The Department intends to amend Rules 65A-1.205, .701-.705, .707-.708, and .716, F.A.C., to revise the Family-Related Medicaid eligibility policies and procedures used to implement the Florida Family-Related Medicaid Program so that the requirements ...  

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    DEPARTMENT OF CHILDREN AND FAMILIES

    Economic Self-Sufficiency Program

    RULE NOS.:RULE TITLES:

    65A-1.205Eligibility Determination Process

    65A-1.701Definitions

    65A-1.702Special Provisions

    65A-1.703Family-Related Medicaid Coverage Groups

    65A-1.704Family-Related Medicaid Eligibility Determination Process

    65A-1.705Family-Related Medicaid General Eligibility Criteria

    65A-1.707Family-Related Medicaid Income and Resource Criteria

    65A-1.708Family-Related Medicaid Budgeting Criteria

    65A-1.716Income and Resource Criteria

    PURPOSE AND EFFECT: The Department intends to amend Rules 65A-1.205, .701-.705, .707-.708, and .716, F.A.C., to revise the Family-Related Medicaid eligibility policies and procedures used to implement the Florida Family-Related Medicaid Program so that the requirements of the Affordable Care Act that govern the Florida Family-Related Medicaid coverage groups are met.

    SUMMARY: The amendments will accomplish the following: (1) Revise definitions of terminology used in the Medicaid program; (2) Revise provisions related to general eligibility determinations; (3) Establish income and resource criteria for both Family-Related and SSI-Related Medicaid Programs; and (4) Set forth the Family-Related Medicaid budgeting process.

    SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:

    The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

    The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: The Department used a checklist to conduct an economic analysis and determine if there is an adverse impact or regulatory costs associated with this rule that exceeds the criteria in section 120.541(2)(a), F.S. Based upon this analysis, the Department has determined that the proposed rule is not expected to require legislative ratification.

    Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

    RULEMAKING AUTHORITY: 409.1451, 409.919, 414.095, 414.45, FS.

    LAW IMPLEMENTED: 409.902, 409.903, 409.904, 409.906, 409.919, 414.045, 414.095, 414.31, 414.41, FS.

    IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE SCHEDULED AND ANNOUNCED IN THE FAR.

    THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Jodi Abramowitz. Jodi can be reached at (850)717-4470 or Jodi.Abramowitz@myflfamilies.com.

     

    THE FULL TEXT OF THE PROPOSED RULE IS:

     

    Substantial rewording of 65A-1.205 follows. See Florida Administrative Code for present text.

    65A-1.205 Eligibility Determination Process

    (1) The individual completes and submits a Department application for public assistance using either the ACCESS Florida Application, CF-ES 2337, 08/2016, incorporated by reference and available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, or an ACCESS Florida Web Application (only accepted electronically), CF-ES 2353, XXX, incorporated by reference and available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX. The following non-English versions of the ACCESS Florida Application are incorporated by reference: CF-ES 2337C (Chinese) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2337F (French)  is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX,  CF-ES 2337H (Creole) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2337I (Italian) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2337P (Portuguese) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2337R (Russian) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2337S (Spanish) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2337SC (Serbo-Croatian) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, and CF-ES 2337V (Vietnamese) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX,  Individuals applying for Family-Related Medical Assistance only or the Children’s Health Insurance Program (CHIP) must complete and submit the Family-Related Medical Assistance Application, CF-ES 2370, 09/2015, incorporated by reference and available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX.  The following non-English versions of the Family-Related Medical Assistance Application are incorporated by reference: CF-ES 2370H (Creole) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, and CF-ES 2370S (Spanish) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX. The Medical Assistance Referral form, CF-ES 2039, 08/2018, incorporated by reference and available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, is submitted to initiate an Emergency Medical Assistance for Noncitizens determination and is used by providers to request a Florida Medicaid ID number assignment for newborns.

    Applicants may apply for public assistance in person or by phone, mail, the internet, or fax. Individuals may also apply for Medicaid through the Federally Facilitated Marketplace (FFM). 

    An application for public assistance benefits must contain at least the individual’s name, address, and signature to initiate the application process. An eligibility specialist determines the eligibility of each household member for public assistance. An applicant can withdraw the application at any time without affecting their right to reapply.

    An application for Medicaid coverage on behalf of a child(ren) in the care of the Department is made by completing and submitting the Child In Care Medicaid Application, CF-ES 2293, 06/2013, incorporated by reference and available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX.

    (a) The Department must determine an applicant’s eligibility for public assistance initially at application and, if the applicant is determined eligible, at periodic intervals thereafter. If an applicant is determined ineligible for Medicaid benefits based on the modified adjusted gross income (MAGI) budgeting methodology as defined in subsection 65A-1.701(45), F.A.C., with income that meets or exceeds 100% of the Federal Poverty Level (FPL), the Department will forward an electronic file to the FFM or the Children’s Health Insurance Program (CHIP). It is the applicant’s responsibility to keep appointments with the eligibility specialist and furnish information, documentation and verification needed to establish eligibility. If the Department schedules a telephonic appointment, it is the Department’s responsibility to be available to answer the applicant’s phone call at the appointed time. The Department will provide the applicant a written notice of action taken on the case including information on fair hearing rights. The eligibility specialist must provide assistance in obtaining information, documentation or verification when requested by the applicant or when assistance appears necessary.

    (b) The Department must verify the Social Security Numbers (SSNs) for each applicant for public assistance benefits, except individuals applying for Medicaid who: are not eligible to receive a SSN; do not have a SSN and may only be issued an SSN for a valid non-work reason in accordance with 20 C.F.R. § 422.104; or refuse to obtain an SSN because of well-established religious objections.

    (c) The Department follows time standards for processing public assistance applications which vary by public assistance program type. The time standards for processing applications for the Food Assistance Program and Temporary Cash Assistance Program are set forth in 7 C.F.R. § 273.2(g)(1) and 45 C.F.R. § 206.10(a)(3)(i) and (ii), respectively. The time standard for processing applications for Medicaid is set forth in 42 C.F.R. § 435.912 (a), (b), and (c). For Food Assistance and Temporary Cash Assistance Programs, time standards begin the date following the date the application was filed and end on the date the Department makes benefits available or mails a notice concerning eligibility, whichever is earlier.

    For the Medicaid Program, the time standard begins on the date of application and ends on the date the Department mails an eligibility notice. The Department must process and determine eligibility within the following time frames:

    1. Expedited Food Assistance -7 days.

    2. Food Assistance - 30 days.

    3. Refugee Assistance, Medicaid not based on disability, Temporary Cash Assistance, Optional State Supplementation, Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), Qualifying Individual (QI1) and Qualified Disabled and Working Individuals (WD) - 45 days.

    4. Medicaid based on disability - 90 days.

    All days counted after the date of application are calendar days. Applicant delay days do not count in determining the Department’s compliance with the time standard. The Department uses information provided on the Screening for Expedited Medicaid Appointments form, CF-ES 2930, 04/2007, incorporated by reference and available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, to expedite processing of Medicaid disability-related applications. The following non-English versions of the Screening for Expedited Medicaid Appointments form are incorporated by reference: CF-ES 2930H (Creole) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX; and CF-ES 2930S (Spanish) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX.  The “Are You Disabled and Applying for Medicaid?” brochure, CF/PI 165-107, 06/2008, incorporated by reference and available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, describes required information for Medicaid Program eligibility determinations. The following non-English versions of the “Are You Disabled and Applying for Medicaid?” brochure are incorporated by reference: CF/PI 165-107H (Creole) is incorporated by reference and available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX; and CF/PI 165/107S (Spanish) is incorporated by reference and available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX.(d) If the eligibility specialist determines during the interview or at any time during the processing of the application that the applicant must provide additional information or verification, or that a member of the assistance group must register for employment services, the eligibility specialist must give the applicant written notice to provide the requested information or verification, or to comply with the work registration process, allowing 10 calendar days from the date of a notice for additional information or verification or the interview date, whichever is later, to comply.

    (e) For all programs, if the requested verifications are not returned within 10 calendar days from the date of written request or the interview, or 30 calender days from the date of application, whichever is later, the application will be denied unless the applicant requests an extension prior to the due date or there is physician delay or emergency delay, as defined in subparagraphs (h)2 and (h)3 below, justifying the additional extension. If the applicant completed the interview, if required, but failed to provide the required verifications and was denied, the applicant may provide the verifications within 60 calendar days after the original date of application and reuse the application that was denied. For food assistance and temporary cash assistance, the new date of application is the date the applicant provided all required verifications.

    (f) For Medicaid only applications, when the applicant must provide medical information, the due date is 30 calendar days following the date of a written request for such information or the interview date, or 60 calendar days from the date of application, whichever is later.

    (g) If the due date falls on a state holiday or weekend, the due date deadline is the next business day.

    (h) In accordance with 42 C.F.R. § 435.912 (e)(1) and (2), the types of unusual circumstance that might affect the application processing time for Medicaid applications include applicant delay, physician delay and emergency delay as defined below. Unusual circumstances are non-agency application processing delays, and the calendar time passing during such delay period(s) does not count as part of the application processing time standard for determining the timeliness of Medicaid eligibility decisions.

    1. “Applicant delay” days are the number of calendar days attributed to the applicant that causes the eligibility decision to be made after the established time standard. Applicant delay can result from an applicant missing a scheduled appointment or failure to provide requested eligibility information, including requested medical information or requested verification. Applicant delay begins the date the applicant misses the deadline for the required action and ends the date the applicant takes the required action.

