Summary

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 and State Children’s Insurance Program (known as Title XXI)).  The Florida Healthy Kids Corporation (FHKC), under contract with AHCA, is the primary provider of Title XXI services.  FHKC responsibilities include eligibility determination, collection of premiums, contracting with authorized insurers, and the development of benefit packages.  Of the $531 million budgeted for the KidCare Program (excluding Medicaid for Children) for the 2005-06 fiscal year, $404 million was budgeted for FHKC.

In audit report No. 2006-072, we disclosed significant findings related to eligibility determinations.  The scope of this audit focused on the current status of those findings during the period January 2006 through February 2006 and selected actions taken through June 2006.  While some improvements were noted since the previous audit, our testing disclosed the following issues:

Finding No. 1:         FHKC did not ensure that only eligible children were participating in the Title XXI Program during the period January 2006 through February 2006.

Finding No. 2:        To help avoid adverse selection, the number of children participating in the Healthy Kids Program whose family income exceeds 200 percent of the Federal Poverty Level must not exceed ten percent of the total enrollees in the Healthy Kids Program.  While FHKC has been monitoring the participation rate for these children, it has not developed written procedures to ensure compliance with the statutory limit.

Finding No. 3:        For some applicants, the KidCare application format did not facilitate the collection of sufficient information to allow a complete evaluation of eligibility.

The Executive Director's response  is included in its entirety at the end of this report as Appendix B.