reglab/statecodes huggingface dataset:
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.603 - Food Assistance Program Income and Expenses

Current through Reg. 50, No. 138; July 16, 2024
(1) Rounding Income and Expenses. With the
				exception of the benefit reduction, cents resulting from budget calculations
				are retained at each level in determining the assistance group's (AGs) food
				assistance benefits. The benefit reduction is rounded up to the next whole
				dollar.
(2) Standard Utility
				Allowance. A standard utility allowance (SUA) of $426 must be used by AGs who
				incur, or within the eligibility period expect to incur, heating or cooling
				expenses separate and apart from their rent or mortgage and by AGs who receive
				direct or indirect assistance authorized under the Low-Income Home Energy
				Assistance Act of 1981. Actual utility expenses are not allowed. Any additional
				utility expenses, including the telephone standard, are not used.
(3) Basic Utility Allowance. A basic utility
				allowance (BUA) of $340 must be used by AGs who do not incur heating or cooling
				expenses, but do incur utility expenses such as electricity, fuel, water,
				sewerage, or garbage pickup, separate and apart from their rent or mortgage.
				Actual utility expenses are not allowed. Any additional utility expenses,
				including the telephone standard, are not used.
(4) Telephone Standard. A telephone standard
				of $49 must be used by AGs who incur only a telephone expense. Actual telephone
				expenses are not allowed. Any additional utility expenses, including the SUA or
				BUA, are not used.
(5) Homeless
				Shelter Deduction. A homeless shelter deduction of $180 must be used by
				homeless AGs who do not receive free shelter throughout the month and incur or
				expect to incur shelter expenses unless higher expenses are claimed.
(6) Child Support Paid Out. Legally obligated
				child support payments are a deduction for the Food Assistance
				Program.
Rulemaking Authority
					 414.45 FS. Law Implemented
					 414.31
					 FS.
New 1-31-94, Formerly 10C-1.603, Amended 1-12-99, 5-25-03,
					 8-22-05, 2-17-09, 12-13-09, 11-1-10, 12-25-11, 10-16-12, 8-11-13, 11-30-14,
					 1-31-16, 6-6-17, 4-4-18, 8-15-18, 12-3-19, 11-25-20, 1-9-22, 2-6-23,
					 2-7-24.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.604 - Food Stamp Issuance (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 414.45 FS. Law Implemented
					 409.942,
					 414.31
					 FS.
New 1-31-94, Formerly 10C-1.604, Amended 3-18-03, Repealed
					 4-17-06.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.606 - Food Stamp Assets (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 414.45 FS. Law Implemented
					 414.075(2)(a),
					 414.31
					 FS.
New 3-24-02, Repealed
					 8-22-05.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.630 - Legal Immigrant's Temporary Income Bridge Program (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 414.45 FS. Law Implemented
					 409.185(2),
					 414.125
					 FS.
New 2-23-98, Repealed
					 12-17-01.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.701 - Definitions

Current through Reg. 50, No. 138; July 16, 2024
As used in Rules
				   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 determined by the Florida Department of Elder Affairs
				(DOEA), Comprehensive Assessment and Review for Long-Term Care Services (CARES)
				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) Asset
				Verification System (AVS): The electronic verification process by which the
				Department verifies disclosed and undisclossed assets for individuals applying
				for Medicaid based on age or disability.
(8) 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.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.702 - Special Provisions

Current through Reg. 50, No. 138; July 16, 2024
(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 Rule
				 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.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.703 - Family-Related Medicaid Coverage Groups

Current through Reg. 50, No. 138; July 16, 2024
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 Section 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.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.704 - Family-Related Medicaid Eligibility Determination Process

Current through Reg. 50, No. 138; July 16, 2024
(1) Public assistance staff determine
				eligibility for Family-Related Medicaid in accordance with Rules
				 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.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.705 - Family-Related Medicaid General Eligibility Criteria

