65A-1.701: Definitions
65A-1.702: Special Provisions
65A-1.710: SSI-Related Medicaid Coverage Groups
65A-1.711: SSI-Related Medicaid Non-Financial Eligibility Criteria
65A-1.712: SSI-Related Medicaid Resource Eligibility Criteria
65A-1.713: SSI-Related Medicaid Income Eligibility Criteria
PURPOSE AND EFFECT: The proposed rule amendments reflect changes in legislation for the elimination of the MEDS-AD program effective January 1, 2006. Medicaid coverage may be continued to some elderly or disabled individuals under a federal waiver.
SUMMARY: The rule amendments remove the MEDS-AD program language from the mandatory and optional Medicaid coverage groups and eligibility criteria.
SUMMARY OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
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.
SPECIFIC 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 TIME, DATE AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
TIME AND DATE: 1:30 p.m., June 19, 2006
PLACE: 1317 Winewood Boulevard, Building 3, Room 439, Tallahassee, Florida 32399-0700
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Nathan Lewis, Acting Chief, Program Policy, Economic Self-Sufficiency, 1317 Winewood Boulevard, Building 3, Room 448, Tallahassee, Florida 32399-0700, telephone (850)414-5927
THE FULL TEXT OF THE PROPOSED RULE IS:
65A-1.701 Definitions.
(1) through (9) No change.
(10) Developmental Services Waiver: A Medicaid HCBS waiver program for developmentally disabled individuals who:
(a) through (b) no change
(c) Have income and resources within the Institutional Care or MEDS-AD Demonstration Waiver program limits.
(11) through (19) No change.
(20) MEDS-AD Demonstration Waiver: An optional categorical Medicaid coverage group for aged or disabled individuals who meet all SSI-related Medicaid non-financial eligibility criteria, whose resources do not exceed the limit in the Medically Needy Program, and whose income is at or below 88 percent of the federal poverty level and are not receiving Medicare or if receiving Medicare are also eligible for Medicaid covered institutional care services, hospice services or home and community based services.
(21) through (31) No change.
(32) Spouse:
(a) For SSI-related programs MEDS-AD Demonstration Waiver, Medically Needy, Emergency Medicaid for Aliens, Qualified Medicare Beneficiary, Special Low-Income Medicare Beneficiary, Working Disabled (WD), and Protected Medicaid Coverage purposes: A person’s husband or wife as defined at 20 C.F.R. § 416.1806 or § 416.1811.
(b) No change
(33) through (36) No change.
(37) Home and Community Based Services: An individual is considered to be receiving home and community based services when they are:
(a) Enrolled in a Home and Community Based Services (HCBS) Medicaid waiver; or
(b) Enrolled in the Program of All-Inclusive Care for the Elderly (PACE); or
(c) Residing in a licensed assisted living facility, adult family care home or mental health residential treatment facility that is enrolled as a Medicaid and Assistive Care Services provider; or
(d) A current participant in the Frail Elder Program who was enrolled in the program as of December 31, 2005.
Specific Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.919 FS. History–New 10-8-97, Amended 2-15-01, 4-1-03, 6-13-04, ________.
65A-1.702 Special Provisions.
(1) through (4) No change.
(5) Requirement to File for Other Benefits.
(a) Documentation that the individual has applied for any annuity, pension, retirement, or disability or Medicare benefits to which they may be entitled must be received by the department prior to approval for Medicaid benefits.
(b) No change.
(6) through (16) No change.
Specific Authority 409.919 FS. Law Implemented 409.903, 409.904, 409.919 FS. History–New 10-8-97, Amended 4-22-98, 2-15-01, 9-24-01, 11-23-04, ________.
65A-1.710 SSI-Related Medicaid Coverage Groups.
(1) MEDS-AD Demonstration Waiver Medicaid for the Aged and Disabled (MEDS-AD). A coverage group for aged and disabled individuals (or couples), as provided in 42 U.S.C. § 1396a(m).
(2) through (3) No change.
(4) HCBS. A coverage group for aged, blind or disabled individuals (or couples) who would be eligible for Medicaid if institutionalized and who would require institutionalization if they did not receive HCBS in accordance with approved waivers as permitted by 42 U.S.C. § 1396n and 42 C.F.R. § 435.217. These programs are intended to prevent institutionalizing individuals who:
(a) No change.
(b) Have resources and income within Institutional Care or MEDS-AD Demonstration Waiver program limits; and
(c) No change.
(5) No change.
(6) Traumatic Brain Injury and Spinal Cord Injury Waiver Program. Individuals must be: eligible for SSI, MEDS-AD Demonstration Waiver or Home and Community Based Services; must be age 18 through 64; must not be enrolled in or eligible for the Medically Needy Program; and, must have a traumatic brain or spinal cord injury.
(7) No change.
Specific Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.9065, 409.919 FS. History–New 10-8-97, Amended 1-27-99, 4-1-03, 6-13-04, ________.
65A-1.711 SSI-Related Medicaid Non-Financial Eligibility Criteria.
To qualify for Medicaid an individual must meet the general categorical requirements in 42 C.F.R. Part 435, subparts E and F, with the exception that individuals who are neither aged nor disabled may qualify for breast and cervical cancer treatment, and the following program specific requirements as appropriate:
(1) For MEDS-AD Demonstration Waiver, the individual must be age 65 or older, or disabled as defined in 20 C.F.R. § 416.905.
(1) through (8) No change.
Specific Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.9065, 409.919 FS. History–New 10-8-97, Amended 4-1-03, ________.
65A-1.712 SSI-Related Medicaid Resource Eligibility Criteria.
(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., with the following exceptions:
(a) For MEDS-AD Demonstration Waiver an individual whose income is equal to or below 88 90 percent of the federal poverty level must not have resources exceeding the current Medically Needy resource limit specified in Rule 65A-1.716, F.A.C.
(b) through (e) No change.
(f) For the Traumatic Brain Injury and Spinal Cord Injury Waiver Program an individual cannot have countable resources that exceed $2,000. If the individual’s income falls within the MEDS-AD Demonstration Waiver limit, the individual can have resources up to $5,000. No penalties apply to transfers of assets or resources made to spouses. But penalties may apply to transfers to others. Spousal impoverishment policies do not apply.
(2) through (4) No change.
Specific Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.9065, 409.919 FS. History–New 10-8-97, Amended 1-27-99, 4-1-03, 9-28-04, ________.
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) For MEDS-AD Demonstration Waiver, income cannot exceed 88 percent of the federal poverty level after application of exclusions specified in subsection 65A-1.713(2), F.A.C.
(b) through (k) No change.
(2) through (3) No change.
(4) Income Budgeting Methodologies. To determine eligibility SSI budgeting methodologies are applied except where expressly prohibited by 42 U.S.C. § 1396, or another less restrictive option is elected by the state under 42 U.S.C. § 1396a(r)(2).
(a) For MEDS-AD Demonstration Waiver, Protected Medicaid, Medically Needy, Qualified Working Disabled Individual, QMB, SLMB, 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. through 3. No change.
(b) through (c) No change.
Specific Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.9065, 409.919 FS. History–New 10-8-97, Amended 1-27-99, 4-1-03, 6-13-04, ________.