Eligibility Determination Process

DEPARTMENT OF CHILDREN AND FAMILY SERVICES
Economic Self-Sufficiency Program

RULE NO: RULE TITLE
65A-1.205: Eligibility Determination Process

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 33 No. 12, March 23, 2007 issue of the Florida Administrative Weekly.

Notice is hereby given that the following changes have been made to the proposed rule published in Vol. 33, No. 5, February 2, 2007, issue of the Florida Administrative Weekly, in accordance with subparagraph 120.54(3)(d)1., F.S. The specific changes were made in response to the comments received from the Joint Administrative Procedures Committee.

Specific changes in the rule text are as follows:

(1)(b) Time standards for processing applications vary by public assistance program in accordance with federal regulations 7 CFR 273.2(g) (food stamps), 45 CFR 206.10(a)(3)(i), (temporary cash assistance), and 42 CFR 435.911 (Medicaid). Time standards begin on the date of application and end on the date benefits are made available or a notice of ineligibility is mailed. For the Medicaid program, the time standard ends on the date an eligibility notice is mailed. Applications must be processed and determinations of eligibility made within the following time frames.

 

Application Processing Program                                       Time Standards

Expedited Food Stamps                                                      7 days

Food Stamps         30 days

Temporary Cash Assistance, Refugee                             45 days

                Assistance and Child In Care

Medical Assistance and State                                           90 days

                Funded Programs for individuals who apply

                on the basis of disability

For all other Medical Assistance and                               45 days

                State Funded Programs for applicants

                on the basis of non-disability eligibility,

                including OSS, OMB, SLMB, and OI1

 

All days counted after the date of application are calendar days. Applicant delay days do not count in determining non-compliance with the time standard. See paragraph (d) of this rule. Information provided on form CF-ES 2930, Screening for Expedited Medicaid Appointments, Apr 07 Oct 05, incorporated by reference, in Administrative Rule 65A-1.400 is used in determining expedited processing of Medicaid disability-related applications.

(1)(e) For Medicaid, every individual who indicates they are a U.S. citizen must provide documentation of U.S. citizenship and identify. Exceptions are those who receive or have received SSI or Medicare and presumptively eligible women or newborns.

(5) Information provided by the applicant or recipient must be substantiated, verified or documented as part of each determination of eligibility. The term verification is used generically to represent this process. For any program, when there is a question about eligibility or the information provided, it is the sole discretion of the department will ask for documentation, verification or substantiation as required to determine if the factor of eligibility and questionable nature of the information dictates whether or not substantiation, verification or documentation is. Verification or documentation of substantiated information is not precluded or prohibited under any circumstances, including circumstances where eligibility information provided by an applicant or recipient appears to have been verified. If verification or documentation is requested, the information about which verification or documentation is sought will not be accepted as proof of the truth, validity, or accuracy of the questioned information if verification or documentation is not received.

(7) Copies of referenced forms and brochure CF/PI 165-107, Notification of Disability Information and Request (information for disabled applying for Medicaid) may be obtained from the ACCESS Florida Program Office, 1317 Winewood Boulevard, Building 3, Room 406, Tallahassee, Florida 32399-0700 or on the department’s web site at http://www.dcf.state.fl.us/cf_web/publications and click on e-forms, then search alphabetically using the title of the form.