65A-1.205: Eligibility Determination Process
PURPOSE AND EFFECT: The proposed rule amendment clarifies the Department’s eligibility processing procedures applicable to all public assistance programs. It also removes reference to the Relative Caregiver Program (RCP) as the provision has been moved to Rule 65A-4.208, F.A.C., since it is only pertinent to individuals who meet Temporary Cash Assistance eligibility factors.
SUMMARY: The proposed rule amendment provides for the use of a paper or web-based application to apply for public assistance. It also provides clarification on the Department’s eligibility determination process and removes reference to the RCP.
SUMMARY OF STATEMENT 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, 414.45 FS.
LAW IMPLEMENTED: 409.903, 409.904, 409.919, 410.033, 414.045, 414.095, 414.31 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: June 11, 2008, 1:30 p.m.
PLACE: 1317 Winewood Boulevard, Building 3, Room 455, Tallahassee, Florida 32399-0700
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Cindy Keil, ACCESS Florida Program Policy, 1317 Winewood Boulevard, Building 3, Tallahassee, Florida 32399-0700, telephone (850)410-3291
THE FULL TEXT OF THE PROPOSED RULE IS:
65A-1.205 Eligibility Determination Process.
(1) The individual receives a Request for Assistance and completes a Department application for assistance it to the best of the individual’s ability using either the ACCESS Florida Application, CF-ES 2337, Jan 08, incorporated by reference in Rule 65A-1.400, F.A.C., or an ACCESS Florida Web Application (only accepted electronically), CF-ES 2353, Mar 08, incorporated by reference in Rule 65A-1.400, F.A.C., and submits it. An application must include at least the individual’s name, address and signature to initiate the application process. An The eligibility specialist determines the potential eligibility of each household member for public assistance. and prints out the data on the Common Application Form (CAF) or alternately, Form CF-ES 2327, Common Application Form and Eligibility Questionnaire, May 04, incorporated by reference, can substitute for the CAF. The individual then decides whether or not to apply for assistance. The Common Application Form or CF-ES 2327 is signed and dated by the individual to complete the process of applying. The applicant must be informed of the department’s standards of assistance, penalties for fraud, right to appeal and to have a fair hearing, the civil rights provisions and other rights and responsibilities. An applicant may withdraw the application at any time without affecting their right to reapply at any time.
(a) The Department must determine an applicant’s eEligibility must be determined initially at application and if the applicant is determined eligible, at periodic intervals thereafter. It is tThe applicant’s is responsibilityle to keep appointments with the eligibility specialist and furnish information, documentation and verification needed to establish eligibility as determined by the eligibility specialist within time periods specified by the eligibility specialist.
(b) The eligibility specialist determines eligibility and provides services and benefits using the Florida On-line Recipient Integrated Data Access (FLORIDA) computer system. When the system is unavailable for a 20 minute or for a longer period of time or unresponsive to the point of rendering the system ineffectual and causes a serious backlog of clients, the eligibility specialist will initiate manual procedures to continue unit operations.
(b)(c) Time standards for processing applications vary by public assistance program in accordance with 7 C.F.R. §273.2(g), 45 C.F.R. §206.10(a)(3)(i) and 42 C.F.R. §435.911. For Food Stamp and Cash Assistance programs, The time standards begins with the date following the date the application was filed on which the department or an outpost site receives a signed and dated application and ends on with the date the Department makes on which benefits are made available or mails a notice concerning a determination of ineligibility is made. For the Medicaid Pprogram, the time standard ends on the date the Department mails an eligibility notice is mailed. The Department Applications must be processed and determineations of eligibility made within the following time frames:
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Program: |
Application Processing Time Standards: |
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Expedited Food Stamps |
7 days |
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Food Stamps |
30 days |
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Temporary Cash Assistance, Refugee Assistance and Child In Care |
45 days |
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Medical Assistance and State Funded Programs for individuals who apply on the basis of disability |
90 days |
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For all other Medical Assistance and State Funded Programs for applicants on the basis of non-disability eligibility, including OSS, Q |
45 days |
All days counted after the date of application are calendar days. Applicant delay days do not count in determining non-compliance with the time standard. See paragraph (e) of this rule. The Department uses iInformation provided on form CF-ES 2930, Screening for Expedited Medicaid Appointments, Apr 07, 7/00 (incorporated in Rule 65A-1.400, F.A.C., to by reference) will be used in determining expedited processing of Medicaid disability-related applications.