Current through Reg. 50, No. 138; July 16, 2024
(1) The Family-Related Medicaid technical
				eligibility factors.
(a) The age criteria for
				children is specified in Rule
				 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 Rule
				 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.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.706 - Family-Related Medicaid Needs Criteria

Current through Reg. 50, No. 138; July 16, 2024
The standards set forth in Rule
				   65A-1.716, F.A.C., are used to
				  determine an individual's needs for Family-related Medicaid.
Rulemaking Authority
					 409.919 FS. Law Implemented
					 409.903,
					 409.904,
					 409.919
					 FS.
New 10-8-97, Amended
					 2-15-01.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.707 - Family-Related Medicaid Income and Resource Criteria

Current through Reg. 50, No. 138; July 16, 2024
(1) The Department uses the Modified Adjusted
				Gross Income (MAGI) based budgeting methodologies as defined in
				26 U.S.C.
				36B(d)(2)(B) 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.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.708 - Family-Related Medicaid Budgeting Criteria

Current through Reg. 50, No. 138; July 16, 2024
(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.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.709 - SSI-Related Medicaid Coverage (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 409.919 FS. Law Implemented
					 409.903,
					 409.904,
					 409.919
					 FS.
New 10-8-97, Repealed
					 1-7-16.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.710 - SSI-Related Medicaid Coverage Groups

Current through Reg. 50, No. 138; July 16, 2024
The Department covers all mandatory coverage groups and the
				  following optional coverage groups:
(1) MEDS-AD Demonstration Waiver. A Medicaid
				coverage group for aged or disabled individuals (or couples), as provided in  42 U.S.C. §
										1396a(m).
(2)
				Institutional Care Program (ICP). A Medicaid coverage group that helps pay for
				the cost of care in a nursing facility for institutionalized aged, blind or
				disabled individuals (or couples) who would be eligible for cash assistance
				except for their institutional status and income as provided in  42 C.F.R. §§
										435.211 and 435.236.
(3) Hospice Program. A Medicaid coverage
				group that provides care and support to individuals who are terminally ill and
				meets the specific Medicaid hospice eligibilty requirements as provided in  42 U.S.C. §
										1396d(a). subsection
				 65A-1.711(3) 
				and Rule  65A-1.713, F.A.C.
(4) Home and Community Based Services (HCBS).
				A Medicaid coverage group for aged, blind or disabled individuals that provides
				coverage for services and activities to prevent institutionalization and allow
				the individual to remain in the community. The approved HCBS Waivers as
				permitted by  42 U.S.C. §
										1396n  and  42 C.F.R. §
										435.217  are intended to
				prevent institutionalizing individuals who:
(a) Satisfy all SSI-Related Medicaid
				financial and non-financial eligibility criteria; and
(b) Have resources and income within
				Institutional Care or MEDS-AD Demonstration Waiver Program
				limits.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.711 - SSI-Related Medicaid Non-Financial Eligibility Criteria

Current through Reg. 50, No. 138; July 16, 2024
To qualify for Medicaid an individual must meet the general
				  and categorical requirements in  42 C.F.R. Part 435, subparts E and F (2007)
				  (incorporated by reference), with the exception that individuals who are
				  neither aged nor disabled may qualify for breast and cervical cancer treatment,
				  and the following program specific requirements as appropriate. Individuals who
				  are in Florida temporarily may be considered residents of the state on a
				  case-by-case basis, if they indicate an intent to reside in Florida and can
				  verify that they are residing in Florida.
(1) For MEDS-AD Demonstration Waiver, the
				individual must be age 65 or older, or disabled as defined in  20 C.F.R. §
										416.905  (2007) (incorporated by reference).
(2) For ICP benefits, an individual must be:
(a) Living in a licensed nursing facility, or
				confined to a hospital swing bed or to a hospital-based skilled nursing
				facility bed, or in an ICF/DD facility that is certified as a Medicaid provider
				and provides the level of care that the client needs as determined by the
				Department; or living in a Florida state mental hospital and be age 65 or over;
				and,
(b) Determined to be in
				medical need of institutional care services according to Rules
				 59G-4.180 and
				 59G-4.290, F.A.C., for nursing
				facility, hospital swing bed placements and placements in a hospital-based
				skilled nursing facility bed according to Chapter 65B-38, F.A.C., for ICF/DD
				facilities or according to Rule
				 59G-4.300, F.A.C., for state
				mental hospitals.
(c) If the
				individual is in a hospital swing bed or in a hospital-based skilled nursing
				facility bed, meet the requirements for length of stay prescribed in Rule
				 59G-4.200,
				F.A.C.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.712 - SSI-Related Medicaid Resource Eligibility Criteria

