SSI-Related Medicaid Post Eligibility Treatment of Income

 

DEPARTMENT OF CHILDREN AND FAMILIES

Economic Self-Sufficiency Program

RULE NO.:RULE TITLE:

65A-1.7141SSI-Related Medicaid Post Eligibility Treatment of Income

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. 41 No. 50, March 13, 2015 issue of the Florida Administrative Register.

(1)(a) through (e) No change.

(1)(f) The community spouse’s excess shelter and utility expenses. The amount by which the sum of the spouse’s expenses for rent or mortgage payment (including principal and interest), taxes and insurance and, in the case of a homeowner’s association, condominium or cooperative, required maintenance charge, for the community spouse’s principal residence and utility expense exceeds thirty percent of the amount of the Minimum Monthly Maintenance Needs Allowance (MMMNA) is allowed. The utility expense is based on the current Food Assistance Program’s standard utility allowance as referenced in Rule 65A-1.603(2), F.A.C.

(1)(g) through (h) No change.

(1)(i)1.b. For other incurred medical expenses, the expense must be for a medical or remedial care service and be medically necessary and recognized under state law as specified in Rule 59G-1.010(166), F.A.C., and be recognized in state law. For medically necessary care, services and items not paid for under the Medicaid State Plan, the actual billed amount will be the amount of the deduction, not to exceed the maximum payment or fee recognized by Medicare, commercial payors, or any other third party payor, for the same or similar item, care, or service.

(1)(i)2. through 5 No change.

(2)(a)1. through 3. No change.

(2)(b)1. For HCBS, a spousal deduction equal to the SSI standard FBR minus the spouse’s monthly income.

(2)(b)2. No change.

(2)(c)1. The service or item claimed as a deduction from the individual’s income must be a medical or remedial care service, be medically necessary as specified in Rule 59G-1.010(166), F.A.C., be recognized in state law as specified in Rule 65A-1.716, F.A.C., and have been incurred no earlier than the three months preceding the month of application providing eligibility, and have not been paid for under the Medicaid State Plan.

(2)(c) through (3)(a) No change.

(3)(b) A spousal deduction equal to the SSI standard FBR minus the spouse’s monthly income is allowed when the spouse is residing in the community.

(3)(c) A deduction for the family at the Temporary Cash Assistance consolidated need standard (CNS).

(3)(d)1. The service or item claimed as a deduction from the individuals income must be a medical or remedial care service, be medically necessary as specified in Rule 59G-1.010(166), F.A.C., be recognized in state law, have been incurred no earlier than the three months preceding the month of application providing eligibility, and have not been paid for under the Medicaid State Plan.

(3)(d)2. through (4)(a) No change.

(4)(b) A spousal deduction equal to the SSI standard FBR minus the spouse’s monthly income is allowed when the spouse is residing in the community.

(4)(c) No change.

(4)(d)1. The service or item claimed as a deduction from the individual’s income must be a medical or remedial care service, be medically necessary as specified in Rule 59G-1.010(166), F.A.C., be recognized in state law, have been incurred no earlier than the three months preceding the month of application providing eligibility, and have not been paid for under the Medicaid State Plan.

(4)(d)2. through (5)(a)2. No change.

(5)(b)1. The Department will apply spousal impoverishment policy according to Section 1924 of the Social Security Act, Treatment of Income and Resources for Certain Institutionalized Spouses, as amended by Section 2404 of the Patient Protection and Affordable Care Act. For HCBS a spousal deduction equal to the SSI FBR minus the spouse’s monthly income.

(5)(b)2. No change.

(5)(c)1. The service or item claimed as a deduction from the individuals income must be a medical or remedial care service, be medically necessary as specified in Rule 59G-1.010(166), F.A.C., be recognized in state law, have been incurred no earlier than the three months preceding the month of application providing eligibility, and have not been paid for under the Medicaid State Plan.

Rulemaking Authority, 409.919, 409.961. FS. Law Implemented 409.902, 409.903 409.904, 409.906, 409.919, 409.961, 409.963, FS. History–New 5-29-05, _____

 

IF REQUESTED WITHIN 7 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW (IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

DATE AND TIME: June 23, 2015, 10:00 a.m.

PLACE: 1317 Winewood Boulevard, Building 3, Room 455 Tallahassee, Florida 32399-0700

Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 7 days before the workshop/meeting by contacting: Vonsenita Tranquille. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Vonsenita Tranquille Economic Self-Sufficiency Program, [phone], Winewood Boulevard, Tallahassee, Florida 32399-0700, [e-mail]