AND AIDS - FLORIDA HEALTHY KIDS CORPORATION DENTAL SERVICES
FROM GENERAL REVENUE FUND
FROM MEDICAL CARE TRUST FUND
SPECIAL CATEGORIES
MEDIKIDS
FROM GENERAL REVENUE FUND
FROM GRANTS AND DONATIONS TRUST FUND
FROM MEDICAL CARE TRUST FUND
SPECIAL CATEGORIES
CHILDREN'S MEDICAL SERVICES NETWORK
FROM GENERAL REVENUE FUND
FROM GRANTS AND DONATIONS TRUST FUND
FROM MEDICAL CARE TRUST FUND
TOTAL
150,709,512
509,849,592

Updates

Removing the lifetime maximum cap on the Florida Healthy Kids Program expenses.  The 2020 Legislature enacted Chapter 2020-12, Laws of Florida, that removes the $1 million lifetime maximum cap on covered expenses for children enrolled in the Florida Healthy Kids Program.  The law took effect April 8, 2020.

Ensuring and Coordinating Children's Mental Health Services.  The 2020 Legislature enacted Chapter 2020-107, Laws of Florida, that requires the Department of Children and Families (DCF) and the Agency for Health Care Administration (AHCA) to identify children and adolescents who are the highest utilizers of crisis stabilization services and take appropriate action to coordinate the behavioral health needs of such children more effectively.  The law also requires DCF and AHCA to jointly submit to the Legislature a quarterly report listing the actions taken by both agencies to better serve such children.  In addition, the law requires AHCA to conduct, or contract for, the systematic and continuous testing of Medicaid managed care plan provider network databases to confirm network accuracy and that behavioral health providers are accepting enrolless.   

Where can I find related OPPAGA reports?

A complete list of related OPPAGA reports is available on our website.

Where can I get more information?

Other Reports
The Auditor General reports on agency operations are available on its website.
The Florida KidCare Program Evaluation Calendar Year 2018, University of Florida, Institute for Child Health Policy, December 2019.
Medicaid and CHIP Eligibility, Enrollment, and Cost Sharing Policies as of January 2020: Findings from a 50-State Survey, Kaiser Family Foundation, March 26, 2020.
Medicaid and CHIP Enrollment Decline Suggests the Child Uninsured Rate May Rise Again, Georgetown University, Health Policy Institute, Center for Children and Families, May 2019.
The Children's Health Insurance Program, Georgetown University, Health Policy Institute, Center for Children and Families, February 2017.
Measuring and Improving Health Care Quality for Children in Medicaid and CHIP: A Primer for Child Health Stakeholders, Georgetown University, Health Policy Institute, Center for Children and Families, March 2016.
2017 Annual Report, Florida Healthy Kids Corporation.
What Would Happen if CHIP Went Away? Our Research Suggests Kids (for now) Would be Significantly Worse Off, Georgetown University, Health Policy Institute, Center for Children and Families, May 2014.
How Do Updated 2014 Federal Poverty Level Thresholds Impact Medicaid, CHIP & Premium Tax Credit Eligibility?, Georgetown University, Health Policy Institute, Center for Children and Families, February 2014.
2014 Annual Report, Florida Healthy Kids Corporation.
Medicaid/CHIP Participation Among Children and Parents, The Robert Wood Johnson Foundation and The Urban Institute, December 2012.
Websites of Interest
Florida Healthy Kids
Florida KidCare
KidCare Online Application
Center for Medicare and Medicaid Services Children's Health Insurance Program
Kaiser Family Foundation, Medicaid/CHIP
Georgetown University, Health Policy Institute, Center for Children and Families
Performance Information


Performance measures and standards for the department may be found in its Long Range Program Plan.

What are the applicable statutes?

Chapter 409 Part II, Florida Statutes.

Whom do I contact for help?

Florida KidCare, 1-888-540-5437

Website