    2. “Physician delay” days are the number of calendar days attributed to the applicant’s physician(s) that causes the eligibility decision to be made after the established time standard. Physician delay can result from a physician not providing requested medical evidence or from not conducting a medical examination timely. Physician delay begins 10 calendar days after the Department makes its initial request for medical evidence from the physician and ends the date the Department receives complete medical evidence that is responsive to the Department’s request; or, physician delay begins 14 calendar days after the Department requests a medical examination and ends the date the Department receives the complete medical examination results.

    3. “Emergency delay” days are the number of calendar days attributed to situations that are beyond the control of the Department that causes the eligibility decision to be made after the established time standard. Emergency delay can result from disasters, unexpected office closure(s), and unexpected or unscheduled computer systems inaccessibility or unavailability. Emergency delay begins the day such an event begins and ends the day the Department is able to resume application processing.

    (2) In accordance with 7 C.F.R. § 273.14(b), 45 C.F.R. § 206.10(a)(9)(iii), and 42 C.F.R. § 435.916(a) or (b), and 42 C.F.R.§ 435.919, the Department must redetermine eligibility at periodic intervals.

    (a) A complete eligibility review is the process of reviewing all factors related to continued eligibility of the assistance group.

    (b) A partial eligibility review entails a review of one or more, but not all factors of eligibility. The Department schedules partial reviews based on known facts or anticipated changes in circumstances concerning the assistance group. The partial review does not usually require an interview unless needed to obtain the necessary information. The Department will complete a review of an unanticipated change concerning the assistance group when the change is reported.

    (c) The Department will make a renewal of eligibility for Medicaid without requiring information from the individual if it is possible to do so based on reliable information contained in the individual’s case or other more current information available to the Department and send the individual a written notice concerning eligibility. The Department will request only the information needed to renew eligibility. If a renewal cannot be made based upon existing and available information, the Department will provide the individual with:

    1. A notice, at least 30 calendar days prior to the end of the eligibility renewal date, informing them it is time to review their eligibility for continued benefits and the options available to complete the renewal process;

    2. A notice of the Department’s decision concerning the renewal of eligibility; and

    3. The Department will reconsider the eligibility of an individual whose case is closed due to failure to submit the renewal application or to provide requested information, if the individual meets the renewal application conditions within three months after the date of closure in accordance with 42 C.F.R.§ 435.911 and 42 C.F.R. § 435.916(f).

    (3) The Department conducts phone or face-to-face interviews with applicants and recipients, or their authorized or designated representatives, when required for the application or to complete the eligibility review process. The Department conducts face-to-face interviews, upon request, in the Office of Economic Self-Sufficiency Program Offices, at the applicant’s or recipient’s home, or at other mutually agreed upon locations. The applicant or recipient, or their authorized or designated representative, must keep the interview appointment or reschedule a missed appointment. The Department mails a notice of missed interview to food assistance households who miss an interview.

    (4) If an applicant or recipient does not sign and date the application, fails to keep an appointment or reschedule with the eligibility specialist, fails to submit the required documentation or verification, or requests an extension of the due date, the Department will deny the application because it cannot establish eligibility.

    (5) The Department can substantiate information provided by the applicant or recipient as part of each determination of eligibility. For any public assistance program, when there is a question about the accuracy of the information provided, the Department will ask for additional information.

    (a) Substantiation establishes accuracy of information by obtaining consistent, supporting information from the individual or other third parties. The information can be obtained or provided electronically, telephonically, in writing, or by personal contact.

    (b) Documentation establishes the accuracy of information by obtaining and including in the case record an official document that supports the statement(s) made by the individual.

    (6) The Department conducts data exchanges with other agencies and systems to obtain relevant public assistance eligibility information on each applicant and recipient. It uses data exchanges to verify or identify social security numbers, verify the receipt of other benefits from other sources or programs, verify other eligibility information reported by the applicant or recipient, and to discover unreported relevant eligibility information. For Medicaid eligibility, information obtained from the Federal Data Services Hub (FDSH) and State Wage Information and Collection Agency (SWICA) that does not adversly affect eligibilty is considered verified upon receipt and does not require third party verification.

    (a) The Department conducts data exchanges with the Social Security Administration, the Internal Revenue Service, the Florida Department of Economic Opportunity, the Florida Department of Lottery, the Federal Data Services Hub, the Florida Department of Corrections, federal and state personnel and retirement systems, other states’ public assistance programs and files, and educational institutions.

    (b) The Department compares information obtained through data exchanges with the information already on file. If the data exchange identifies new or different information than what is already on file, the Department conducts a partial eligibility review to determine whether benefit levels must change.

    (c) The Department considers beneficiary and Supplemental Security Income (SSI) benefit data from the Social Security Administration, unemployment compensation benefits, the Department of Health, Department of Corrections, and information obtained from the Office of Vital Statistics verified upon receipt and does not require third party verification. Other information and data obtained by the Department may require third party verification before the Department will rely upon it to take adverse actions on a case. If the information provided by or on behalf of an individual is consistent with the information obtained by the Department, the Department will consider the information reasonably compatible and determine or renew eligibility, except where the law requires other procedures (such as citizenship, immigration status and identity).

    (d) The Department will collect additional information as needed to determine eligibility for non-MAGI related Medicaid eligibility for:

    1. Individuals whom the Department identifies based on information contained in the application as potentially eligible for non-MAGI related Medicaid coverage;

    2. Individuals who request a determination of eligibility on a basis other than the MAGI rules. The Department will require individuals to provide only the information necessary to make an eligibility determination.

    (7) In accordance with 42 C.F.R. § 435.907(e)(3), the Department may collect SSNs of individuals who are not requesting assistance but must provide clear notice to non-applicants that providing the SSN is voluntary as well as provide information about the Department’s purpose for collecting the non-applicant’s SSN.

    (8) In accordance with Food Assistance Program waivers, food assistance applicants and recipients who have been interviewed, but have not returned the requested verification by the due date, can be denied prior to the 30th day. Face-to-face interviews are not required.

    (9) The following additional forms, which are incorporated into this rule by reference, can be used in the eligibility determination process:

    (a) Verification of Employment/Loss of Income, CF-ES 2620, 05/2010, available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2620H (Creole) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2620S (Spanish) is https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX;

    (b) Verification of Dependent Care Expenses, CF-ES 2621, 03/2010, available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2621H (Creole) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2621S (Spanish) is https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX;

    (c) Verification of Shelter Expenses, CF-ES 2622, 03/2010, available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2622H (Creole) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2622S (Spanish) is https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX;

    (d) School Verification, CF-ES 2623, 10/2005, available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2623H (Creole) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2623S (Spanish) is https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX;

    (e) Work Calendar, CF-ES 3007, 10/2005, available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 3007H (Creole) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 3007S (Spanish) is https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX;

    (f)  Designation of Beneficiary, CF-ES 990, 10/2005, available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX;

    (g) Medical Assistance Referral, CF-ES 2039, 08/2018, available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX;

    (h) Authorization to Disclose Information, CF-ES 2514, 02/2007, available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2514H (Creole) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2514S (Spanish) is https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX; and

    (i) Financial Information Release, CF-ES 2613, 10/2005, available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX, CF-ES 2613H (Creole) is available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX.

    Rulemaking Authority 409.919, 414.095, 414.45 FS. Law Implemented 409.903, 409.904, 409.919, 414.045, 414.095, 414.31, 414.41 FS. History–New 4-9-92, Amended 11-22-93, 8-3-94, Formerly 10C-1.205, Amended 11-30-98, 9-27-00, 7-29-01, 9-12-04, 9-11-08, 7-1-10, 2-20-12, Amended_______.

     

    Substantial rewording of Rule 65A-1.701 follows. See Florida Administrative Code for present text.

    65A-1.701 Definitions.

    As used in 65A-1.701 through 65A-1.716, F.A.C., the following terms have the following meanings unless a different meaning is given:

    (1) Adoption Subsidy: A monthly payment to assist adoptive parents in caring for an adopted child who has been determined to meet the eligibility criteria of a special needs child.

    (2) Adoptive Parent: A person who provides a child(ren) a permanent home through a court process, that once final, names the adoptive parent as the child’s legal parent.

    (3) Affordable Care Act (ACA): The Patient Protection and Affordable Care Act in accordance with 42 U.S.C. 18001 et seq.

    (4) Agency for Health Care Administration (AHCA): The designated single state agency responsible for the administration of the Florida Medicaid Program.

    (5) Appropriate Placement: Placement of an individual into a Medicaid-participating nursing facility that provides the type and level of care the Department determines the individual requires; or the receipt of approved Home and Community Based (HCBS) waiver services by an individual in accordance with an approved plan; or the receipt by an individual of hospice services provided by a Medicaid participating hospice provider; or by an individual in accordance with 42 U.S.C. § 1396d.

    (6) Assistance Group: All individuals within the standard filing unit (SFU) who are potentially eligible for benefits. For Family-Related Medicaid eligibilty, all applicants are considered to be an assistance group of one.

