Medicaid, SCHIP, and Federal Authority²

Florida Medicaid Reform Waiver - In October 2005, Florida received approval for its Medicaid Reform waiver. The waiver does not expand eligibility; however, it makes significant changes to the program. The Florida Medicaid Reform Model comprises comprehensive and catastrophic financing mechanisms, an individual enhanced benefit account, or an option to opt-out of Medicaid and direct their Medicaid premium to employer-sponsored insurance. The program will be initially implemented in two counties and after one year expand to three additional counties. Individuals covered under the Medicaid Reform proposal will have their choice of managed care plans and benefit packages.

High-Risk Pool  

Florida's high-risk pool, the Florida Comprehensive Health Association has been closed to new enrollment since 1991. There are approximately 500 individual who remain enrolled in the program which was originally established in 1983. The premium cap varies (between 200 percent and 250 percent) and is determined by risk. The program is financed through premiums and assessments on insurers.

Limited-Benefit Plan  

In 2002, the Florida legislature passed SB46E, which allowed a Health Flex Plan to be sold by insurers, HMOs, provider-sponsored organizations, and public or private community-based organizations as a pilot in areas of the state with a high uninsured rate. In 2004, legislation was approved allowing Health Flex plans throughout the state.

Health Flex can limit/exclude benefits required by law, cap the total amount of claims paid per year, limit enrollment, or take any combination of these actions. Health Flex plans may enroll individuals with family incomes no greater than 200 percent FPL and who have been uninsured for the past 6 months and are not otherwise eligible for public programs. Plans are free from all statutorily required health care benefit mandates.

	Notes and Sources

Information presented in the profile was summarized in December 2006 from a review of state Web sites and reports, and through contacts with state officials. In most cases the profiles were reviewed by state officials; however, it is possible that states have implemented strategies that are not reflected in this profile.

² The profile only includes Medicaid and SCHIP waivers intended to make comprehensive expansions to the uninsured. At this time, the profiles do not include Family Planning, Pharmacy Plus waivers, or long-term care waivers.

³ Urban Institute and Kaiser Commission on Medicaid and the Uninsured estimates based on the Census Bureau’s March 2005 and 2006 Current Population Survey.