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Florida Administrative Code (Last Updated: November 11, 2024) |
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65. Department of Children and Families |
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65A. Economic Self-Sufficiency Program |
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65A-1. Public Assistance Programs |
1(1) The Department uses the Modified Adjusted Gross Income (MAGI) based budgeting methodologies as defined in 26 U.S.C. 1936B(d)(2)(B) 20to determine the financial eligibility of individuals applying for Medicaid. Resources are not considered as part of the eligibility determination for 41individuals whose eligibility is determined using MAGI methodologies. MAGI methodologies will not apply to the following:
57(a) Individuals whose eligibility for Medicaid does not require a determination of income by the Department, including individuals receiving Supplemental Security Income (SSI).
80(b) Individuals who are age 65 or older when age is a condition of eligibility.
95(c) Individuals whose eligibility is being determined on the basis of being blind or disabled.
110(d) Individuals who request coverage for long-term services and supports, including nursing facility services, or individuals who request a level of care in any institution equivalent to nursing facility services, or individuals who request home and community-based services provided under a Medicaid waiver.
153(e) Individuals who are being evaluated for Medicare cost sharing assistance.
164(f) Individuals who are being evaluated for coverage as SSI-Related Medically Needy.
176(2) Countable Net income is defined as: The sum of income counted for the assistance group based on the number of individuals and their income included in the SFU, except as provided in 42 C.F.R. §435.603(d)(4). To determine eligibility using MAGI-based income criteria, an amount equivalent to the MAGI five percent of the Federal Poverty Level (FPL) is subtracted from the countable income of the individual based on the size of the SFU. 249The standard disregard as defined at 65A-1.701(67) is subtracted from total gross income to determine countable net income. 267The MAGI five percent is not applied if the countable net income of the individual is at or below the income limit for the coverage group. This disregard is not applied in Medically Needy.
301(3) MAGI-based income is defined as: Income calculated using the same financial methodologies used to determine modified adjusted gross income as defined in section 32526 U.S.C. 36B(d)(2)(B), 328with the exceptions specified in 33342 C.F.R. §435.603(e).
336(4) SFU: Refer to 34065A-1.705(2), 341F.A.C., for information on households.
346(5) Income standard for infants and children under age 19: The maximum income standard for infants under age one is 200 percent countable net income of the MAGI converted FPL and the maximum income standard for children ages one through 18 is 133 percent of the FPL, 393pursuant to 395Florida’s Medicaid State Plan, Approved Conversion Thresholds, 4026/27/13, incorporated by reference and available at 409https://www.flrules.org/Gateway/reference.asp?No=Ref-11664 411and h413ttps://ahca.myflorida.com/Medicaid/stateplan_aca.shtml414.
415(6) Income standard for Parents and Caretaker Relatives: The maximum income standard for parents and caretaker relatives is the state’s Aid to Families with Dependent Children (AFDC) payment standard in effect as of July 16, 1996, converted to a MAGI equivalent standard included in 459Florida’s 460Medicaid State Plan, Approved Conversion 465Thresholds466.
467(7) Income standard for children ages 19 and 20. The maximum income standard for children ages 19 and 20 is the state’s AFDC payment standard in effect as of July 16, 1996, converted to a MAGI equivalent standard included in Florida’s Medicaid State Plan, Approved Conversion Thresholds.
514(8) Income standard for pregnant women. The maximum income standard for pregnant women is 185 percent of the FPL 533as specified in Florida’s Medicaid State Plan, Approved Conversion Thresholds543.
544(9) Medically Needy Income Level (MNIL). The Department deducts the MNIL, as provided in 55865A-1.716(2) 559F.A.C., from the SFU countable income to determine the amount of Share of Cost (SOC) available to meet medical care and services each month.
583(10) Exceptions to MAGI-based income referenced in 59042 C.F.R. §435.603(e).
593Rulemaking Authority 595409.919 FS. 597Law Implemented 599409.903, 600409.904, 601409.919 FS. 603History–New 10-8-97, Amended 2-15-01, 11-23-04, 2-20-07, 5-6-08, 6-4-12, 3-25-20.