(c)(d) If the eligibility specialist determines at the interview or at any time during the application process that the applicant must provide additional information or verification is required, or that a member of the an assistance group must member is required to register for employment services, the eligibility specialist must give the applicant ten grant the assistance group 10 calendar days to furnish the requested information required documentation or to comply with the verification or employment registration requirement(s). For all programs, the verifications are due ten 10 calendar days from the date of written request (i.e., the date the verification checklist is generated) or 30 days from the date of application, whichever is later. In cases where the applicant must provide medical information, is requested the return due date is 30 calendar days following the request or 30 days from the date of application, whichever is later. If the verification due date falls on a holiday or weekend, the deadline for the requested information is the next working day. If the verification or information is difficult for the person to obtain, the eligibility specialist must provide assistance in obtaining the verification or information when requested or when it appears necessary. If the applicant does not provide required verifications or and information, as applicable, are not provided by the deadline date, the application will be is denied, unless the applicant a requests an for extension is made by the applicant or there are extenuating circumstances justifying an additional extension. The eligibility specialist makes the decision of whether to grant the request for extension based on extenuating circumstances beyond the control of the individual, such as sickness, lack of transportation, etc. When the applicant provides all required information or verification, as applicable is obtained, the eligibility specialist determines eligibility for the public assistance programs. If the eligibility criteria are met, benefits are authorized.
(d)(e) In accordance with 42 C.F.R. §435.911, There are situations of non-agency processing delays due to unusual circumstances for Medicaid disability-related applications. uUnusual circumstances that might affect the timely processing of Medicaid applications are determined and documented in accordance with 42 CFR subpart 435.911 and include applicant delay, physician delay and emergency delay as defined below. Unusual circumstances are considered non-agency processing delays, and the calendar time passing during such delay(s) does is not counted as part of the 90-day time standard for determining the timeliness of Medicaid eligibility decisions based on disability.
1. Applicant delay is defined as the time attributed to the applicant who fails to keep any scheduled appointment or to provide requested and required eligibility information or verification. Applicant delay begins: the date the applicant does not keep attend an Department agency scheduled appointment with either the Department agency or health professionals and ends the date the applicant keeps attends that appointment as rescheduled; or, the date the applicant does not bring requested and required information to the initial interview and ends the date the applicant provides the that information is supplied to the Department agency. The “Are You Disabled and Applying for Medicaid?” brochure, CF/PI 165-107, Jan 08, incorporated by reference, describes rRequested and required information for eligibility determination is as indicated in the brochure, CF/PI 165-107, Notification of Disability Information and Request, 11/99 (incorporated by reference).
2. Physician delay is defined as the time attributed to a physician for not providing requested when medical evidence or conducting a medical examination is requested and is not provided timely. Physician delay begins: ten days after the Department makes its an initial request by the agency for medical evidence from the physician applicant’s medical source and ends the date the Department agency receives complete medical evidence from the medical source that is responsive to the Department’s agency’s request; or, fourteen days after the Department requests a medical examination is requested by the agency and ends the date the Department agency receives the complete medical examination results.
3. Emergency delay is defined as time attributed to other situations beyond the Department’s agency’s control. These delays are situations such as disasters, unexpected office closure(s) and systems inaccessibility or unavailability. Emergency delay begins with the day date such an event occurs and ends the day the Department agency is able to resume application processing.
(f) Copies of the brochure CF/PI 165-107 and the form CF-ES 2930 may be obtained from the Economic Self-Sufficiency Program Office, 1317 Winewood Boulevard, Building 3, Room 406, Tallahassee, Florida 32399-0700.
(2) Eligibility must be redetermined at periodic intervals iIn accordance with federal regulations 7 C.F.R. §273.14 (food stamps), 45 C.F.R §206.10(a)(9)(iii), 42 C.F.R. §435.916 (Medicaid), 45 CFR 206.10(a)(9)(iii) (temporary cash assistance), and Section 414.095, F.S., the Department must determine eligibility at periodic intervals.
(a) A complete eligibility review is the process of in which the eligibility specialist reviewings all factors related to continued eligibility of the assistance group.