    (7) Caretaker relative: A dependent child’s relative by blood, adoption, or marriage with whom the child is living, and who is assuming primary responsibility for the child’s care. The relative must be one of the following:

    (a) The child's legal or biological father, mother, grandfather, grandmother, brother, sister, including those of half-blood, stepfather, stepmother, stepbrother, stepsister, uncle, aunt, first cousin, first cousin once removed, nephew, or niece; and persons of preceding generations as denoted by prefix of “grand”, “great”, “great-great”, “great-great-great”, etc.; or

    (b) The present or former spouse of a person listed in (a) above, even after the marriage is terminated by death or divorce.

    (8) Child: A natural, adopted or stepchild.

    (9) Child-Placing Agency: A child welfare agency that is any institution, society, agency, or facility which places children in foster homes for temporary care or in prospective adoptive homes for adoption.

    (10) Children’s Health Insurance Program (CHIP): Premium health insurance coverage for children under age 19, as referenced in 65A-1.703, F.A.C..

    (11) Code: The Internal Revenue Code of Rules and Regulations.

    (12) Community Spouse: The legal spouse of a married individual who lives in the community when one spouse is in or seeking institutional care.

    (13) Community Spouse Income Allowance: The portion of an institutionalized spouse’s monthly income, if any, which may be protected for the community spouse’s maintenance needs if agreed to by the institutionalized spouse.

    (14) Community Spouse Resource Allowance: The portion of the couple’s total assets which is protected for the community spouse and not considered to be available to the institutionalized spouse for purposes of determining eligibility.

    (15) Coverage Group: A classification under which one or more individuals may be eligible for benefits.

    (16) Department: The Department of Children and Families (DCF).

    (17) Dependent: The person who depends upon another person for all or part of their support or maintenance.

    (18) Developmental Disabilities Individual Budgeting (iBudget) Waiver: A Medicaid HCBS Program for persons with intellectual disabilities.

    (19) Eligible Couple: A married couple with both persons meeting the criteria for Medicaid eligibility. See the definition for “spouse.”

    (20) Enrollment: The status of an individual who satisfies the non-financial and resource eligibility criteria for the Medically Needy Program but who is not eligible for any benefits until their share of cost is met.

    (21) Excess Shelter Allowance: The amount by which the sum of a community spouse’s shelter expenses and the standard utility allowance exceeds 30 percent of the Minimum Monthly Maintenance Needs Allowance (MMMNA).

    (22) Ex Parte Determination: An exploration of Medicaid eligibility under another Medicaid coverage group when an individual is no longer eligible under their current Medicaid coverage group based on available information.

    (23) Familial Dysautonomia (FD): A home and community-based waiver program designed specifically for individuals who are diagnosed with this genetic disorder.  The waiver provides support and services that will minimize the effects of the disease and stabilize the health of the participant to remain in a noninstitutionalized setting in the community.  Participants for this waiver group must be age three through age 64.

    (24) Family Size: The number of persons counted as members of an individual’s SFU.

    (25) Federal Benefit Rate (FBR): Income standard levels established by the federal government to determine income eligibility and payment benefits for the Supplemental Security Income (SSI) Program.

    (26) Federally Facilitated Marketplace (FFM): A federally designated entity used by small businesses and individuals to find, compare, and purchase qualified health plans.

    (27) Foster Care: Twenty-four-hour substitute care for children removed by the courts and placed away from their parents or guardians and for whom the State agency has placement and care responsibility. This includes, but is not limited to, placements in foster family homes, foster homes of relatives, group homes, emergency shelters, residential facilities, child care institutions, and preadoptive homes.

    (28) Home and Community-Based Services Waiver Program (HCBS): A Waiver authorized under section 1915(c) of the Social Security Act.  HCBS Waivers are designed to provide services for a particular targeted population based on the individual’s need for care and support that will delay or prevent institutionalization. 

    (29) Hospice: A coverage group which provides care and support to individuals who are terminally ill (with a life expectancy of six months or less).

    (30) Hospital Swing Beds: Medicaid approved beds in rural hospitals designated to provide acute hospital care or nursing facility care.

    (31) Household: Individuals residing together whose presence in the home may affect the eligibility of other individuals residing in the home.

    (32) iBudget Florida Developmental Disabilities (DD) Waiver: A home and community-based waiver program for individuals diagnosed with an intellectual (mental) disability.  The waiver provides support and services that will assist with stabilizing the health and welfare of the individual in a noninstitutionalized setting in the community.

    (33) Income: For Family-Related Medicaid Programs refer to 65A-1.707, F.A.C. For SSI-related programs refer to 20 C.F.R. § 416.1100 and 65A-1.713, F.A.C.

    (34) Institutional Care Program (ICP): A program that helps to pay for the cost of care in a nursing facility and provides Medicaid coverage.

    (35) Institutional Vendor Payment: The payment made by the Medicaid Program to a Medicaid licensed nursing facility for the medical care of eligible individuals.

    (36) Institutionalized Individual: An inpatient in a nursing facility, hospital swing bed, hospital distinct-part skilled nursing facility, or intermediate care facility for the developmentally disabled for whom Medicaid payments are paid based on the level of care provided.

    (37) Institutionalized Spouse: An inpatient or individual seeking placement in a medical or nursing facility who is legally married to a community spouse.

    (38) Intermediate Care Facility for individuals with Intellectual Disabilities (ICF/ID): An institution or distinct part of an institution for treatment, care or rehabilitation of the developmentally disabled or persons with related conditions as set forth in 42 C.F.R. § 435.1010. These were formerly called “intermediate care facilities” for the mentally retarded (ICF/MR).

    (39) Lawfully Residing Child: A child under the age of 19 who has a lawful immigration status or a qualified noncitizen status as provided for in the Immigration and Nationality Act.

    (40) Medically Needy: Coverage which provides Mediciad eligibility for individuals whose countable income exceeds the applicable Medically Needy Income Levels (MNIL) in subsection 65A-1.716(2), F.A.C.

    (41) Medically Needy Income Level (MNIL): Income in excess of the Medically Needy Income Level available to pay for medical care and services.

    (42) MEDS-AD Demonstration Waiver: Medicaid coverage group for aged and disabled individuals with income at or below 88 percent of the federal poverty level.

    (43) Minimum Monthly Maintenance Needs Allowance (MMMNA): The minimum monthly maintenance needs allowance recognized by the state for the community spouse of an institutionalized individual.

    (44) Model Waiver: A home and community-based waiver program for individuals diagnosed with degenerate spinocerebellar disease.  The waiver provides support and services that will assist with stabilizing the health and welfare of an individual to remain in a noninstitutionalized setting in the community.  Participants for this waiver group are age 20 or younger.

    (45) Modified Adjusted Gross Income (MAGI): The financial methodologies set forth in 42 C.F.R. § 435.603 to determine the financial eligibility of all individuals for Medicaid, except for individuals identified in 42 C.F.R.  § 435.603(j).

    (46) Modified Adjusted Gross Income (MAGI) Disregard: An amount that may be subtracted from countable income of the SFU as provided for in 42 C.F.R. § 435.603(d)(4) and 65A-1.707(2)F.A.C.

    (47) Modified Project Aids Care: A limited coverage group for individuals diagnosed with the Human Immunodeficiency Virus (HIV) Acquired Immunodeficiency Deficiency Syndrome (AIDS), who do not meet the criteria for enrollment in the Statewide Medicaid Managed Care Long Term Care Program and meet other program requirements. 

    (48) Non-Filer: An individual who is not required to file a tax return and does not expect to be claimed as a tax dependent on another person’s tax return.

    (49) Others Outside of the Household (OOTH): An individual not living in the home, whom the tax-filer intends to claim on their federal tax return or an individual outside the home who intends to claim an individual on their federal tax return.

    (50) Parent: A natural, legal, adoptive parent, or stepparent.

    (51) Patient Responsibility: The amount by which AHCA must reduce its payments to a medical institution or intermediate care facility, or reduce its payments for home and community-based services provided to an individual towards their cost of care.

    (52) Presumptive Eligibility by Hospitals: An abbreviated determination of eligibilty completed by a qualified hospital approved by AHCA.

    (53) Program of All-Inclusive Care for the Elderly (PACE): An optional Medicaid program intended to serve the frail and elderly in the home and community.  The PACE program includes a comprehensive medical and social service delivery system using an interdisciplinary team approach in an adult day health center that is supplemented by in-home and referral services in accordance with participants' needs.

    (54) Qualified Designated Provider (QDP): An entity approved to conduct presumptive eligibility determinations for Medicaid for pregnant women.

    (55) Qualified Disabled Trust: A trust established by a parent, grandparent, legal guardian, or court on or after October 1, 1993, or a trust created by the individual if created on or after December 13, 2016, for the sole benefit of a disabled individual under the age of 65 which may consist of the disabled individual’s resources and income. The trust must provide that upon the death of the disabled individual the State shall receive all amounts remaining in the trust up to an amount equal to the total amount of medical assistance paid on behalf of the disabled individual by the Medicaid program pursuant to the state’s Title XIX state plan.

    (56) Qualified Hospital: A hospital that is an approved Medicaid provider under the Florida Medicaid State Plan and approved  to make presumptive eligibility determinations as outlined by AHCA.

    (57) Qualified Income Trust: A trust established on or after October 1, 1993, for the benefit of an individual whose income exceeds the ICP income standard and who needs institutional care or HCBS. The trust must consist of only the individual’s pension, Social Security and other income. The trust must be irrevocable and provide that upon the death of that individual the State shall receive all amounts remaining in the trust up to an amount equal to the total amount of medical assistance paid on behalf of that individual pursuant to the state’s Title XIX state plan.

