Florida KidCare Health Coverage

Quick Facts

• Program structure: Umbrella covering four programs—Medicaid for Children, MediKids, Florida Healthy Kids, and Children’s Medical Services (CMS) Health Plan.
• Cost: Many families pay $0; subsidized plans start at $15 or $20 per month for comprehensive benefits.
• Coverage: Includes doctor visits, hospital stays, dental, vision, behavioral health, prescriptions, and preventive services.
• Enrollment: Open year-round with processing times typically under 30 days; emergency expedited enrollment available.
• Administration: Managed by the Florida Healthy Kids Corporation in partnership with the Agency for Health Care Administration (AHCA).
• Renewal: Annual renewal required; income and residency must be reverified.

Program Overview

Florida KidCare ensures that children have access to affordable health care regardless of family income. The program acts as a “one-stop shop” where families submit a single application and are routed to the appropriate coverage tier. Medicaid covers the lowest-income households; MediKids and Florida Healthy Kids serve moderate-income families, and CMS Health Plan supports children with special medical needs. In 2025, Florida expanded telehealth benefits and increased reimbursement rates for pediatric specialists, making KidCare more robust.

KidCare offers continuity: children can transition between programs as family income fluctuates without losing coverage. For example, a child might start on Medicaid when a parent is unemployed, then move to Florida Healthy Kids when the parent gains employment. Premiums adjust accordingly, and families receive 60-day notice before changes take effect.

2025 Enhancements

• Telehealth parity: All plans now cover telehealth visits at the same rate as in-person visits, including behavioral health.
• Mental health navigator: Each county assigns a navigator to connect families with therapists, autism services, and crisis lines, reducing wait times.
• Premium relief: Families facing temporary hardship can request up to three months of premium deferment without losing coverage, provided they submit hardship affidavits.
• Dental expansion: Florida Healthy Kids added orthodontia coverage for severe cases upon prior authorization.
• Language access: The application portal supports 15 languages and offers live chat translation.

Eligibility Pathways

1. Residency: Child must live in Florida and intend to remain. Proof includes school enrollment, lease agreements, or utility bills.
2. Age: Under 19 at time of application. Coverage extends through the month of the child’s 19th birthday.
3. Citizenship/immigration: U.S. citizens, lawful permanent residents, and certain noncitizens (including refugees and asylees) qualify. Undocumented children may receive emergency services but not full coverage; however, some counties fund local programs.
4. Income thresholds: Medicaid for Children serves families up to 133% of the Federal Poverty Level (FPL); MediKids and Florida Healthy Kids extend to 210% FPL with subsidized premiums. Full-pay options exist for higher incomes.
5. Insurance status: Children must be uninsured or have limited benefits that do not meet KidCare standards. Families transitioning from employer coverage must observe waiting periods unless coverage loss was involuntary.
6. Premium payment: For subsidized plans, families pay monthly premiums via auto-draft, online portal, or cash at authorized retailers.

Application Roadmap

1. Gather documents: Birth certificates, Social Security numbers, proof of income (pay stubs, self-employment ledgers), and proof of Florida residency.
2. Complete online application: Visit FloridaKidCare.org or call 1-888-540-KIDS for telephone assistance. The system determines the appropriate program and calculates preliminary premiums.
3. Submit verification: Upload documents within 60 days. Acceptable forms include employer letters, unemployment statements, or IRS transcripts for self-employed families.
4. Respond to requests: AHCA may request additional information. Respond within 10 days to avoid delays. Check email and mail for notices.
5. Receive eligibility notice: Review the program assignment (Medicaid, MediKids, Healthy Kids, or CMS). Select a health or dental plan within the designated timeframe (usually 30 days).
6. Pay initial premium (if required): Coverage starts the month after payment. For Medicaid, coverage can be retroactive up to three months if eligibility existed.
7. Select primary care provider: Choose a pediatrician within the network. Many plans allow online provider selection.

Documentation Checklist

• Proof of identity and citizenship (birth certificate, passport, naturalization papers)
• Social Security numbers for applicants (if available)
• Proof of Florida residency (lease, mortgage statement, school enrollment letter)
• Proof of income (recent pay stubs, employer statement, self-employment ledger, child support documentation)
• Insurance termination letter (if dropping employer coverage)
• Medical documentation for CMS Health Plan (doctor’s evaluation, Individualized Education Program)
• Premium payment method (bank account, debit card, or payment voucher)

Timeline Benchmarks

• Day 1: Submit application.
• Day 10: Receive notice if additional documents required.
• Day 30: Eligibility determination. If no decision, contact customer service for escalation.
• Day 35: Choose health plan; failure to choose leads to auto-assignment.
• Day 40: Coverage begins after premium payment; Medicaid can activate retroactively.
• Annual: Renewal notice arrives 60 days prior to anniversary. Update income promptly.

