Florida Administrative Code

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.

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History-New 10-1-87, Formerly 10C-24.020, 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-24.021, Repealed 11-14-10.

Rulemaking Authority 414.45 FS. Law Implemented 414.35 FS. History-New 10-1-87, Formerly 10C-24.023, 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-24.024, Amended 9-28-99, Repealed 11-14-10.

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History-New 3-13-88, Amended 7-15-93, Formerly 10C-33.003, Amended 2-16-00, Transferred to 65I-1.001.

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History-New 3-13-88, Amended 7-15-93, Formerly 10C-33.004, Amended 2-16-00, Transferred to 65I-1.002.

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History-New 3-13-88, Formerly 10C-33.005, Amended 2-16-00, Transferred to 65I-1.003.

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History-New 3-13-88, Formerly 10C-33.006, Amended 2-16-00, Transferred to 65I-1.004.

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History-New 3-13-88, Amended 4-2-91, 7-15-93, Formerly 10C-33.007, Amended 2-16-00, Transferred to 65I-1.005.

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History-New 3-13-88, Amended 4-2-91, 7-15-93, Formerly 10C-33.008, Amended 2-16-00, Transferred to 65I-1.006.

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History-New 3-13-88, Amended 4-2-91, Formerly 10C-33.009, Transferred to 65I-1.007.

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History-New 3-13-88, Formerly 10C-33.010, Transferred to 65I-1.008.

Rulemaking Authority 414.45 FS. Law Implemented 414.16 FS. History-New 3-13-88, Amended 4-2-91, 7-15-93, Formerly 10C-33.011, Amended 2-16-00, Transferred to 65I-1.009.

(1) Hardship Extension and Exemption Determinations. An extension or exemption from the time limit for receipt of Temporary Cash Assistance (TCA) cannot be authorized until a hardship review is completed, using the Hardship Extension Review, CF-ES 2082, 05/2023, which is incorpor…

(1) Family Member. A family member is any individual related to any member of the assistance group by blood or marriage. The disabled family member must reside in the home with the caregiver. The family member with the disability can be a child or any adult member of the family, …

(1) Penalty Requirements. The provisions for receipt of temporary cash assistance (TCA) include the requirement of individuals who do not meet exemptions to participate in work activities or alternative requirement plans. For the purposes of this rule "work activities" include al…

(1) The provisions for receipt of temporary cash assistance (TCA) include the requirement of individuals who do not meet exemptions to participate in work activities or alternative requirement plans which allow an individual to meet program requirements based on the individual's …

(1) To be included in a Temporary Cash Assistance (TCA) benefit, a child must be a minor child as defined in Section 414.0252(8), F.S. An unmarried child means the child has never been married or if married, the marriage was annulled. (a) A secondary school is considered grades 6…

(1) The Department determines financial eligibility by comparing the income, assets and needs of standard filing unit members to the eligibility/payment standard applicable to the assistance group pursuant to Section 414.095, F.S. Assistance group members are always members of th…

(1) Income is cash received at periodic intervals from any source including but not limited to wages, benefits, contributions, and rental property. Cash is money or an equivalent, such as a check, money order or other negotiable instrument. Income must be substantiated and docume…