    (58) Qualified Noncitizen: A category of noncitizens who meet at least one of the sections of the Immigration and Nationality Act, 8 U.S.C. § 1101 et seq., which allows them to receive Medicaid. 

    (59) Qualified Pooled Trust for the Disabled: A trust established by a disabled individual’s parent, grandparent, or legal guardian, or a court on or after October 1, 1993, for the sole benefit of the disabled individual and managed by a non-profit or not-for-profit association as defined in the Internal Revenue Code. A separate account must be maintained for each disabled beneficiary. For investment and management purposes, the separate accounts may be pooled together. To the extent that any amounts remaining in the beneficiary’s account upon their death are not retained by the trust, the trust must provide that upon the death of the disabled beneficiary, the State shall receive all amounts remaining in the trust up to an amount equal to the total amount of medical assistance paid on behalf of that individual pursuant to the state’s Medicaid Title XIX state plan.

    (60) Reasonably Compatible Income: Income reported that is consistent with information verified by an electronic data source and does not vary in a way that is meaningful for eligibility. Information is considered verified when the difference between reported income and information from electronic sources is no more than 10 percent.

    (61) Resource Allowance: The amount of the couple’s total countable resources which may be allocated to the community spouse of an institutionalized person.

    (62) Resources: Cash or other liquid assets, or any real or personal property that an individual owns and could convert to cash to be used for their support and maintenance. The terms “resources” and “assets” are used interchangeably in this rule chapter.

    (63) Retroactive Coverage: The provision that allows individuals to apply for Medicaid for any of the three months prior to the month of application for Medicaid.

    (64) Share of Cost (SOC): The amount of the individual’s or family’s income that exceed the Medically Needy Income Level (MNIL). A SOC represents the amount of allowable medical expenses that a Medically Needy assistance group must incur each month before becoming eligible to receive Medicaid.

    (65) Sibling: A natural, adopted, or step brother or sister.

    (66) Spouse: An individual lawfully married to another individual under state statute, federal regulation and federal laws.

    (67) Standard Disregard: Determined based on the converted data and figure of the Federal Poverty Level (FPL) and an average of the expenses and deductions allowed for a filing unit receiving assistance under the Florida Medicaid State Plan.  The amount is deducted from the total gross income to determine if the “Countable Net Income” is at or below the income limit for the coverage group based on the size of the filing unit.

    (68) Standard Filing Unit (SFU): All individuals whose needs, income, and/or assets are considered in the determination of eligibility for a category of assistance.

    (69) Statewide Medicaid Managed Care Long Term Care (SMMC-LTC): A program for individuals who need long term care, support and services in nursing homes, in their own homes or other community-based settings. 

    (70) Tax Dependent: Someone for whom a deduction may be claimed under the Internal Revenue Service (IRS) tax code.

    (71) Tax-Filer: An individual required to file federal income taxes and who claims the exemption amounts cited in 42 C.F.R. § 435.603(f).

    (72) Temporary Absence: A period of time for which Medicaid may continue when an otherwise eligible member is out of the home.

    (73) Title XVI: The provisions of the Social Security Act that set forth Supplemental Security Income (SSI) policies and procedures. The terms “Title XVI” and “SSI” are used interchangeably in this rule chapter.

    (74) Title XIX: The provisions of the Social Security Act that set forth Medicaid policies and procedures. The terms “Title XIX” and “Medicaid” are used interchangeably in this rule chapter.

    Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.919 FS. History–New 10-8-97, Amended 2-15-01, 4-1-03, 6-13-04, 8-10-06, Amended_______.

     

    Substantial rewording of Rule 65A-1.702 follows. See Florida Administrative Code for present text.

    65A-1.702 Special Provisions.

    (1) Date of Eligibility. Eligibility for Medicaid begins the first day of a month if an individual was eligible any time during the month, except as provided below:

    (a) Presumptive Eligibility for Pregnant Women (PEPW). The period of presumptive eligibility for pregnant women begins when a Qualified Designated provider, as defined in 65A-1.701, F.A.C., determines that the woman is eligible. Presumptive eligibility ends when a determination for full Medicaid is made (approved or denied), or on the last day of the month following the month the presumptive eligibility determination is made if an application for ongoing Medicaid coverage is not filed.

    (b) Presumptive Eligibility by Hospitals. The period of presumptive eligibility by hospitals begins on the date the determination is made. Presumptive eligibility ends when a determination for full Medicaid is made (approved or denied) or on the last day of the month following the month the presumptive eligibility determination is made if an application for ongoing Medicaid coverage is not filed.

    (c) Presumptive Eligiblity for Newborn (PEN). Eligibilty for a  presumptively eligible newborn begins on the date of birth and continues for one year unless one of the following occurs:

    1. The child leaves the state,

    2. The child dies, or

    3. There is a request for voluntary closure.

    (d) Medically Needy Program. Enrollment under the Medically Needy Program begins on the first day of the month the individual satisfies the non-financial and resource eligibility criteria, if applicable, but not earlier than the third month prior to the month of application.

    Medicaid Eligibilty under the Medically Needy Program begins on the date their incurred allowable medical expenses equal the amount of their share of cost (SOC).

    (e) Emergency Medicaid for Aliens (EMA). Coverage for individuals eligible for EMA begins the first day of a covered emergency and ends the day following the last day of the emergency medical situation. A Medicaid renewal date of 12 months will be assigned. Subsequent medical emergencies require documentation, but the individual will not have to file a new application and the Department will not make a new eligibility determination during this 12 month period. Changes in the SFU circumstances will continue to affect eligibility.

    (2) Processing Medicaid Applications for Supplemental Security Income (SSI) Denials.

    (a) The Department will use data obtained from the Social Security Administration’s (SSA) State Data Exchange (SDX) to identify individuals who have been denied SSI benefits.

    (b) The Department will identify the individuals for whom the Department does not have an open Medicaid case or a pending Medicaid application at the time the SDX data is received. The Department will explore eligibilty under another coverage group with information based on available information receieved from the SDX data.  These individuals or their SSA payee will be notified in writing to contact the Department within 30 calendar days. Failure to do so without good cause, will result in the issuance of a written notice of Medicaid denial for failure to follow through in determining eligibility.

    (c) Good cause means illness of the individual or a family member, an accident involving the individual or a family member, hospitalization of the individual or a family member, death of the individual or a family member, natural disasters in a relevant geographical area, being away from home or the unexpected closure of a  Department’s office.

    (d) Those individuals whom the Department identifies as having an open Medicaid case or a pending Medicaid application at the time the SDX data is reviewed will not be required to contact the Department, unless additional information is needed to complete the eligibility process.

    (e) A determination of eligibility will be completed on the individuals who respond to written notice to contact the Department.

    (3) Ex Parte Process.

    (a) When a recipient’s eligibility for Medicaid ends under one coverage group, the Department must evaluate their eligibility, using available information, under any other Medicaid coverage group before terminating Medicaid coverage. If additional information is required to make an ex parte determination it can be requested from the recipient. There is no requirement for the individual to contact the Department or file an application to initiate the ex parte review for continued Medicaid eligibility.

    (b) All individuals who lose Medicaid eligibility under one coverage group will continue to receive Medicaid under that coverage group until the ex parte Medicaid renewal process is complete.

    (c) Qualified individuals losing eligibility due to income that was calculated based on the Modified Adjusted Gross Income (MAGI) budgeting methodology will be transferred to the Children’s Health Insurance Program (CHIP) or the Federally Facilitated Marketplace (FFM) for a determination of eligibility.

    (4) Requirement to File for Other Benefits. As a condition of eligibility for Medicaid, the Department must require an individual to take all necessary steps to obtain any annuities, pensions, retirement, and disabilty benefits to which they are entitled, unless they can show good cause, as defined in subparagraph (2)(c) of this rule, for not doing so. Annuities, pensions, retirement and disability benefits include, but are not limited to, veterans' compensation and pensions, OASDI benefits, railroad retirement benefits, and unemployment compensation. After the Department notifies an individual that they must apply for the other benefit(s), if the individual fails to do so, they are not eligible for Medicaid.

    (5) Child Support Enforcement Cooperation (CSE). For the purpose of establishing Medicaid eligibility, a pregnant woman is not required to cooperate with CSE as a condition of eligibility. Cooperation with CSE is also not required in Medicaid cases where benefits are only requested for a child.

    (6) Re-evaluating Medicaid Adverse Actions for Individuals who do not Request a Hearing. The Department shall re-evaluate any adverse Medicaid determination upon a showing of good cause by the individual that the Department’s previous determination was incorrect. This provision applies only when benefits were terminated or denied in error or the amount of a share of cost or patient responsibility was determined incorrectly. A re-evaluation must be requested within 12 months from the effective date of the notice of adverse action.

    (a) Good cause for establishing the previous determination was incorrect consists of any of the following:

    1. Mathematical Error – The Department made a mechanical, computer or human error in its mathematical computations of resources or income requirements for Medicaid eligibility.

    2. Records Error – The Department made an error in a Medicaid determination which caused an incorrect decision. For example, there is evidence showing that the individual’s resources satisfied Florida’s standard of eligibility but the application was denied on the basis of excess resources.

    3. New and Material Evidence – The Department’s determination was correct when made but new and material evidence that the Department did not previously consider establishes that a different decision should be made.

