Florida Administrative Code › 65 - DEPARTMENT OF CHILDREN AND FAMILIES › 65A - Economic Self-Sufficiency Program › Chapter 65A-1 - PUBLIC ASSISTANCE PROGRAMS › Section 65A-1.205 - Eligibility Determination Process

Current through Reg. 50, No. 138; July 16, 2024
(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-11698
,
				or an ACCESS Florida Web Application (only accepted electronically), CF-ES
				2353, 11/2020, incorporated by reference and available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11627
.
				The following non-English versions of the ACCESS Florida Application are
				incorporated by reference: CF-ES 2337C (Chinese), 11/2011, is available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11669
,
				CF-ES 2337F (French-Canadian), 11/2011, is available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11700
,
				CF-ES 2337H (Creole), 08/2016, is available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11701
,
				CF-ES 2337I (Italian), 11/2011, is available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11702
,
				CF-ES 2337P (Portuguese), 11/2011, is available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11703
,
				CF-ES 2337R (Russian), 11/2011, is available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11704
,
				CF-ES 2337S (Spanish), 08/2016, is available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11705
,
				CF-ES 2337SC (Serbo-Croatian), 11/2011, is available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11726
,
				and CF-ES 2337V (Vietnamese), 11/2011, is available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11727
,
				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-11729
.
				The following non-English versions of the Family-Related Medical Assistance
				Application are incorporated by reference: CF-ES 2370H (Creole), 09/2015, is
				available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11730
,
				and CF-ES 2370S (Spanish), 09/2015, is available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11731
.
				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-11634
,
				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, 01/2020, incorporated by
				  reference and available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11635
.
(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., the Department will forward an electronic file to the Children's Health
				Insurance Program (CHIP) or the Federally Facilitated Marketplace (FFM) for a
				determination of eligibility. 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:
1. Are not eligible to receive a
				SSN,
2. Do not have a
				SSN,
3. May only be issued an SSN
				for a valid non-work reason in accordance with  20 C.F.R. §
												422.104,
				or
4. Individuals who 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-11636
,
				  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), 04/2007,
				  available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11637
;
				  and CF-ES 2930S (Spanish), 04/2007, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11638
.
				  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-11725
,
				  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),
				  06/2008, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11723
;
				  and CF/PI 165/107S (Spanish), 06/2008, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11724
.
(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.