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Ped-I-Care

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Ped-I-Care’s History

The Balanced Budget Act of 1997 created a new children’s health insurance program under Title 21 of the Social Security Act called SCHIP, or State Children’s Health Insurance Program. The purpose of this program was to provide insurance to children who were uninsured. States were allowed to create new programs or expand existing Medicaid programs. Included in this was a mandate for the development of managed care organizations for members, including children with special health care needs (CSHCN). Florida opted to create KidCare in 1998 as a result of this legislation, with one component being the CMS Network (CMS subsequently developed the Integrated Care System model which, as developed by The University of Florida, later became known as Ped-I-Care).

In Florida, no one would assume risk for this group and the state of Florida was in danger of losing the 70% federal match offered by the government. It was UF’s Department of Pediatrics that stepped up to the plate and assumed not only the leadership but responsibility in caring for children with special needs. They orchestrated the organization and implementation of an integrated care system known as both “The ICS” and as “Ped-I-Care.”  Ped-I-Care went live in November 2003 in the 16-county area formerly known as CMS Districts 3 and 13. All children covered under CMS Title 21 were automatically enrolled into Ped-I-Care (ICS) on this date. In July 2006 the program expanded into seven additional counties, for a 23-county total coverage area in the state of Florida. In May 2007 Ped-I-Care further expanded to become a Provider Service Network under Medicaid Reform (Title 19) in Duval County. In 2013, the program was awarded an $18 million expansion contract to administer Title 21 benefits to members in 51 of Florida’s 67 counties. The program was later awarded a Medicaid expansion project and now administers benefits to children enrolled in Managed Medical Assistance (Medicaid) in those same 51 counties. Without the creation of Ped-I-Care by UF’s Department of Pediatrics, the state of Florida would have lost millions of dollars in matching funds from the federal government and the full burden of care for CSHCN enrolled in Titles 19 and 21 would have fallen on the state.

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