Florida Administrative Code

Rulemaking Authority 402.17 FS. Law Implemented 402.17 FS. History-New 1-27-86, Amended 4-27-93, Formerly 10-6.026, Repealed 9-30-18.

(1) When the department determines that a client should be placed in a program which requires financial eligibility and the client is income eligible, but exceeds the program's resource limitation, the department may apply excess resources in the Client Trust Fund to the cost of …

Except as otherwise provided within, the following definitions apply to this chapter. (1) Public Assistance: Food Assistance, Temporary Cash Assistance, Medicaid, Refugee Assistance, Optional State Supplementation. (2) Economic Self-Sufficiency (ESS): The entity within the Depart…

(1) An individual has the right to apply for assistance, to have eligibility determined, and if found eligible, to receive benefits. The applicant for or recipient of public assistance must assume the responsibility of furnishing information, documentation and verification needed…

(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 We…

(1) The automatic Lifeline service enrollment process is an electronic interface between the Department and the Public Service Commission. Applicants and recipients can indicate their interest in receiving Lifeline service within the ACCESS Florida Web Application, CF-ES 2353, 09…

(1) The individual whose needs are included must meet the citizenship and noncitizen status established in: P.L. 104-193, The Personal Responsibility and Work Opportunity Reconciliation Act of 1996; P.L. 105-33, the Balanced Budget Act of 1997; P.L. 105-185, the Agricultural Rese…

(1) To be eligible for public assistance, the individual must either provide the social security number (SSN) when known for each person whose needs are included in the assistance group or SFU or, apply for a SSN for each individual who either does not have a number assigned or w…

(1) Specific policies concerning assets vary by program and are found in federal statutes and regulations and Florida Statutes. (2) Any individual who has the legal ability to dispose of an interest in an asset owns the asset. (3) Once the individual's ownership interest of an as…

The following forms are used for Public Assistance Programs to provide applicants and recipients with required notice of the agency's and client's rights and responsibilities and other necessary program information. These forms are hereby incorporated by reference. (1) Forms that…

(1) Food Assistance Program case processing is done in accordance with the eligibility determination process in Rule 65A-1.205, F.A.C., and in 7 C.F.R. § 271.2, 273.1 - 273.18, 273.24 and 273.25. (2) Responsible Member is defined as any member of the Standard Filing Unit (SFU) ca…

(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. (…

(1) The Food Assistance Employment and Training (E&T) Program is administered in accordance with the requirements of 7 C.F.R. §273.7, P.L. 104-193, The Personal Responsibility and Work Opportunity Reconciliation Act of 1996, and P.L. 107-171, Food Stamp Reauthorization Act of 200…

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 eligibi…

(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 beg…

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 Socia…

(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) T…

(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 physicall…

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. History-New 10-8-97, Amended 2-15-01.

(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 …

(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 Depar…

Rulemaking Authority 409.919 FS. Law Implemented 409.903, 409.904, 409.919 FS. History-New 10-8-97, Repealed 1-7-16.

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 M…

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 tr…

(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.,…

(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 fede…

After an individual is determined eligible for Hospice, Institutional Care Program (ICP), Program of All-Inclusive Care for the Elderly (PACE), Individual Budgeting (iBudget), or Statewide Medicaid Managed Care Long-Term Care (SMMC-LTC) Program, the Department determines the indi…

(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 m…

(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) 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 Implem…

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 entra…

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 …

(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 …

(1) Any individual has the right to apply for Optional State Supplementation (OSS) and, if found eligible according to these rules and Section 409.212, F.S., to receive an established monthly payment. Individuals residing in Assisted Living Facilities (ALF) and Adult Family Care …

(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…

(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…

(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 noti…

(1) An eligible individual must be age 65 or older, or age 18 or older and blind or disabled as defined by Title XVI of the Social Security Act (SSA). Federal disability criteria are found at 20 C.F.R. §§416 et seq. (2) An eligible individual must be living in the state of Florid…

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 …

(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…

(1) The Department establishes the base provider rates for specialized living arrangements (the amount the individual is to pay the facility) specified in subsection (4), below, within funds appropriated by the Legislature. Base provider rates may vary depending upon type of spec…

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History-New 10-1-87, Formerly 10C-24.010, Repealed 11-14-10.

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History-New 10-1-87, Formerly 10C-24.011, Repealed 11-14-10.

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History-New 10-1-87, Formerly 10C-24.012, Amended 9-28-99, Repealed 11-14-10.

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History-New 10-1-87, Formerly 10C-24.014, Amended 9-28-99, Repealed 11-14-10.

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History-New 10-1-87, Formerly 10C-24.015, Amended 9-28-99, Repealed 11-14-10.

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History-New 10-1-87, Formerly 10C-24.016, Amended 9-28-99, Repealed 11-14-10.

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History-New 10-1-87, Formerly 10C-24.017, Amended 9-28-99, Repealed 11-14-10.

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History-New 10-1-87, Formerly 10C-24.018, Amended 9-28-99, Repealed 11-14-10.

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History-New 10-1-87, Formerly 10C-24.019, Amended 9-28-99, Repealed 11-14-10.