Florida Healthy Kids is a state-run health and dental insurance program for children ages 5 through 18, with subsidized monthly premiums as low as $15 or $20 for families that meet income requirements. It’s one of four programs under the Florida KidCare umbrella and is aimed at school-age children in families earning too much for Medicaid but not enough to comfortably afford private coverage.1Florida KidCare. Frequently Asked Questions Families above the subsidy limits can still buy in through a full-pay option.
Who Qualifies
Your child may be eligible if they are between the ages of 5 and 18 (coverage runs until the 19th birthday), live in Florida, and are a U.S. citizen or lawfully present non-citizen.1Florida KidCare. Frequently Asked Questions Undocumented immigrants are not eligible.2Florida Senate. Florida Code 409814 – Eligibility
To qualify for the subsidized plan, your child generally can’t already be enrolled in Medicaid or covered under a family member’s group health plan. One important exception: if the cost of adding your child to an employer-sponsored plan would exceed 5 percent of your family’s income, your child can still enroll in the subsidized KidCare program.2Florida Senate. Florida Code 409814 – Eligibility
Families whose income exceeds the subsidy thresholds can still enroll their children through the full-pay option, which offers the same benefits at a higher monthly premium. The Florida Healthy Kids Corporation is authorized to serve families up to 300 percent of the federal poverty level as its primary population, and full-pay is open above that.3The 2025 Florida Statutes. Florida Code 62491 – Florida Healthy Kids Corporation
What You’ll Pay
Florida KidCare uses Modified Adjusted Gross Income to evaluate your family’s finances, comparing your household income against the Federal Poverty Level guidelines to place you in a premium tier. Household size follows your tax filing: the filer, spouse if filing jointly, and anyone claimed as a dependent.
The premium tiers for Florida Healthy Kids break down as follows:4Florida KidCare. Florida KidCare Income Guidelines
- Up to 133% of FPL: children at this level are typically eligible for Medicaid, which has no monthly premium.
- 133.01% to 158% of FPL: $15 per month for all eligible children in the household.
- 158.01% to 200% of FPL: $20 per month for all eligible children in the household.
- Above 200% of FPL: full-pay at $276 per month per child (with dental).
The $15 and $20 tiers are flat household rates that cover every qualifying child, not per-child charges. That’s a real savings if you have more than one child. Full-pay, by contrast, charges per child.
Copays
For subsidized enrollees, most copays are $5. Preventive care, well-child visits, behavioral health and substance use services, inpatient hospital stays, and all dental services carry no copay. Primary care, specialist visits, and prescription drugs cost $5. Emergency room visits and ambulance rides are $10, and corrective lenses and frames are $10.5Florida KidCare. Florida Healthy Kids Enrollees American Indian and Alaska Native children who meet certain requirements pay no copays at all.
Federal law caps your total annual out-of-pocket spending, including premiums and copays, at 5 percent of your family’s total income for the length of your child’s eligibility period. The state must give you your family’s specific dollar cap in writing at enrollment and each renewal.6eCFR. 42 CFR 457560 – Cumulative Cost-Sharing Maximum
What’s Covered
Florida Healthy Kids delivers care through a managed care model. A health plan is automatically selected when your child enrolls, though you can change plans during certain periods.7Florida KidCare. Plan Information
Medical coverage includes well-child checkups, immunizations, primary care, specialist referrals, hospital stays, emergency room treatment, prescription drugs, and durable medical equipment.8Florida KidCare. Benefits Annual eye exams and corrective lenses are included.
Mental health and substance use services carry no copay, and federal parity rules require CHIP programs to cover behavioral health on the same terms as medical care, without stricter visit limits, higher copays, or tougher approvals than a comparable physical condition would face.9Medicaid.gov. Parity
Dental care is built into the plan at no additional copay. Covered services include twice-yearly exams, cleanings, and bitewing X-rays, plus fluoride treatments, sealants on permanent molars, fillings, crowns, root canals, and space maintainers when teeth are extracted.10DentaQuest. Florida Healthy Kids Member Handbook The dental handbook doesn’t list orthodontia as a standard benefit, so if your child needs braces, check directly with your assigned dental plan about any case-by-case coverage.