    (b) Good cause for not requesting a hearing within the prescribed 90 day time period exists when the failure was due to circumstances beyond the individual’s control or due to an unexpected closure of  Department offices.

    (c) Failure of the individual to provide information required by the Department to accurately determine eligibility for Medicaid where the failure was beyond the individual’s control constitutes good cause for re-evaluation. However, if the individual fails to cooperate with the Department in establishing eligibility, good cause for re-evaluation does not exist.

    (d) The Economic Self Sufficiency Specialist (ESSS) is responsible for the initial determination of whether good cause for re-evaluation exists. The decision must be reviewed by the ESSS’s supervisor. If both the ESSS and the ESSS’s supervisor determine that good cause does not exist, the next level administrator, in consultation with the Regional Program Administrator, must review the decision.

    1. If a determination is made by the Regional Program Administrator that good cause does not exist, the individual will be notified of the decision and of the right to to request a fair hearing.

    2. If a determination is made by the Regional Program Administrator that good cause exists and the Department discovers that an error was made in the eligibility determination, benefits must be provided retroactively as follows:

    a. If an application was denied, benefits will be awarded back to the date of application, provided all other eligibility requirements are met.

    b. If an ongoing case was terminated, benefits will be awarded back to the effective date of the termination, provided all other eligibility requirements are met.

    3. If a determination is made by the Regional Program Administrator that good cause exists and the original determination is determined to be correct, the individual will be notified of the Department’s decision. The individual has 90 calendar days from the date of notice of disposition to request a hearing. If at the end of 90 calendar days a hearing is not requested, the Department’s decision is final and binding upon the individual.

    (7) Assignment of Rights to Benefits. Each individual applying for or receiving Medicaid must cooperate in securing the receipt of medical support and payments from third parties that are otherwise due to the individual, unless good cause exists for not cooperating. Good cause exists when the individual previously applied for and was denied third party benefits or medical support, and the reason for denial has not changed.

    (8) Retroactive Medicaid. Retroactive Medicaid is based on an approved, denied, or pending application for ongoing Medicaid benefits. For applications submitted on or after February 1, 2019, retroactive coverage only applies to applications for children under age 21 and pregnant women, including their postpartum period.

    (a) Retroactive Medicaid eligibility is not effective before the third month prior to the month of application. The individual must meet all Medicaid eligibility requirements during the retroactive months. A request for retroactive Medicaid can be made for a deceased individual by a designated representative or caretaker relative, by filing a medical assistance application. However, Qualified Medicare Beneficiaries (QMB’s) are not eligible for retroactive Medicaid benefits as indicated in Title XIX of the Social-Security Act § 1902(e)(8).

    (b) SSI Cash Assistance Recipients. Upon SSI approval, all SSI recipients receive a system-generated notice of potential entitlement for retroactive Medicaid benefits and a reply card to be returned to the Department if the SSI recipient is interested in receiving retroactive Medicaid benefits. If the SSI recipient or their designated representative or caretaker relative contacts the Department, the Department will proceed with an eligibility determination.

    (9) Re-Enrollment. In order for an individual or family to be eligible for re-enrollment in the Medically Needy program, they must:

    (a) Continue to satisfy the resource criteria, if applicable;

    (b) Continue to satisfy all non-financial eligibility criteria; and

    (c) Provide verifications as needed. The re-enrollment period may exceed 12 months when there is a delay in the Department’s processing of the re-enrollment.

    (10) Limits of Coverage.

    (a) Qualified Medicare Beneficiary (QMB). Under QMB coverage, individuals are eligible for Medicare cost-sharing benefits, including payment of Medicare premiums.

    (b) Specified Low-Income Medicare Beneficiary (SLMB). Under SLMB coverage, individuals are eligible for payment of the Part B Medicare premium. If eligible, AHCA will pay the premium for up to three months retroactive to the month of application.

    (c) Working Disabled (WD). Under WD coverage, individuals are eligible for payment of their Medicare Part A premium.

    (d) Qualifying Individuals 1 (QI1). Under QI1 coverage, individuals are eligible for payment of their Medicare Part B premium. (This is coverage for individuals who would be eligible for QMB or SLMB coverage except that their income exceeds the limits for those programs.)

    (11) Determining Share of Cost (SOC). The SOC is determined by deducting the appropriate Medically Needy Income Level from the individual’s or family’s income.

    (12) Eligibility of SSI Cash Assistance Recipients. Eligible SSI recipients who are residents of Florida are automatically eligible for Medicaid pursuant to 42 C.F.R. § 435.120.

    (13) Trusts.

    (a) The Department applies trust provisions set forth in § 1902 of the Social Security Act.

    (b) Funds transferred into a trust or other similar device established other than by a will prior to October 1, 1993, by the individual, a spouse, or a legal representative are available resources if the trust is revocable or if the trustee has any discretion over the distribution of the principal. Such funds are a transfer of a resource or income, if the trust is irrevocable and the trustee does not have discretion over distribution of the corpus, or if the individual is not the beneficiary. No penalty can be imposed when the transfer occurs beyond the 60 month look-back period. Any disbursements which can be made from the trust to the individual or to someone else on the individual’s behalf shall be considered available income to the individual. Any language which limits the authority of a trustee to distribute funds from a trust, if such distribution would disqualify an individual from participation in government programs, including Medicaid, shall be disregarded.

    (c) Funds transferred into a trust, other than a trust specified in 42 U.S.C. § 1396p(d)(4), by a person or entity specified in 42 U.S.C. § 1396p(d)(2) on or after October 1, 1993, shall be considered available resources or income to the individual in accordance with 42 U.S.C. § 1396p(d)(3) if there are any circumstances under which disbursement of funds from the trust could be made to the individual or to someone else for the benefit of the individual. If no disbursement can be made to the individual or to someone else on behalf of the individual, the establishment of the trust shall be considered a transfer of resources or income.

    (d) The trustee of a qualified income trust, qualified disabled trust, or a pooled trust shall provide quarterly statements to the Department which identify all deposits to and disbursements from the trust for each month during the eligibility period.

    (e) Undue Hardship. A period of ineligibility shall not be imposed if the Department determines that the denial of eligibility based on counting funds in an irrevocable trust according to provisions in subparagraph 65A-1.702(13)(b), F.A.C., would create an undue hardship on the individual. Undue hardship exists when application of a trust policy would deprive an individual of food, clothing, shelter or medical care such that their life or health would be endangered. This can be caused by legal restrictions or by illegal actions of a trustee. All efforts by the individual, or their legal spouse or representative, to access the resources or income must be exhausted before this exception applies.

    (14) Statewide Inpatient Psychiatric Program (SIPP). SIPP is for Medicaid eligible children under the age of 21 who require a residential level of care for treatment of a serious emotional disturbance. Those who are Medically Needy and those who are Medicare recipients are excluded from this program. Services must be received from a designated SIPP provider selected by the Agency for Health Care Administration (AHCA). SIPP providers must be licensed as a hospital or residential treatment center for children and adolescents by AHCA. This program provides an exception to provisions that residents of an institution for mental disease (IMD) are not eligible for Medicaid.

    Rulemaking Authority 409.919 FS. Law Implemented 409.903, 409.904, 409.919 FS. History–New 10-8-97, Amended 4-22-98, 2-15-01, 9-24-01, 11-23-04, 5-31-06, 8-10-06, Amended______    

     

    Substantial rewording of Rule 65A-1.703 follows. See Florida Administrative Code for present text.

    65A-1.703 Family-Related Medicaid Coverage Groups.

    The Department determines eligibility for mandatory and optional Medicaid coverage groups for individuals, families and children described in “The Patient Protection and Affordable Care Act”, under “The Health Care and Education Reconciliation Act 2010”, Section 1931 of the Social Security Act, relevant provisions of the Medicaid Program under Title XIX of the Social Security Act, the Children’s Health Insurance Program under Title XXI of the Social Security Act and 409.903. F.S.

    (1) The mandatory and optional Family-Related coverage groups are stated in each subsection of this rule that are entitled to coverage under the Florida Medicaid Program:

    (a) Children under age 19.

    (b) Children age 19 to 21.

    (c) Children in foster care.

    (d) Children placed for adoption and adopted children.

    (e) Former foster care individuals up to age 26.

    (f) Parents and caretaker relatives of children.

    (g) Pregnant women.

    (2) For each coverage group listed in subsection (1) above there is no asset or resource limit, and the following additional criteria must be met to qualify under the specific coverage group:

    (a) Children under age 19 and ages 19 to 21, the child must have never been married or emancipated, and must meet the eligibility criteria of Title XIX of the Social Security Act and the general requirements specified in 65A-1.705, F.A.C.  The countable net income for a child is based on the filing unit/family size of the coverage group.  To determine eligibility for a child, if the countable net income is at or above the limit for the coverage group, the MAGI five percent disregard for the filing unit/family size is subtracted from the countable net income to determine if the child will qualify.  If the countable net income for the child is below the income limit of the coverage group, the MAGI five percent disregard is not applied.  Income limits are based on the coverage group, the filing unit/family size of the child and listed below, as follows;

    1. The standard disregard is applied for a child under age one, children age 1-5.

    2. The countable net income for the filing unit/family size of a child under age one must be less than or equal to 200 percent of the FPL.

    3. The countable net income for the filing unit/family size of a child age one and up to age 19 is less than or equal to 133 percent of the FPL.

