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Report Number:

2006-072

Report Title:

Florida KidCare Program - Florida Healthy Kids Corporation - Eligibility Issues - Operational Audit

Report Period:

07/2004-03/2005

Release Date:

12/16/2005

The KidCare Program was created to provide health care benefits to previously uninsured, low-income children.  The Agency for Health Care Administration (AHCA) is the lead State agency for the Federally funded portion of the KidCare Program (i.e., Medicaid for Children and State Children’s Insurance Program (known as Title XXI)).  The Florida Healthy Kids Corporation (FHKC), under contract with AHCA, is the largest of several providers of Title XXI services.  FHKC responsibilities include eligibility determination, collection of premiums, contracting with authorized insurers, and the development of benefit packages.  Approximately $531 million was budgeted for the KidCare Program (excluding Medicaid for Children) for the 2004-05 fiscal year.  Of that amount, $398 million was budgeted for FHKC.

The audit covered the period July 2004 through March 2005, and disclosed the following issues related to eligibility:

Finding No. 1:         FHKC did not ensure that only eligible children were redetermined eligible for the Title XXI Program during the period July 2004 through December 2004.  In addition, redeterminations were not always completed within the established time periods. 

Finding No. 2:         The presumptive eligibility period established by FHKC allowed children to be enrolled, pending redeterminations, for up to four months after their six-month eligibility period. 

Finding No. 3:         FHKC did not ensure that only eligible children were enrolled in the Title XXI Program during the January 2005 enrollment period. 

Finding No. 4:         The KidCare application format did not collect sufficient information to properly demonstrate eligibility. 

Finding No. 5:         Despite legislative changes effective January 1, 2005, FHKC did not discontinue State-subsidized KidCare coverage for State employee dependents until February 28, 2005.  The additional two months of coverage cost approximately $35,000.

Finding No. 6:         KidCare procedures allowed for the potential concurrent enrollment of a child in both Medicaid and Title XXI.

Finding No. 7:         Due to a programming error, the Department of Health (DOH) incorrectly enrolled children in the Children’s Medical Services (CMS) component of KidCare.

The Executive Director of Florida Healthy Kids Corporation and the Secretary of Department of Health provided responses which are included in their entirety at the end of this report as Appendices B and C.