How to Apply
All four Florida KidCare programs share one application. You don’t need to figure out which program your child qualifies for in advance; the system routes your child based on age, income, and other factors.1Florida KidCare. Frequently Asked Questions
Before you start, gather:11Florida KidCare. Florida KidCare Application
- Social Security numbers for each child applying, or immigration document numbers for lawfully present non-citizens
- Employer and income information for everyone in the household, such as pay stubs or W-2s
- Policy numbers for any current health insurance
- Details about any job-related health insurance available to your family
The application verifies much of what you enter electronically through IRS, Social Security, and Department of Homeland Security databases, so you may not need to submit physical proof unless something doesn’t match. You can apply three ways:
- Online through the Florida KidCare Parent Portal at floridakidcare.org, year-round.
- By paper application downloaded from the site, mailed or faxed in.
- By phone at 1-888-540-5437 to request a paper application or have an agent complete it with you.12Florida KidCare. Florida KidCare
If your application is complete and all documentation checks out, expect a decision letter within a couple of weeks. If the program needs additional information, the process can take up to six weeks.1Florida KidCare. Frequently Asked Questions Once your child is found eligible and you pay the first month’s premium, coverage starts on the first day of the following month.
Keeping Coverage in Place
Once enrolled, your child gets 12 months of uninterrupted coverage. Since January 2024, federal law requires states to provide continuous eligibility for all children under 19 in Medicaid and CHIP programs.13Medicaid.gov. Continuous Eligibility for Medicaid and CHIP Coverage If your income fluctuates within that 12-month period, your child stays covered until the next annual renewal. Exceptions are narrow: aging out, moving out of Florida, or voluntarily canceling.
Coverage is not automatic beyond that first year. You must complete an annual renewal to confirm your child still qualifies. About two months before the renewal date, you will receive a notification prompting you to verify your household information.14Florida KidCare. Renew The fastest way is through the Parent Portal, but you can also renew by mail, email, or fax. Electronic data matching handles much of the verification, so you’ll only be asked for documents the system can’t confirm on its own.
Report major household changes when they happen, even outside renewal season: a move, a new job, an income change, a marriage or divorce, a new baby. These can shift which KidCare program your child belongs to or change what you pay.
If you miss a premium payment, Florida law gives you a 30-day grace period. Coverage isn’t terminated as long as you pay within 30 days of the due date.15Florida Senate. Florida Senate Bill 0210 Miss that window and enrollment can be canceled. Families who lose coverage for nonpayment typically have to reapply from scratch.
Aging Out at 19
Florida KidCare eligibility ends when a child turns 19.16The 2025 Florida Statutes. Florida Code 409814 – Eligibility One exception: a child who becomes pregnant or is in a postpartum period before turning 19 can keep coverage through the pregnancy and for 12 months after delivery, as long as they aren’t eligible for Medicaid.
For everyone else, losing CHIP coverage triggers a Special Enrollment Period on the federal Health Insurance Marketplace. The standard window for reporting a loss of coverage is 60 days, but people losing Medicaid or CHIP have up to 90 days after the loss to enroll in a marketplace plan.17Centers for Medicare & Medicaid Services. Understanding Special Enrollment Periods If your child is close to 19, start looking at marketplace or employer-sponsored options a few months ahead to avoid a gap.
If Your Application Is Denied
If your child is found ineligible, you can request a fair hearing to challenge the decision. Fair hearings are administrative proceedings where you can present evidence, bring witnesses, and question the state’s reasoning. You can represent yourself or bring a lawyer, family member, or friend. The hearing officer must be someone who wasn’t involved in the original decision.
Deadlines vary, but in most states the window is between 30 and 90 days from the date on the denial notice. If your child already has coverage and you file the appeal before termination takes effect, benefits generally continue until the hearing decision. If you win, the agency must reinstate coverage retroactively to the date it was incorrectly stopped.