Current through Reg. 50, No. 138; July 16, 2024
(1) Resource Limits. If an individual's total
				resources are equal to or below the prescribed resource limits at any time
				during the month the individual is eligible on the factor of resources for that
				month. The resource limit is the SSI limit specified in Rule
				 65A-1.716, F.A.C., with the
				following exceptions:
(a) For Medicaid for
				the Aged or Disabled Demonstration Waiver (MEDS-AD), an individual whose income
				is equal to or below 88 percent of the federal poverty level must not have
				resources exceeding the current Medically Needy resource limit specified in
				Rule 65A-1.716, F.A.C.
(b) For Qualified Medicare Beneficiary (QMB),
				an individual cannot have resources exceeding three times the SSI resource
				limit with increases based on the Consumer Price Index.
(c) For Working Disabled (WD), an individual
				cannot have resources exceeding the Medically Needy resource limit.
(d) For Specified Low Income Medicare
				Beneficiary (SLMB), an individual cannot have resources exceeding three times
				the SSI resource limit with increases based on the Consumer Price
				Index.
(e) For Qualifying
				Individuals 1 (QI1), an individual cannnot have resources exceeding three times
				the SSI resource limit with increases based on the Consumer Price
				Index.
(f) For Medically Needy, an
				individual or couple cannot have resources exceeding the applicable Medically
				Needy resource limit set forth in subsection
				 65A-1.716(3),
				F.A.C.
(g) For the Home and
				Community Based Services (HCBS) Waiver Program, an individual cannot have
				countable resources that exceed $2, 000. If the individual's income falls
				within the MEDS-AD Demonstration Waiver limit, the individual can have
				resources up to $5, 000.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.713 - SSI-Related Medicaid Income Eligibility Criteria

Current through Reg. 50, No. 138; July 16, 2024
(1) Income limits. An individual's income
				must be within limits established by federal or state law and the Medicaid
				State Plan. The income limits are as follows:
(a) For Medicaid for the Aged or Disabled
				(MEDS-AD) Demonstration Waiver, income cannot exceed 88 percent of the federal
				poverty level (FPL) after application of exclusions specified in subsection
				(2).
(b) For Qualified Medicare
				Beneficiary (QMB), income must be less than or equal to the FPL after
				application of exclusions specified in subsection (2).
(c) For Working Disabled (WD), income must be
				less than or equal to 200 percent of the FPL after application of exclusions
				specified in subsection (2).
(d)
				For Institutional Care Program (ICP), gross income cannot exceed 300 percent of
				the Supplemental Security Income (SSI) federal benefit rate after consideration
				of allowable deductions set forth in subsection (2). Individuals with income
				over this limit may qualify for institutional care services by establishing an
				income trust which meets criteria set forth in subsection
				 65A-1.702(15),
				F.A.C.
(e) For Home and
				Community-Based Services (HCBS), gross income cannot exceed 300 percent of the
				SSI federal benefit rate after consideration of allowable deductions set forth
				in subsection (2). Individuals with income over this limit may qualify for HCBS
				services by establishing a qualified income trust which meets criteria set
				forth in subsection  65A-1.702(15),
				F.A.C.
(f) For hospice services,
				income cannot exceed 300 percent of the SSI federal benefit rate or income must
				meet Medically Needy eligibility criteria, including the share of cost
				requirement. Effective October 1, 1998, institutionalized individuals with
				income over this limit may qualify for institutional hospice services by
				establishing an income trust which meets criteria set forth in subsection
				 65A-1.702(15),
				F.A.C.
(g) For Specified Low-Income
				Medicare Beneficiary (SLMB), income must be greater than 100 percent of the FPL
				but equal to or less than 120 percent of the FPL.
(h) For Medically Needy, income must be less
				than or equal to the Medically Needy income standard after deduction of
				allowable medical expenses.
(i) For
				Protected Medicaid, income cannot exceed the limits established in accordance
				with 42 U.S.C. §
											1383c (2000 Ed., Sup. IV) (incorporated by
				reference).
(j) For a Qualified
				Individual 1 (QI1), income must be greater than 120 percent of the FPL, but
				equal to or less than 135 percent of the FPL. QI1 is eligible only for payment
				of the Part B Medicare premium through Medicaid.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.714 - SSI-Related Medicaid Post-Eligibility Treatment of Income (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 409.919 FS. Law Implemented
					 409.903,
					 409.904,
					 409.919
					 FS.
New 10-8-97,red book doesn't give information, need to look
					 it up.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.715 - Emergency Medical Services for Aliens