Strategies for Success

1. Automate premiums: Set up auto-draft to avoid lapses. Missed payments can trigger disenrollment after 30 days.
2. Use premium relief: If you face job loss, submit a hardship request via the online portal. Provide documentation within 30 days to qualify for deferment.
3. Update income changes immediately: Mid-year increases can shift you from Medicaid to Healthy Kids. Reporting quickly prevents overpayments and ensures continuous coverage.
4. Leverage wellness benefits: Schedule annual well visits, dental cleanings, and vision screenings. Completing these can qualify you for Healthy Kids reward points redeemable for gift cards or sports physicals.
5. Coordinate with schools: School nurses often assist with applications and can fax documents directly to KidCare.
6. Track important mail: Many notices arrive via USPS. Opt into text alerts to receive reminders about premiums, renewals, and plan changes.

Common Pitfalls

• Missing document deadlines: If you fail to verify income within 60 days, the application closes. Use the document tracker to ensure uploads are successful.
• Not choosing a plan: Auto-assigned plans may not include your preferred doctors. Research networks immediately and make an active selection.
• Premium lapses: Two missed payments lead to termination. Re-enrollment may require a waiting period and payment of past-due amounts.
• Misreporting household size: Include all children and tax dependents. Incorrect household counts can inflate premiums or disqualify you.
• Not updating address: Returned mail can cause coverage termination. Update online portal within 10 days of moving.

Coordination with Other Programs

• SNAP/TANF: Eligibility systems share data. If you already receive SNAP, pre-populated income data speeds KidCare approval.
• WIC: Many KidCare families qualify for Women, Infants, and Children nutritional support. Coordinated appointments reduce paperwork.
• Children’s Medical Services (CMS): For complex medical needs, KidCare routes families to CMS for care coordination, durable medical equipment, and specialists.
• School-based health centers: Use KidCare coverage for services delivered at school clinics, especially for behavioral health.
• Dental sealant programs: Florida Healthy Kids partners with county health departments to provide free sealants, using KidCare coverage to ensure follow-up care.

Success Stories

• Entrepreneur family: The Lopez family runs a food truck with fluctuating income. KidCare routed their 8-year-old to Healthy Kids with a $20 premium and their toddler to Medicaid. When their income dipped, both children transitioned to Medicaid without a gap.
• Special needs support: Maya, age 12, has cystic fibrosis. CMS Health Plan coordinates pulmonology visits, home nursing, and pharmacy deliveries. The family’s navigator also linked them to respite care grants.
• Rural access: The Carter family in the Panhandle uses telehealth to connect with pediatric specialists in Jacksonville. KidCare’s telehealth parity ensures copays mirror in-person visits, saving travel costs.

Frequently Asked Questions

Can undocumented parents apply for their citizen children? Yes. Parents without Social Security numbers can complete the application; only the child’s status is considered.

Does KidCare cover mental health? Yes. Behavioral therapy, counseling, and psychiatric services are covered. Telehealth options are available statewide.

What happens if my income changes mid-year? Report the change. The system recalculates premiums or program assignment. You’ll receive notice before any change takes effect.

Can my child see specialists out of network? Most plans require referrals. CMS Health Plan offers broader networks for complex conditions. Request prior authorization for out-of-network care.

Is there coverage for college students under 19? Yes. KidCare covers students enrolled in high school or college as long as they remain under age 19 and meet residency and income rules.

Resource Guide

• FloridaKidCare.org: Application portal, premium calculator, provider search.
• KidCare customer service: 1-888-540-KIDS with multilingual support.
• County navigators: Local organizations (Healthy Start, Boys & Girls Clubs) assist with applications and renewals.
• Healthcare.gov: For parents aging out of KidCare, explore Marketplace plans with premium tax credits.
• Florida SHOTS: Immunization registry accessible to KidCare providers; request printouts for school requirements.

Glossary

• FPL (Federal Poverty Level): Income benchmarks used to determine eligibility and premium levels.
• Premium deferment: Temporary pause on premium payments granted during financial hardship.
• Primary care provider (PCP): Doctor chosen to coordinate care; required for referrals.
• CMS Health Plan: Specialized KidCare component for children with chronic or serious medical conditions.
• Redetermination: Annual process of verifying eligibility for continued coverage.

Florida KidCare’s streamlined application and comprehensive benefits make it a cornerstone for family health security. By staying organized, leveraging navigators, and maximizing preventive care, families can keep children insured and thriving from infancy through adolescence.