    4. The countable net income for the filing unit/family size of a child age 19 to 21, must be less than or equal to the income limits included in the Florida Medicaid State Plan. 

    5. To determine eligibility for a pregnant woman, the filing unit shall include each anticipated unborn child as a family member including the pregnant woman.

    (b) Children in Foster Care. Children for whom the Department is assuming full or partial responsibility, the child must be:

    1. Placed in either a foster home, a home of a relative or nonrelative, or an approved adoptive home by a child-placing agency, or the child must be placed with a residential child care agency; or

    2. In an independent living facility; or

    3. In a licensed emergency shelter home; or

    4. In a publicly operated community residential facility.

    (c) Children placed for adoption and adopted children are:

    1. Children under the age of 18 for whom there is a state adoption assistance agreement in effect, other than under Title IV-E of the Social Security Act, between the state and an adoptive parent. In addition to the adoption assistance agreement, the state adoption agency shall determine;

    a. If the child has a pre-existing special need for medical or rehabilitative care that would have precluded adoption placement without receipt of Medicaid coverage under the Florida Medicaid State Plan, and

    b. Prior to execution of the adoption assistance agreement, the child:

    I. Was receiving or was eligible to receive Medicaid or

    II. Would have been eligible for Medicaid if the Title IV-E financial requirements specified in 42 U.S.C. §473(2)(A), had been used to determine Medicaid eligibility.

    2. Children placed for adoption. Children under the age of 18 for whom there is a state adoption assistance agreement under Title IV-E of the Social Security Act in effect are deemed eligible for Medicaid even if the assistance payments are not being made.  If an adoption assistance agreement is in effect, Medicaid eligibility begins when the child is placed for adoption according to state law even if an interlocutory or final judicial decree or adoption has not been issued.

    (d) Former foster care individuals who are:

    1. Under age 26.

    2. In the Florida foster care system on their 18th birthday and receiving full Medicaid when they aged out of foster care.

    3. There is no income or resource limit.

    4. Not eligible and enrolled for other Medicaid mandatory coverage groups.

    (e) Parents (natural or adoptive), caretaker relatives and their spouses may derive their eligibility from a child under age 18 (natural or adoptive) within the fifth degree of the relationship who has never married and is not emancipated residing with them, provided their filing unit/family size is equal to or below the income limit established in the Florida’s Medicaid State Plan for the coverage group.  The fifth degree of relationships includes the following individuals:

    1. Brother, sisters (including step and those of half-blood),

    2. Aunts, uncles, nieces and nephews,

    3. First cousins (first cousins once removed), and

    4. Individuals of preceding generations as denoted by prefix of “grand”, “great”, “great-great”, “great-great-great”, etc.

    (f) Medicaid for pregnant women. To be eligible for this coverage group an expectant mother must meet the eligibility requirements specified in 65A-1.705, F.A.C.  The following additional eligibility criteria apply:

    1. The countable net income of the filing unit/family size is at or below 185 percent of the FPL.

    2. When eligibility is based solely on a pregnancy, the Department will accept the individual’s attestation of the number of expected births.

    3. The expectant mother is not required to comply with Child Support Enforcement requirements.

    4. Eligibility is extended through the month of birth and the two post-partum months regardless of changes in the income for the filing unit/family size.  At the end of the extended period, an ex-parte determination must be completed and the individual notified of any changes in eligibility. 

    (3) Medically Needy. To be eligible for this coverage group the individual must meet the eligibility requirements prescribed in 65A-1.705, F.A.C. 

    (a) Included in this coverage group are the following individuals:

    1. Children under age 21,

    2. A parent or caretaker relative and their spouse if living together with a child up to age 19, within the fifth degree of the specified relationships:

    a. Brother, sisters (including step and those of half-blood),

    b. Aunts, uncles, nieces and nephews,

    c. First cousins (first cousins once removed),

    d. Individuals of preceding generations as denoted by prefix of “grand”, “great”, “great-great”, “great-great-great”, etc.,

    e. The natural and other legally adopted children and other relatives of the adoptive parents, if they are within the specified degree, and

    f. Legal spouses of any person’s names in the above groups.

    3. Pregnant Women, and

    4. Children in foster care or receiving an adoption subsidy.

    (b) The following provisions apply to Medically Needy:

    1. The individual must have income at or below the respective Medically Needy Income Limit set forth in subsection 65A-1.716(2), F.A.C.  If income exceeds the Medically Needy Income Limits refer to subsection 65A-1.707(9), F.A.C.  Refer to paragraph 65A-1.713(1)(h), F.A.C. for additional income criteria applicable to the Medically Needy Program.

    2. There is no asset or resource limit.

    Rulemaking Authority 409.1451, 409.919 FS. Law Implemented 409.903, 409.904, 409.919 FS. History–New 10-8-97, Amended 9-28-98, 2-15-01, 6-13-04, Amended______

     

    Substantial rewording of Rule 65A-1.704 follows. See Florida Administrative Code for present text.

    65A-1.704 Family-Related Medicaid Eligibility Determination Process.

    (1) Public assistance staff determine eligibility for Family-Related Medicaid in accordance with 65A-1.703, 65A-1.705 and 65A-1.707, F.A.C., at the time of the initial application and annually thereafter and when a change potentially affecting eligibility is reported.

    (2) The Department must make a redetermination of eligibility for Medicaid without requiring information from the individual if it is able to do so based on reliable information contained in the individual's case or other more current information available to the Department.

    (a) If the Department is able to renew eligibility based on the information available, the Department will send a written notice of the eligibility determination to the individual.

    (b) If the Department is unable to redetermine eligibility based on the information available, the Department will provide the individual with:

    1. A notice, at least 30 calendar days prior to the end of the eligibility redetermination date, that it is time to renew their eligibility and the options available to the individual to complete the redetermination. These options are:

    a. Via the internet Web site,

    b. By telephone,

    c. Via mail,

    d. In person, or

    e. By fax.

    2. If the individual fails to provide the information for renewal, eligibility cannot be determined, and coverage will end. A notice of adverse action advising the individual of the Department’s actions will be sent. Medicaid coverage will be reinstated back to the effective date of the closure if the individual provides the requested information within three months of the effective date of the closure and continues to be eligible. 

    (3) Presumptive Eligibility for Pregnant Women. Qualified Designated providers determine presumptive eligibility for pregnant women. The period of presumptive eligibility for pregnant women begins when a qualified designated provider, as defined in 65A-1.701(53), F.A.C., determines that the woman is eligible. Presumptive eligibility ends when a determination (approved or denied) for full Medicaid is made, or on the last day of the month following the month the presumptive eligibility determination was made, if an application for ongoing Medicaid coverage is not filed. Citizenship status and providing a social security number (SSN) are not required for eligibility. A pregnant woman determined presumptively eligible may receive no more than one presumptive eligibility period per pregnancy.

    (4) Presumptive Eligibility by Hospitals. Pregnant women, infants and children under age 19, parents and caretaker relatives and former foster care children may receive Medicaid eligibility during a presumptive period when determined eligible by a qualified hospital, as defined in 65A-1.701(56), F.A.C. The period of presumptive eligibility begins on the date the determination is made. Presumptive eligibility ends when a determination (approved or denied) for full Medicaid is made, or on the last day of the month following the month the presumptive eligibility determination was made, if an application for ongoing Medicaid coverage is not filed. An individual may receive no more than one presumptively eligibility determination during a 12-month period, starting with the effective date of the initial presumptive eligibility period.

    Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.919 FS. History–New 10-8-97, Amended 2-7-01, 10-21-01, 4-1-03, 2-4-04, 6-26-08, 8-10-10,              Amended                            .

     

    Substantial rewording of Rule 65A-1.705 follows. See Florida Administrative Code for present text.

    65A-1.705 Family-Related Medicaid General Eligibility Criteria.

    (1) The Family-Related Medicaid technical eligibility factors.

    (a) The age criteria for children is specified in 65A-1.703, F.A.C.

    (b) The individual must be a resident of Florida as required by subsection 1902(a)(16) of the Social Security Act. Individuals who are physically present in Florida on a temporary basis may be considered residents of the State on a case-by-case basis if they indicate an intent to remain in Florida. A lawfully residing child under the age of 19 is considered to meet the residency requirement for Medicaid.

    (c) An absence from the home of less than 30 days does not affect Medicaid eligibility.  An individual is considered to be temporarily absent and may be eligible for Medicaid, under the following conditions:

    1.The parent or relative continues to exercise care and control of the child during the absence

    2.A definite plan exists for the absent child or parent/relative to return to the home at the end of the temporary period.

    (d) The individual must be a citizen of the United States, or a qualified non-citizen, or a lawfully residing child as defined in 65A-1.701 F.A.C.

    (e) The identity of each U.S. citizen, or qualified non-citizen, applying for or receiving Medicaid must be documented and verified.

    (2) Standard Filing Unit (SFU)

    (a) Taxpayers not claimed as a tax dependent: For individuals who expect to file a tax return for the taxable year in which an initial determination or renewal of eligibility is being made, and who do not expect to be claimed as a tax dependent by another taxpayer, the SFU consists of the taxpayer and, subject to paragraph (e) of this section, all persons whom such individual expects to claim as a tax dependent.