Current through Reg. 50, No. 138; July 16, 2024
(1) Aliens who would be eligible for Medicaid
				but for their immigration status are eligible only for emergency medical
				services. Section  409.901(10),
				F.S., defines emergency medical conditions.
(2) The Utilization Review Committee (URC) or
				medical provider will determine if the medical condition warrants emergency
				medical services and, if so, the projected duration of the emergency medical
				condition. The projected duration of the emergency medical condition will be
				the eligibility period provided that all other criteria are continuously
				satisfied.
(3) Emergency services
				are limited to 30 consecutive days without prior approval. For continued
				coverage beginning with the 31st day prior authorization must be obtained from
				the Agency for Health Care Administration (Medicaid Program
				Office).
Rulemaking Authority
					 409.919 FS. Law Implemented
					 409.904,
					 409.919
					 FS.
New 10-8-97.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.716 - Income and Resource Criteria

Current through Reg. 50, No. 138; July 16, 2024
(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
$945
$1, 074
$1, 288
$1, 428
$1, 449
$1, 986
$2, 147
2
$1, 278
$1, 452
$1, 742
$1, 931
$1, 960
$2, 686
$2, 904
3
$1, 830
$2, 434
$3, 386
$3, 660
4
$2, 208
$2, 938
$4, 086
$4, 417
5
$2, 587
$3, 441
$4, 786
$5, 174
6
$2, 965
$3, 944
$5, 486
$5, 930
7
$3, 344
$4, 447
$6, 186
$6, 687
8
$3, 722
$4, 950
$6, 886
$7, 444
9
$4, 100
$5, 453
$7, 585
$8, 200
10
$4, 478
$5, 957
$8, 285
$8, 957
11
$4, 857
$6, 460
$8, 985
$9, 714
12
$5, 235
$6, 963
$9, 685
$10, 470
For each addtl. person
$329
$374
$448
$497
$691
$747
(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
Family Size
Monthly Asset 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.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.720 - Medicare Buy-In Demonstration Project (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 409.919 FS. Law Implemented
					 409.903,
					 409.904
					 FS.
New 11-11-99, Repealed
					 5-18-04.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.730 - Medikids

Current through Reg. 50, No. 138; July 16, 2024
(1) The department has elected to contract
				with the Healthy Kids Corporation for MediKids eligibility
				determinations.
(2) The application
				for the MediKids program will be the Florida Healthy Kids and Florida KidCare
				Program Application.
Rulemaking Authority
					 409.818 FS. Law Implemented
					 409.818
					 FS.
New 4-5-99.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.801 - Purpose (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 409.026 FS. Law Implemented
					 409.185,
					 409.235
					 FS.
New 8-3-94, Formerly 10C-1.801, Repealed
					 10-8-98.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.802 - Administrative Definitions and Acronyms Applicable to RAP (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 414.45 FS. Law Implemented
					 414.095
					 FS.
New 8-3-94, Formerly 10C-1.802, Repealed
					 2-15-01.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.803 - General Eligibility

