Current through Reg. 50, No. 187; September 24, 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.
(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; and
2. A
notice of the Department's decision concerning the renewal of
eligibility.
(d) 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 fails to request an extension of the due date, the Department
will deny the application because it cannot establish eligibility.
(5) The Department must 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 adversely 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-11642,
CF-ES 2620H (Creole), 05/2010, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11643,
CF-ES 2620S (Spanish), 05/2010, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11644;
(f) Designation of Beneficiary, CF-ES 990,
01/2020, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11657;
(g) Medical Assistance Referral, CF-ES 2039,
incorporated in subsection (1) of this rule;
(h) Authorization to Disclose Information,
CF-ES 2514, 02/2007, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11658,
CF-ES 2514H (Creole), 02/2007, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11660,
CF-ES 2514S (Spanish), 02/2007, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11661;
and
(i) Financial Information
Release, CF-ES 2613, 10/2005, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11662,
CF-ES 2613H (Creole), 10/2005, available at
https://www.flrules.org/Gateway/reference.asp?No=Ref-11663.
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.
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,
3-25-20.