    (b) Individuals claimed as a tax dependent: For individuals who expect to be claimed as a tax dependent by another taxpayer for the taxable year in which an initial determination or renewal of eligibility is being made, the SFU consists of the taxpayer claiming such individual as a tax dependent, except that the SFU must be determined in accordance with paragraph (c) of this section.  Such individuals include:

    1. Individuals other than a spouse or a natural, adopted, or stepchild who expect to be claimed as a tax dependent by another taxpayer;

    2. Individuals under age 19, or in the case of full-time students under age 21, who expect to be claimed by one parent as a tax dependent and are living with both parents but whose parents do not expect to file a joint tax return; and

    3. Individuals under age 19, or in the case of full-time students under age 21, who expect to be claimed as a tax dependent by a parent not living in the home. For purposes of this subparagraph:

    a. A court order or binding separation, divorce, or custody agreement establishing physical custody controls; or

    b. If there is no such order or agreement or in the event of a shared custody agreement, the custodial parent is the parent with whom the child spends most nights.

    (c) Individuals who neither file a tax return nor are claimed as a tax dependent. In the case of individuals who do not expect to file a federal tax return and do not expect to be claimed as a tax dependent for the taxable year in which an initial determination or renewal of eligibility is being made, or who are described in subparagraph (4)(b)(1), (4)(b)(2), or (4)(b)(3) of this section, the SFU consists of the individual and, if living with the individual:

    1. The individual's spouse;

    2. The individual's natural, adopted or stepchildren under age 19 or, in the case of full-time students, age 21; and

    3. Individuals under age 19, or in the case of full-time students under age 21, the individual's natural, adoptive, and stepparents and natural, adoptive, and stepsiblings under age 19, or in the case of full-time students under age 21.

    (d) Married couples. In the case of a married couple living together, each spouse will be included in the SFU of the other spouse, regardless of whether they expect to file a joint tax return.

    (e) If the taxpayer cannot reasonably establish that another individual is a tax dependent of the taxpayer for the taxable year in which Medicaid eligibility is being determined, the inclusion of the individual in the SFU of the taxpayer is determined in accordance with paragraph (c) of this section.

    Rulemaking Authority, 409.919 FS. Law Implemented, 409.903, 409.904, 409.919 FS. History–New 10-8-97, Amended 9-28-98, 4-5-99, 11-23-99, 2-15-01, 9-24-01, 4-1-03, 6-26-08, 9-16-08, Amended_____    

     

    Substantial rewording of Rule 65A-1.707 follows. See Florida Administrative Code for present text.

    65A-1.707 Family-Related Medicaid Income and Resource Criteria.

    (1) The Department uses the Modified Adjusted Gross Income (MAGI) based budgeting methodologies as defined in section 36B(d)(2)(B) of the Internal Revenue Code to determine the financial eligibility of individuals applying for Medicaid. Resources are not considered as part of the eligibility determination for individuals whose eligibility is determined using MAGI methodologies. MAGI methodologies will not apply to the following:

    (a) Individuals whose eligibility for Medicaid does not require a determination of income by the Department, including individuals receiving Supplemental Security Income (SSI).

    (b) Individuals who are age 65 or older when age is a condition of eligibility.

    (c) Individuals whose eligibility is being determined on the basis of being blind or disabled.

    (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.

    (e) Individuals who are being evaluated for Medicare cost sharing assistance.

    (f) Individuals who are being evaluated for coverage as SSI-Related Medically Needy.

    (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.  The MAGI five percent is not applied if the countable income of the individual is at or below the income limit for the coverage group.  This disregard is not applied in Medically Needy

    (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 36B(d)(2)(B) of the Internal Revenue Code, with the exceptions specified in 42 C.F.R. § 435.603(e).

    (4) Household: Refer to 65A-1.705(2), F.A.C., for information on households.

    (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.

    (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 the Florida Medicaid State Plan, Approved Conversion Standards, incorporated by reference and available at https://www.flrules.org/gateway/reference.asp?NO=Ref-XXX.

    (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 the Florida Medicaid State Plan, Approved Conversion Standards.

    (8) Income standard for pregnant women. The maximum income standard for pregnant women is 185 percent of the FPL.

    (9) Medically Needy Income Level (MNIL). The Department deducts the MNIL, as provided in 65A-1.716(2) F.A.C., from the SFU countable income to determine the amount of excess countable income Share of Cost (SOC) available to meet medical care and services each month.

    (10) Exceptions to MAGI-based income referenced in 42 C.F.R. § 435.603(e).

    Rulemaking Authority 409.919 FS. Law Implemented 409.903, 409.904, 409.919 FS. History–New 10-8-97, Amended 2-15-01, 11-23-04, 2-20-07, 5-6-08, 6-4-12, Amended______

     

    Substantial rewording of Rule 65A-1.708 follows. See Florida Administrative Code for present text.

    65A-1.708 Family-Related Medicaid Budgeting Criteria.

    (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.

    (a) Weekly income is converted to a monthly amount by using the conversion factor of 4.

    (b) Biweekly income is converted to a monthly amount by using the conversion factor of 2.

    (c) Semi-monthly income is converted to a monthly amount by using the conversion factor of 2.

    (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:

    1. 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.

    2. 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.

    (2) There is no asset or resources test.

    (3) The Department will apply the standard disregard as defined in 65A-1.701(68) F.A.C., based on the standard filing unit size to all budgets using the Family-Related Medicaid budgeting criteria except Medically Need.

    (4) Budgeting for Medically Needy individuals.

    (a) Determining share of cost (SOC). The Department will deduct the following amounts from an individual’s countable income to determine their SOC:

    1. 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 65A-1.716(2), F.A.C., for Family-Related Medicaid coverage groups.

    2. For aged, blind, or disabled individuals, the Department will deduct the MNIL amounts found in 65A-1.716(2), F.A.C., SSI-Related Medicaid coverage groups.

    (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:

    1. 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:

    a. A recognized health insurance costs (premiums, copays and deductibles), or

    b. Medical expenses that are unpaid and the payment of the expenses remains the responsibility of the individual or a member of the SFU, or

    c. Medical expenses paid during the month for which bill tracking is being completed.

    2. 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:

    a. Subject to third party payment or

    b. Previously used to meet SOC.

    3. Medical expenses reimbursed by a state or local government not funded in full by federal funds, excluding Medicaid program payments, are allowable deductions.

    4. 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.

    Rulemaking Authority 409.919 FS. Law Implemented 409.903, 409.904, 409.919 FS. History–New 10-8-97, Amended 2-15-01, 10-16-07, Amended_____

     

    Substantial rewording of 65A-1.716 follows. See Florida Administrative Code for present text.

    65A-1.716 Income and Resource Criteria.

    (1) The monthly federal poverty level figures based on the family size are as follows:

    Family

    Size

    88% of Poverty Level

    100% of Poverty Level

    120% of Poverty level

    133% of Poverty Level

    135% of Poverty Level

    185% of Poverty Level

    200% of Poverty Level

    1

    $916

    $1,041

    $1,249

    $1,385

    $1.406$ 

    $1,926

    $2,082

    2

    $1,241

    $1,410

    $1,691

    $1,875

    $1,903

    $2,607

    $2,819

    3

     

    $1,778

     

    $2,365

     

    $3,289

    $3,555

    4

     

    $2,145

     

    $2,854

     

    $3,970

    $4,292

    5

     

    $2,515

     

    $3,344

     

    $4,652

    $5,029

    6

     

    $2,883

     

    $3,834

     

    $5,333

    $5,765

    7

     

    $3,251

     

    $4,324

     

    $6,015

    $6,502

    8

     

    $3,620

     

    $4,814

     

    $6,696

    $7,239

    9

     

    $3,988

     

    $5,304

     

    $7,377

    $7,975

    10

     

    $4,356

     

    $5,794

     

    $8,059

    $8,712

    11

     

    $4,725

     

    $6,284

     

    $8,740

    $9,449

    12

     

    $5,093

     

    $6,771

     

    $9,422

    $10,185

    For each addtl person

     

    $369

     

    $490

     

    $682

    $737

     

    (2) Monthly income levels for Family-Related and SSI (Supplemental Security Income)-Related Medically Needy Income Levels (MNIL) are by family size as follows:

    Family Size

    Monthly Income Level

    Family-Related MNIL

    SSI-Related MNIL

    1

    $180

    $289

    $180

    2

    $241

    $387

    $241

    3

    $303

    $486

     

    4

    $364

    $585

     

    5

    $426

    $684

     

    6

    $487

    $783

     

    7

    $549

    $882

     

    8

    $610

    $981

     

    9

    $671

    1079

     

    10

    $733

    1179

     

    Add for each addtl. person

    $62

    $100

     

    Exception: In determining eligibility for a pregnant woman, the income limits for Monthly Income Level and MNIL used shall be increased to the higher limit corresponding to the applicant’s actual family size. Family size shall include each anticipated unborn child as a family member.

    (3) The resource limits for the Medically Needy program are as follows:

    (a) Family-Related Medicaid: $0

    (b) SSI-Related Medicaid:

    1. $5,000 per individual; and

    2. $6,000 per couple

     

    Monthly

    Family

    Asset

    Size

    Level

    1

    $5,000

    2

    $6,000

    3

    $6,000

    4

    $6,500

    5

    $7,000

    6

    $7,500

    7

    $8,000

    8

    $8,500

    9

    $9,000

    10

    $9,500

     

    For each additional person add $500.

    Exception: In determining eligibility for a pregnant woman, the resource limit used shall be increased to the higher limit corresponding to the applicant’s actual family size, including each anticipated unborn child as a family member.