Current through Reg. 50, No. 138; July 16, 2024
Determinations of eligibility for RAP and program specific
				  definitions required in these eligibility determinations are conducted in
				  accordance with 45 C.F.R., Chapter IV, Part 400, Subparts A through G, and Part
				  401. Additionally, the specific definition of a Cuban/Haitian entrant as used
				  in this program is found in Section 501e of the Refugee Education Assistance
				  Act of 1980.
Rulemaking Authority
					 402.86 FS. Law Implemented
					 Specific Appropriation 435, 2000 General Appropriations
					 Act.
New 8-3-94, Formerly 10C-1.803, Amended
					 2-15-01.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.804 - Citizenship (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 414.45 FS. Law Implemented
					 414.095
					 FS.
New 8-3-94, Formerly 10C-1.804, Repealed
					 2-15-01.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.805 - Employment Registration and Participation in Employment and Language Training Programs (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 414.45 FS. Law Implemented
					 414.095
					 FS.
New 8-3-94, Formerly 10C-1.805, Repealed
					 2-15-01.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.806 - Need Requirement (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 414.45 FS. Law Implemented
					 414.095
					 FS.
New 8-3-94, Formerly 10C-1.806, Repealed
					 2-15-01.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.807 - Assets (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 414.45 FS. Law Implemented
					 414.095
					 FS.
New 8-3-94, Formerly 10C-1.807, Repealed
					 2-15-01.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.808 - Income (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 414.45 FS. Law Implemented
					 414.095
					 FS.
New 8-3-94, Formerly 10C-1.808, Repealed
					 2-15-01.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.809 - Budgeting (Repealed)

Current through Reg. 50, No. 138; July 16, 2024
Rulemaking Authority
					 414.45 FS. Law Implemented
					 414.095
					 FS.
New 8-3-94, Formerly 10C-1.809, Repealed
					 2-15-01.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.900 - Overpayment and Benefit Recovery

Current through Reg. 50, No. 138; July 16, 2024
This section sets forth the administrative policies
				  applicable to the establishment and recovery of overpayments in the food
				  assistance and cash assistance programs.
(1) Administrative Definitions Applicable to
				Overpayment and Benefit Recovery.
(a) Adult,
				for the purpose of this rule, is:
1. Eighteen
				years of age or older;
2. A teen
				parent receiving public assistance for themselves as an adult;
3. An emancipated minor; or
4. An individual who has been married even if
				the marriage ended in divorce.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.901 - Public Assistance Fraud Reward Program

Current through Reg. 50, No. 138; July 16, 2024
(1) Intake Documentation. To facilitate
				tracking, eligible fraud reports are submitted using the CF-ES Form 3415,
				Report of Suspected or Known Public Assistance Fraud, 12/2014, incorporated by
				reference,
https://www.flrules.org/Gateway/reference.asp?No=Ref-05434
,
				and sent to the Department of Children and Families (Department); or by
				submitting the online form. The form can be completed online at the
				Department's fraud reporting website,
www.myflfamilies.com/ReportFraud
,
				or mailed to DCF ACCESS Central Mail Center Fraud Report, P.O. Box 1770, Ocala,
				FL 34478-1770, or faxed to (850)487-0800. Reports not received through the
				Department's fraud reporting website and those received by the Department of
				Financial Services (DFS) or the Florida Department of Law Enforcement (FDLE)
				will be submitted by a state employee on behalf of the reporter using the
				online form. Copies of forms and materials incorporated by reference in this
				rule may be obtained by the public from the Office of Public Benefits Integrity
				(OPBI) at 1317 Winewood Boulevard, Tallahassee, Florida 32399-0700. Forms are
				also available on the Department's website at
http://www.dcf.state.fl.us/DCFForms/Search/DCFFormSearch.aspx
.
(a) Once submitted, the report will be
				assigned a tracking number and a notification will be sent to the reporter
				containing the tracking number, and describing the responsibilities of the
				reporter to be eligible for the Public Assistance Fraud Reward
				Program.
(b) A reporter has the
				opportunity to opt-out of the reward program or to report the allegation
				anonymously. If a reporter chooses either of these options, the report will be
				processed, but the reporter will not be eligible to receive a reward.
(c) State employees and individuals under
				contract with the state are not eligible to be public assistance fraud report
				reward recipients if the information provided was obtained in the performance
				of their official duties.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-2 - OPTIONAL STATE SUPPLEMENTATION › Section 65A-2.023 - Application and Determination of Eligibility

