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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 a prospective budgeting method at the initial application and renewal of eligibility in the financial determination for Medicaid coverage for current and future months. A prospective budgeting methodology is used to determine eligibility based on the Department’s best estimate of the coverage group’s income and circumstances. This estimate shall be based on the Department’s expectation and knowledge of current or future circumstances. When eligibility is being determined for a prior month, the actual income and circumstances for that month shall be used.
87(a) Weekly income is converted to a monthly amount by using the conversion factor of 4.
103(b) Biweekly income is converted to a monthly amount by using the conversion factor of 2.
119(c) Semi-monthly income is converted to a monthly amount by using the conversion factor of 2.
135(d) When averaging income, the four most recent weeks of income shall be used if it is representative of the individual’s future earnings. A longer period of income history may be used if necessary to provide a more accurate indication of anticipated fluctuations in future income, for example self-employment in a seasonal industry, with the following exceptions:
1921. Income from the most recent quarter provided to the State Wage Information Collection Agency (SWICA) within the Florida Department of Economic Opportunity (DEO) shall be used if it is representative of the individual’s future earnings.
2282. In budgeting income received by an individual on a contractual basis, income received under an employment contract of less than one year will be prorated over the months it is intended to cover.
262(2) There is no asset or resources test.
270(3) The Department will apply the standard disregard as defined in subsection 65A-1.701(66) F.A.C., except Medically Needy.
287(4) Budgeting for Medically Needy individuals.
293(a) Determining share of cost (SOC). The Department will deduct the following amounts from an individual’s countable income to determine their SOC:
3151. For individuals under age 21, parents and other caretaker relatives, and pregnant women, the Department will deduct the Medically Needy Income Level (MNIL) amounts found in subsection 34365A-1.716(2), 344F.A.C., for Family-Related Medicaid coverage groups.
3502. For aged, blind, or disabled individuals, the Department will deduct the MNIL amounts found in subsection 36765A-1.716(2), 368F.A.C., SSI-Related Medicaid coverage groups.
373(b) Meeting SOC. An individual is eligible (entitled to Medicaid) when their allowable medical bills are equal to or exceed the SOC. An individual who meets their share of cost must contact the Department to complete bill tracking and to be enrolled in Medicaid. When tracking medical expenses, the Department will:
4241. Deduct incurred medical expenses. The Department shall deduct allowable medical expenses in chronological order, by date of service. To qualify as an allowable medical expense, it must be:
453a. A recognized health insurance costs (premiums, copays and deductibles), or
464b. Medical expenses that are unpaid and the payment of the expenses remains the responsibility of the individual or a member of the SFU, or
489c. Medical expenses paid during the month for which bill tracking is being completed.
5032. Global Prenatal Expenses. The individual has the option of using her total global prenatal bill, whether paid or unpaid, to meet her share of cost during a specified month (including month of delivery) or prorating it to cover several months during her pregnancy and not:
549a. Subject to third party payment or
556b. Previously used to meet SOC.
5623. Medical expenses reimbursed by a state or local government not funded in full by federal funds, excluding Medicaid program payments, are allowable deductions.
5864. Allowable medical expenses, such as medical services and personal care services in the home, provided or prescribed by a recognized member of the medical community.
612Rulemaking Authority 614409.919 FS. 616Law Implemented 618409.903, 619409.904, 620409.919 FS. 622History–New 10-8-97, Amended 2-15-01, 10-16-07, 3-25-20.
