1999 Florida Code
TITLE XXX SOCIAL WELFARE
Chapter 409 Social and Economic Assistance  
409.816   Limitations on premiums and cost-sharing.

1409.816  Limitations on premiums and cost-sharing.--The following limitations on premiums and cost-sharing are established for the program.

(1)  Enrollees who receive coverage under the Medicaid program may not be required to pay:

(a)  Enrollment fees, premiums, or similar charges; or

(b)  Copayments, deductibles, coinsurance, or similar charges.

(2)  Enrollees in families with a family income equal to or below 150 percent of the federal poverty level, who are not receiving coverage under the Medicaid program, may not be required to pay:

(a)  Enrollment fees, premiums, or similar charges that exceed the maximum monthly charge permitted under s. 1916(b)(1) of the Social Security Act; or

(b)  Copayments, deductibles, coinsurance, or similar charges that exceed a nominal amount, as determined consistent with regulations referred to in s. 1916(a)(3) of the Social Security Act. However, such charges may not be imposed for preventive services, including well-baby and well-child care, age-appropriate immunizations, and routine hearing and vision screenings.

(3)  Enrollees in families with a family income above 150 percent of the federal poverty level, who are not receiving coverage under the Medicaid program or who are not eligible under s. 409.814(5), may be required to pay enrollment fees, premiums, copayments, deductibles, coinsurance, or similar charges on a sliding scale related to income, except that the total annual aggregate cost-sharing with respect to all children in a family may not exceed 5 percent of the family's income. However, copayments, deductibles, coinsurance, or similar charges may not be imposed for preventive services, including well-baby and well-child care, age-appropriate immunizations, and routine hearing and vision screenings.

History.--ss. 41, 57, ch. 98-288.

1Note.--Section 57, ch. 98-288, provides that:

"Sections 409.810 through 409.820, Florida Statutes, as created by this act, are repealed, subject to prior legislative review, on the first July 1 occurring at least 1 year after the effective date of an act of the United States Congress or the federal Health Care Financing Administration which:

"(1)  Reduces Florida's federal matching rate under Title XXI of the Social Security Act to less than 65 percent federal match; or

"(2)  Reduces the federal funds allotted to Florida under Title XXI of the Social Security Act to less than $250 million annually."