Current through Reg. 50, No. 138; July 16, 2024
(1) An individual applying to receive an
				Optional State Supplementation (OSS) payment must submit an ACCESS Florida
				Application, CF-ES 2337, 08/2016, incorporated by reference in Rule
				 65A-1.205, F.A.C. Once the
				completed, dated and signed application is received, and date stamped as
				received by the Department, the application process begins.
(2) Applications are processed and the
				eligibility decision is made in accordance with the standards in Rule
				 65A-1.205, F.A.C., with the
				exception that the ACCESS Florida Application is the application for the OSS
				Program. The individual is notified of the eligibility decision by a Notice of
				Case Action, CF-ES 2235, 02/2012,
http://www.flrules.org/Gateway/reference.asp?No=Ref-01205
,
				incorporated by reference. The following non-English versions of the Notice of
				Case Action are incorporated by reference: CF-ES 2235H (Creole), 02/2012,
				available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-13627
,
				and CF-ES 2235S (Spanish), 02/2012, available at
http://www.flrules.org/Gateway/reference.asp?No=Ref-13628
.
(3) This rule will be reviewed and repealed,
				modified, or renewed through the rulemaking process five years from the
				effective date.
Rulemaking Authority
					 409.212(7) FS.
					 Law Implemented 409.212
					 FS.
New 1-1-77, Formerly 10C-2.23, Amended 2-9-88, Formerly
					 10C-2.023, Amended 12-16-01, 6-4-12,
					 10-26-21.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-2 - OPTIONAL STATE SUPPLEMENTATION › Section 65A-2.024 - Determination of Continued Eligibility

Current through Reg. 50, No. 138; July 16, 2024
(1)
				The individual receiving Optional State Supplementation (OSS) must notify the
				Department of changes in circumstances as indicated in subsection
				 65A-2.022(3),
				F.A.C. The Department, in cooperation with the individual, must redetermine the
				individual's eligibility for continued assistance at least annually.
(2) Individuals who do not cooperate with the
				Department by providing required information or documentation shall have their
				case terminated, as continuing eligibility cannot be established.
(3) If an individual leaves the special
				living arrangement for a period of 30 consecutive days, the individual is no
				longer eligible for continued OSS benefits and must reapply in order for their
				eligibility to be determined.
Rulemaking Authority
					 409.212(7) FS.
					 Law Implemented 409.212
					 FS.
New 1-1-77, Amended 10-7-80, Formerly 10C-2.24, 10C-2.024,
					 Amended 12-16-01.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-2 - OPTIONAL STATE SUPPLEMENTATION › Section 65A-2.031 - Advance Notice: Written Ten Day Advance Notice

