65A-1.713: SSI-Related Medicaid Income Eligibility Criteria
PURPOSE AND EFFECT: The proposed rule amendment adds the Request for Veterans Information, CF-ES 2262, and incorporates it by reference. The proposed rule adds language for Veterans Administration benefits and the Department’s policy and procedures of such benefits. Included in this proposed rule amendment are some technical changes of a non-substantive nature improving the overall content of the rule.
SUMMARY: The proposed rule amendment adds the Request for Veterans Information CF-ES 2262 and associated policy of Veterans Administration benefits.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION:
The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the agency.
The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: The Department considered the factors in Section 120.541, F.S. The proposed rule is not expected to exceed the criteria in paragraph 120.541(2)(a), F.S., therefore legislative ratification is not required under subsection 120.541(3), F.S.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
RULEMAKING AUTHORITY: 409.919 FS.
LAW IMPLEMENTED: 409.902, 409.903, 409.904, 409.906, 409.919 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE,TIME AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
DATE AND TIME: February 29, 2011, 1:30 p.m.
PLACE: 1317 Winewood Boulevard, Building 3, Room 455, Tallahassee, Florida 32399-0700
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 7 days before the workshop/meeting by contacting: Cindy Keil. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Cindy Keil, ACCESS Florida Program Policy, 1317 Winewood Boulevard, Building 3, Room 455, Tallahassee, Florida 32399-0700, cindy_keil@dcf.state.fl.us, (850)717-4113
THE FULL TEXT OF THE PROPOSED RULE IS:
65A-1.713 SSI-Related Medicaid Income Eligibility Criteria.
(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) through (c) No change.
(d) For ICP, gross income cannot exceed 300 percent of the Supplemental Security Income (SSI) SSI federal benefit rate after consideration of allowable deductions set forth in subsection (2) below 65A-1.713(2), F.A.C. 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) through (h) No change.
(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) No change.
(2) Included and Excluded Income. For all SSI-related coverage groups the Ddepartment follows the SSI policy specified in 20 C.F.R. § 416.1100 et seq. (2007) 20 C.F.R. 416.1100 (2007) (incorporated by reference) et seq., including exclusionary policies regarding Veterans Administration benefits such as VA Aid and Attendance, unreimbursed Medical Expenses, and reduced VA Improved pensions, to determine what counts as income and what is excluded as income with the following exceptions:
(a) through (e) No change.
(3) The Veterans Administration (VA) provides a housebound allowance to eligible individuals who do not qualify for regular aid and attendance payments. This allowance can be paid to a veteran or widow or a widower who receives dependency or indemnity compensation. It is excluded income.
(4) The Veterans Administration provides an allowance for unreimbursed medical expenses incurred by the veteran that exceeds five percent of an individual’s annual income. Unreimbursed medical expenses is excluded income. The Department can use form CF-ES 2262, Request for Veteran’s Information, 11/2011 (incorporated by reference) to verify through the Department of Veterans Affairs the type and amount of VA payments.
(5)(3) When Income Is Considered Available for Budgeting. The Ddepartment counts income when it is received, when it is credited to the individual’s account, or when it is set aside for their use, whichever is earlier.
(a) If a regular periodic payment is occasionally received in a month other than the normal month of receipt and there is no intent to interrupt the regular payment schedule the Ddepartment considers the funds to be available income in the normal month of receipt. Examples include checks advance dated because the regular payment date falls on a weekend or holiday, or electronic fund transfers or direct deposits which are posted to a bank account before or after the month they are payable.
(b) No change.
(6)(4) Income Budgeting Methodologies. To determine eligibility SSI budgeting methodologies are applied except where expressly prohibited by 42 U.S.C. § 1396 (2000 Ed., Sup. IV) (incorporated by reference), or another less restrictive option is elected by the state under 42 U.S.C. § 1396a(r)(2) (2000 Ed., Sup. IV) (incorporated by reference). When averaging income, all income from the most recent consecutive four weeks shall be used if it is representative of future earnings. A longer period of past time may be used if necessary to provide a more accurate indication of anticipated fluctuations in future income.
(a) For MEDS-AD Demonstration Waiver, Protected Medicaid, Medically Needy, Qualified Working Disabled Individual, QMB, SLMB, QI1, and to compute the community spouse income allocation for spouses of ICP individuals, the following less restrictive methodology for determining gross monthly income is followed:
1. When income is received monthly or more often than once per month the monthly income from that source shall be computed by first determining the weekly income amount and then multiplying that amount by four 4. A five-week month shall not be treated any differently than a four-week month.
2. No change.
3. When earned income is received less often than monthly, the Ddepartment counts the total amount in the month received and does not prorate.
(b) For institutional care, hospice, and HCBS waiver programs the Ddepartment applies the following methodology in determining eligibility:
1. No change.
2. If the individual’s monthly income does not exceed the institutional care income standard in any month the Ddepartment will prorate the income over the period it is intended to cover to compute patient responsibility, provided that it does not result in undue hardship to the client. If it causes undue hardship it will be counted for the anticipated month of receipt.
(c) Medically Needy. The amount by which the individual’s countable income exceeds the Medically Needy income level, called the “share of cost”, shall be considered available for payment of medical care and services. The Ddepartment computes available income for each month eligibility is requested to determine the amount of excess countable income available to meet medical costs. If countable income exceeds the Medically Needy income level the Ddepartment shall deduct allowable medical expenses in chronological order, by day of service. Countable income is determined in accordance with subsection (2) above 65A-1.713(2), F.A.C. To be deducted the expenses must be unpaid, or if paid, must have been paid in the month for which eligibility is being determined or incurred and paid during the three previous calendar months to the month for which eligibility is being determined but no earlier than the three retroactive application months. The paid expense may not have been previously deducted from countable income during a period of eligibility. Medical expenses reimbursed by a state or local government not funded in full by federal funds, excluding Medicaid Pprogram payments, are allowable deductions. Any other expenses reimbursable by a third party are not allowable deductions. Examples of recognized medical expenses include:
1. through 2. No change.
(7) Materials incorporated by reference are available from the Economic Self-Sufficiency Headquarter’s Office 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.
Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.919 FS. History–New 10-8-97, Amended 1-27-99, 4-1-03, 6-13-04, 8-10-06 (1), (4), 8-10-06 (1), 2-20-07, 10-16-07, 5-6-08,________.