(b) A partial eligibility review entails review of one or more, but not all factors of eligibility. The Department schedules pPartial reviews are scheduled based on known facts or anticipated changes or when an unanticipated change occurs. It does not usually require aA face-to-face interview is not usually required, unless it cannot obtain the necessary information cannot be obtained without the this interview exchange.
(3) The Department must conduct fFace-to-face interviews with the food stamp and cash assistance applicants/recipients or their authorized designated representatives must be held at each application unless waived due to hardship as described in 7 C.F.R. §273.2(e)(2). The Department conducts cComplete redeterminations of eligibility and recipient interviews are conducted in accordance with federal regulations governing the benefit type. These interviews are held at by phone, in the ACCESS Florida CF local office, the recipient’s home, or other location upon which the applicant/recipient and eligibility specialist mutually agree. The applicant/recipient must is required to keep the interview appointment or make arrangements with the eligibility specialist prior to the appointment time to reschedule the appointment, if necessary.
(4) If aAn applicant or recipient who fails to keep an appointment without arranging another time with the eligibility specialist;, fails or refuses to sign and date the applications form(s) described in subsection (1); fails or refuses to submit a periodic report; or fails or refuses to submit required documentation or verification the Department will be denyied benefits as it cannot establish eligibility cannot be established.
(5) The Department may substantiate, verify or document iInformation provided by the applicant/recipient must be substantiated, verified or documented as part of each determination of eligibility. For any program, when there is a question about the validity of the information provided, the Department will ask for additional documentation or verification as required. The term verification is used generically to represent this process. The factor of eligibility and questionable nature of information dictates whether or not substantiation, verification or documentation is required.
(a) No change.
(b) Verification confirms the accuracy of information through a source(s) other than the individual. The Department may secure vVerification may be secured electronically, on the telephonicallye, in writing ten form, or by personal contact.
(c) No change.
(6) The Ddepartment conducts data exchanges with other agencies and systems to obtain information on each applicant and recipient. It uses dData exchanges are performed to validate or identify social security numbers (SSN), verify the receipt of benefits from other sources, verify reported information, and obtain previously unreported information.
(a) The Department conducts dData exchanges are conducted with the Social Security Administration, Internal Revenue Service, Agency for Workforce Innovation Department of Labor, federal and state personnel and retirement systems, other states’ public assistance files, and educational institutions.
(b) The Department compares iInformation found through the data exchanges process, is compared with the information already on file. The system determines which cases meet targeting criteria and alerts the case manager that the information needs to be reviewed. FLORIDA automatically schedules cases for reviews. If the data exchange identifies new or different information than was previously available, the Department conducts a partial eligibility review is conducted to determine whether it must change benefit levels must be changed.
(c) The Department considers bBeneficiary and, SSI benefit and earnings data from the Social Security Administration, and unemployment compensation benefit data and Department of Health, Office of Vital Statistics data are considered verified upon receipt and does not require third party verification. Other data requires third party verification before the Department takes adverse case actions on a case are made.
(7) In accordance with Food Stamp Program waivers, food stamp applicants that have been interviewed, but failed to return the requested verification by the deadline, may be denied prior to the 30th day. Under approved federal Food Stamp Program waivers face-to-face interviews are not required.
(8)(7) The Notice of Case Action (denial) (automated notice), Request for Assistance Withdrawal (automated notice) and Appointment Letter (automated notice) used in the eligibility determination process are hereby incorporated by reference. Referral to the Family Safety Program for the caregiver home study as to adequacy and readiness of the caregiver to provide permanent care will be on the Relative Caregiver Program Request for Eligibility Consideration, CF-ES 2305, Apr 01 (incorporated by reference). Copies of these CF-ES 2337, CF-ES 2930 and CF/PI 165-107 are available forms may be obtained from the ACCESS Florida Headquarters Economic Self-Sufficiency Program Office, 1317 Winewood Boulevard, Building 3, Room 427, Tallahassee, Florida 32399-0700 or on the Department’s web site at http://www.dcf.state.fl.us/publications. The CF-ES 2353 is available on the Department’s web site at http://www.myflorida.com/accessflorida/.
Specific Authority 409.919, 414.45 FS. Law Implemented 409.903, 409.904, 409.919, 410.033, 414.045, 414.095, 414.31 FS. History– 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,________.