Current through Reg. 50, No. 138; July 16, 2024
(1) Written notification must be given or
				mailed to an individual receiving Optional State Supplementation ten days in
				advance of action to terminate or reduce the payment.
(2) Exception. Conformity to ten day advance
				notice is waived in the following situations, but written notification must be
				given or mailed to the individual or their authorized representative prior to
				the effective date of the action:
(a) When
				termination is due to death;
(b)
				When an individual or their authorized representative requests termination or
				reduction of assistance in writing;
(c) When the Department is unable to locate
				an individual as evidenced by the return of a letter of a recent date, with an
				indication that the letter could not be delivered due to no forwarding address,
				and no further information for locating the individual is available;
(d) When an administrative or fair hearing
				has been denied, the benefits that were continued without reduction pending the
				outcome of the hearing may be reduced with no advance notice of adverse action
				to the individual, or
(e) When
				systems transactions fail to reduce or terminate assistance correctly and
				notice has previously been given.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-2 - OPTIONAL STATE SUPPLEMENTATION › Section 65A-2.033 - Optional State Supplementation Coverage Groups

Current through Reg. 50, No. 138; July 16, 2024
To be determined eligible for Optional State Supplementation
				  (OSS), an individual must qualify under one of the following coverage
				  groups.
(1) The individual must be
				eligible for and receiving a check from the Supplemental Security Income (SSI)
				Program administered by the Social Security Administration. The Department
				accepts receipt of SSI as meeting all factors of OSS eligibility criteria in
				Rule  65A-2.032, F.A.C., except age
				and placement need as specified in subsections
				 65A-2.032(1) and
				(7), F.A.C., which must be verified by
				Department staff.
(2) The
				individual must meet all SSI and OSS eligibility criteria, except for income
				which must be equal to or less than the OSS income standard established by the
				Department. These individuals must meet eligibility criteria in Rule
				 65A-2.032, F.A.C.
(3) The individual must have been eligible
				for and receiving Aid to the Aged, Blind or Disabled from the state as of
				December 1973. This federally mandated coverage group did not qualify for the
				same level of benefits under SSI in 1974. For this coverage group, the special
				living facility criteria at subsection
				 65A-2.032(7),
				F.A.C., does not apply.
(4) The
				individual must: reside in an Assisted Living Facility or Mental Health
				Residential Treatment Facility; have been eligible for and receiving OSS
				payments for August 2001; have become ineligible for OSS as of September 2001
				solely because their income exceeds the applicable OSS income standard of
				$609.40; and, not be categorically eligible for full Medicaid benefits as of
				September 2001. Additionally, in regard to an Adult Family Care Home (AFCH),
				the individual must: reside in an AFCH; have been eligible for and receiving
				OSS payment for December 2001; have become ineligible for OSS as of January
				2002, solely because their income exceeds the applicable OSS income standard of
				$623.40; and, not be categorically eligible for full Medicaid benefits as of
				January 2002. As long as the individual continues to meet all OSS eligibility
				criteria and the income standard test in paragraph
				 65A-2.036(3)(b),
				F.A.C., they will remain eligible for payment under the provider rates in
				paragraph  65A-2.036(4)(b),
				F.A.C. Once an OSS recipient no longer meets all OSS eligibility criteria or
				the income standard in paragraph
				 65A-2.036(3)(b),
				F.A.C., they will no longer be eligible under this coverage
				group.
Rulemaking Authority
					 409.212(7) FS.
					 Law Implemented 409.212
					 FS.
New 1-1-77, Formerly 10C-2.33, Amended 9-30-86, 2-9-88,
					 Formerly 10C-2.033, Amended 12-16-01,
					 5-14-02.
Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-2 - OPTIONAL STATE SUPPLEMENTATION › Section 65A-2.035 - Income Calculation

Current through Reg. 50, No. 138; July 16, 2024
(1) To be determined
				eligible for Optional State Supplementation, an individual must not have gross
				monthly income, after the following exclusions, in excess of Department
				standards, as found in subsection
				 65A-2.036(3),
				F.A.C.:
(a) Gross income, less an earned
				income exclusion of $65 plus one-half of the remaining earned income;
(b) Other federal exclusions to the
				individual's income; and,
(c)
				Additional exclusions provided by Section
				 409.212(5),
				F.S.