    (4) The maximum resource limit is $2,000 for those individuals:

    (a) Whose Medicaid coverage is based on payment standard income criteria. Refer to subsection 65A-1.716(2), F.A.C.; or

    (b) Are children living with their parent(s) and who, as children, would qualify for cash assistance except for their age. The maximum resource limit of $2,000 also applies to those coverage groups indicated in 65A-1.703, F.A.C. However, there is no asset limit for the coverage groups specified in paragraphs 65A-1.703(3) through (5), F.A.C.

    (5) The SSI-Related Medicaid Program Standards:

    (a) SSI (42 U.S.C. §§ 1382 – 1383c) Resource Limits:

    1. $2000 per individual.

    2. $3000 per eligible couple, or per eligible individual with an ineligible spouse who is living together.

    (b) The income limit which applies to an individual in Home and Community-Based Services (HCBS) waiver programs, Institutional Care Programs (ICP), and hospice is 300 percent of the Federal Benefit Rate (FBR) for an individual.

    (c) Spousal Impoverishment Standards.

    1. Resource Allocation. The amount of the couple’s total countable resources which may be allocated to the community spouse of an institutionalized person is equal to the maximum allowed by 42 U.S.C. § 1396r-5(f)(2)(A).

    2. Minimum Monthly Maintenance Needs Allowance (MMMNA). The minimum monthly maintenance needs allowance the Department recognizes for a community spouse is equal to 150 percent of the federal poverty level (FPL) for a family of two as set forth in 42 U.S.C. § 1396r-5(d)(3)(A)(i) and (ii).

    3. Excess Shelter Allowance. The community spouse’s shelter expenses must exceed 30 percent of the MMMNA to be considered excess shelter expenses to be included in the maximum income allowance: MMMNA × 30% = Excess Shelter Allowance, as defined in 42 U.S.C. § 1396r-5(d)(3)(A)(ii). This standard changes July 1 of each calendar year.

    4. Food Assistance Program Standard Utility Allowance. The amount specified in subsection 65A-1.603(2), F.A.C.

    5. Cap of Community Spouse Needs Allowance. The MMMNA plus excess shelter allowance cannot exceed the maximum amount allowed under 42 U.S.C. § 1396r-5(d)(3)(A)(C). This needs allowance changes January 1 of each year.

    (d) The average monthly private pay nursing facility rate is $9,485.

    (e) The following life expectancy tables are compiled from information published by the Office of the Chief Actuary of the Social Security Administration:

    FEMALE LIFE EXPECTANCY TABLE

    Age

    Life Expectancy

    Age

    Life Expectancy

    Age

    Life Expectancy

    0

    80.99

    40

    42.50

    80

    9.74

    1

    80.43

    41

    41.56

    81

    9.15

    2

    79.46

    42

    40.62

    82

    8.58

    3

    78.48

    43

    39.69

    83

    8.04

    4

    77.49

    44

    38.76

    84

    7.51

    5

    76.50

    45

    37.83

    85

    7.01

    6

    75.51

    46

    36.90

    86

    6.53

    7

    74.52

    47

    35.98

    87

    6.07

    8

    73.53

    48

    35.07

    88

    5.64

    9

    72.54

    49

    34.16

    89

    5.23

    10

    71.54

    50

    33.26

    90

    4.85

    11

    70.55

    51

    32.36

    91

    4.50

    12

    69.56

    52

    31.48

    92

    4.18

    13

    68.56

    53

    30.59

    93

    3.88

    14

    67.57

    54

    29.72

    94

    3.67

    15

    66.58

    55

    2885

    95

    3.37

    16

    65.60

    56

    27.99

    96

    3.16

    17

    64.62

    57

    27.13

    97

    2.96

    18

    63.63

    58

    26.28

    98

    2.79

    19

    62.66

    59

    25.44

    99

    2.63

    20

    61.68

    60

    24.60

    100

    2.48

    21

    60.71

    61

    23.76

    101

    2.33

    22

    59.73

    62

    22.94

    102

    2.19

    23

    58.73

    63

    22.12

    103

    2.06

    24

    57.80

    64

    21.30

    104

    1.93

    25

    56.83

    65

    20.49

    105

    1.81

    26

    55.86

    66

    19.69

    106

    1.69

    27

    54.90

    67

    18.89

    107

    1.58

    28

    53.93

    68

    18.11

    108

    1.47

    29

    52.97

    69

    17.33

    109

    1.37

    30

    52.01

    70

    16.57

    110

    1.27

    31

    51.05

    71

    15.82

    111

    1.18

    32

    50.09

    72

    15.09

    112

    1.09

    33

    49.14

    73

    14.37

    113

    1.01

    34

    48.19

    74

    13.66

    114

    0.93

    35

    47.23

    75

    12.97

    115

    0.86

    36

    46.28

    76

    12.29

    116

    0.79

    37

    45.34

    77

    11.62

    117

    0.73

    38

    44.39

    78

    10.98

    118

    0.67

    39

    43.45

    79

    10.35

    119

    0.62

     

    MALE LIFE EXPECTANCY TABLE

    Age

    Life Expectancy

    Age

    Life Expectancy

    Age

    Life Expectancy

    0

    76.04

    40

    38.59

    80

    8.34

    1

    75.52

    41

    37.69

    81

    7.82

    2

    74.55

    42

    36.78

    82

    7.32

    3

    73.58

    43

    35.88

    83

    6.84

    4

    72.59

    44

    34.98

    84

    6.38

    5

    71.60

    45

    34.08

    85

    5.69

    6

    70.62

    46

    33.19

    86

    5.52

    7

    69.63

    47

    32.30

    87

    5.12

    8

    68.64

    48

    31.43

    88

    4.75

    9

    67.64

    49

    30.55

    89

    4.40

    10

    66.65

    50

    29.69

    90

    4.08

    11

    65.66

    51

    28.84

    91

    3.78

    12

    64.66

    52

    27.99

    92

    3.50

    13

    63.67

    53

    27.16

    93

    3.25

    14

    62.68

    54

    26.34

    94

    3.03

    15

    61.70

    55

    25.52

    95

    2.83

    16

    60.73

    56

    24.72

    96

    2.66

    17

    59.76

    57

    23.93

    97

    2.51

    18

    58.81

    58

    23.15

    98

    2.37

    19

    57.86

    59

    22.37

    99

    2.25

    20

    56.91

    60

    21.61

    100

    2.13

    21

    55.98

    61

    20.85

    101

    2.02

    22

    55.05

    62

    20.11

    102

    1.91

    23

    54.13

    63

    19.37

    103

    1.81

    24

    53.22

    64

    18.65

    104

    1.71

    25

    52.30

    65

    17.92

    105

    1.61

    26

    51.38

    66

    17.20

    106

    1.52

    27

    50.47

    67

    16.49

    107

    1.43

    28

    49.55

    68

    15.78

    108

    1.35

    29

    48.63

    69

    15.09

    109

    1.27

    30

    47.72

    70

    14.40

    110

    1.19

    31

    46.80

    71

    13.73

    111

    1.11

    32

    45.89

    72

    13.07

    112

    1.04

    33

    44.97

    73

    12.43

    113

    0.97

    34

    44.06

    74

    11.80

    114

    0.91

    35

    43.15

    75

    11.18

    115

    0.84

    36

    42.23

    76

    10.58

    116

    0.78

    37

    41.32

    77

    10.00

    117

    0.73

    38

    40.41

    78

    9.43

    118

    0.67

     

    39

    39.50

    79

    8.88

    119

    0.62

     

     

     

     

     

     

     

     

     

     

     

    Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.919 FS. History–New 10-8-97, Amended 12-9-99, 2-15-01, 11-25-01, 7-28-02, 4-1-03, 9-10-03, 8-30-04, 8-10-06, 4-15-12, 10-16-12, 11-4-12, 9-18-13, Amended___.

     

    NAME OF PERSON ORIGINATING PROPOSED RULE: Suzann Fauci

    NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Chad Poppel

    DATE PROPOSED RULE APPROVED BY AGENCY HEAD: November 4, 2019

    DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: December 13, 2018

Document Information

Comments Open:
11/12/2019
Summary:
The amendments will accomplish the following: (1) Revise definitions of terminology used in the Medicaid program; (2) Revise provisions related to general eligibility determinations; (3) Establish income and resource criteria for both Family-Related and SSI-Related Medicaid Programs; and (4) Set forth the Family-Related Medicaid budgeting process.
Purpose:
The Department intends to amend Rules 65A-1.205, .701-.705, .707-.708, and .716, F.A.C., to revise the Family-Related Medicaid eligibility policies and procedures used to implement the Florida Family-Related Medicaid Program so that the requirements of the Affordable Care Act that govern the Florida Family-Related Medicaid coverage groups are met.
Rulemaking Authority:
409.1451, 409.919, 414.095, 414.45, F.S.
Law:
409.902, 409.903, 409.904, 409.906, 409.919, 414.045, 414.095, 414.31, 414.41, F.S.
Contact:
Jodi Abramowitz. Jodi can be reached at 850-717-4470 or Jodi.Abramowitz@myflfamilies.com.
Related Rules: (9)
65A-1.205. Eligibility Determination Process
65A-1.701. Definitions
65A-1.702. Special Provisions
65A-1.703. Family-Related Medicaid Coverage Groups
65A-1.704. Family-Related Medicaid Eligibility Determination Process
More ...