65A-2.033. Optional State Supplementation Coverage Groups

To be determined eligible for Optional State Supplementation (OSS), an individual must qualify under one of the following coverage groups.

(1) The individual must be eligible for and receiving a check from the Supplemental Security Income (SSI) Program administered by the Social Security Administration. The Department accepts receipt of SSI as meeting all factors of OSS eligibility criteria in Rule 65A-2.032, F.A.C., except age and placement need as specified in subsections 65A-2.032(1) and (7), F.A.C., which must be verified by Department staff.

(2) The individual must meet all SSI and OSS eligibility criteria, except for income which must be equal to or less than the OSS income standard established by the Department. These individuals must meet eligibility criteria in Rule 65A-2.032, F.A.C.

(3) The individual must have been eligible for and receiving Aid to the Aged, Blind or Disabled from the state as of December 1973. This federally mandated coverage group did not qualify for the same level of benefits under SSI in 1974. For this coverage group, the special living facility criteria at subsection 65A-2.032(7), F.A.C., does not apply.

(4) The individual must: reside in an Assisted Living Facility or Mental Health Residential Treatment Facility; have been eligible for and receiving OSS payments for August 2001; have become ineligible for OSS as of September 2001 solely because their income exceeds the applicable OSS income standard of $609.40; and, not be categorically eligible for full Medicaid benefits as of September 2001. Additionally, in regard to an Adult Family Care Home (AFCH), the individual must: reside in an AFCH; have been eligible for and receiving OSS payment for December 2001; have become ineligible for OSS as of January 2002, solely because their income exceeds the applicable OSS income standard of $623.40; and, not be categorically eligible for full Medicaid benefits as of January 2002. As long as the individual continues to meet all OSS eligibility criteria and the income standard test in paragraph 65A-2.036(3)(b), F.A.C., they will remain eligible for payment under the provider rates in paragraph 65A-2.036(4)(b), F.A.C. Once an OSS recipient no longer meets all OSS eligibility criteria or the income standard in paragraph 65A-2.036(3)(b), F.A.C., they will no longer be eligible under this coverage group.

Rulemaking Authority 409.212(7) FS. Law Implemented 409.212 FS. History–New 1-1-77, Formerly 10C-2.33, Amended 9-30-86, 2-9-88, Formerly 10C-2.033, Amended 12-16-01, 5-14-02.