65A-1.205: Eligibility Determination Process
PURPOSE AND EFFECT: The proposed rule amendment amends the ACCESS Florida Application, CF-ES 2337, amends the interview requirements, incorporates forms that can be used in the eligibility determination process, and includes some wording changes and technical changes of a non-substantive nature improving the overall content of the rule.
SUMMARY: The proposed rule amendment amends the general eligibility determination process.
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: April 28, 2010, 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, (850)410-3291, cindy_keil@dcf.state.fl.us
THE FULL TEXT OF THE PROPOSED RULE IS:
65A-1.205 Eligibility Determination Process.
(1) The individual completes a Department application for assistance to the best of the individual’s ability using either the ACCESS Florida Application, CF-ES 2337, 03/2010 01/2008, incorporated by reference in Rule 65A-1.400, F.A.C., or an ACCESS Florida Web Application (only accepted electronically), CF-ES 2353, 03/2008, 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 eligibility specialist determines the eligibility of each household member for public assistance. An applicant can may withdraw the application at any time without affecting their right to reapply at any time.
(a) The Department must determine an applicant’s eligibility initially at application and if the applicant is determined eligible, at periodic intervals thereafter. 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. If the information, documentation or verification is difficult for the applicant to obtain, the eligibility specialist must provide assistance in obtaining it when requested or when it appears necessary.
(b) 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 Pprograms, 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. For the Medicaid Program, the time standard ends on the date the Department mails an eligibility notice. The Department must process and determine eligibility within the following time frames:
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Application Processing |
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Program: |
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 |
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Funded Programs for individuals who |
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apply on the basis of disability |
90 days |
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For all other Medical Assistance and |
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State Funded Programs for applicants |
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on the basis of non-disability eligibility, |
|
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including OSS, QMB, SLMB, and QI1 |
45 days |
All days counted after the date of application are calendar days. Applicant delay days do not count in determining compliance with the time standard. The Department uses information provided on the Screening for Expedited Medicaid Appointments form, CF-ES 2930, Screening for Expedited Medicaid Appointments, 04/2007, incorporated by reference, in Rule 65A-1.400, F.A.C. to expedite processing of Medicaid disability-related applications.
(c) If the eligibility specialist determines during at the interview or at any time during the application process that the applicant must provide additional information or verification, or that a member of the assistance group must comply with Child Support Enforcement or register for employment services, the eligibility specialist must give the applicant written notice allowing ten calendar days from request or the interview to furnish the requested information or to comply with the verification or employment registration requirement(s). For all programs, verifications are due ten calendar days from the date of written request or the interview, or 30 days from the date of application, whichever is later. In cases where the applicant must provide medical information, the return due date is 30 calendar days following the written request or the interview, or 30 days from the date of application, whichever is later. If the due date falls on a holiday or weekend, the deadline 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 information, as applicable, by the deadline date, the application will be denied, unless the applicant requests an extension or there are extenuating circumstances justifying an additional extension. The eligibility specialist makes the decision of whether to grant the request for extension. When the applicant provides all required information or verification, as applicable, the eligibility specialist determines eligibility for the public assistance programs. If the eligibility criteria are met, benefits are authorized.
(d) In accordance with 42 C.F.R. §435.911, unusual circumstances that might affect the timely processing of Medicaid applications include applicant delay, physician delay and emergency delay as defined below. Unusual circumstances are non-agency processing delays, and the calendar time passing during such delay(s) does not count as part of the 90-day time standard for determining the timeliness of Medicaid eligibility decisions based on disability.
1. Applicant delay is the time attributed to the applicant who does not 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 a Department scheduled appointment with either the Department or health professionals and ends the date the applicant keeps that appointment as rescheduled; or, the date the applicant does not provide bring requested and required information for to the initial interview and ends the date the applicant provides the information to the Department. The “Are You Disabled and Applying for Medicaid?” brochure, CF/PI 165-107, 06/2008, incorporated by reference, describes requested and required information for eligibility determination.
2. through 3. No change.
(2) In accordance with 7 C.F.R. §273.14, 45 C.F.R. §206.10(a)(9)(iii), 42 C.F.R. §435.916, and Section 414.095, F.S, the Department must determine eligibility at periodic intervals.
(a) No change.
(b) A partial eligibility review entails review of one or more, but not all factors of eligibility. The Department schedules partial reviews based on known facts or anticipated changes or when an unanticipated change occurs. It does not usually require an a face-to-face interview unless it cannot obtain the necessary information without the interview.
(3) The Department conducts phone or must conduct face-to-face interviews with food stamp and cash assistance applicants/recipients or their authorized/designated authorized representatives when required for the at each application or complete eligibility review process unless waived due to hardship as described in 7 C.F.R. §273.2(e)(2). The Department conducts face-to-face interviews upon request complete redeterminations of eligibility and recipient interviews in accordance with federal regulations governing the benefit type by phone, in the ACCESS Florida office, the applicant’s/recipient’s home, or other agreed upon location upon which the applicant/recipient and eligibility specialist mutually agree. The applicant/recipient or their authorized/designated representative must keep the interview appointment or make arrangements with the eligibility specialist prior to the appointment time to reschedule the missed appointment, if necessary.
(4) If an applicant or recipient does not fails to keep an appointment without arranging another time with the eligibility specialist; or does not fails or refuses to sign and date the applications described in subsection (1); fails or refuses to submit a periodic report; or does not fails or refuses to submit required documentation or verification the Department will deny benefits as it cannot establish eligibility.
(5) The Department can may substantiate, verify or document information provided by the applicant/recipient 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.
(a) No change.
(b) Verification confirms the accuracy of information through a source(s) other than the individual. The Department can may secure verification electronically, telephonically, in writing, or by personal contact.
(c) No change.
(6) No change.
(7) In accordance with Food Stamp Program waivers, food stamp applicants/recipients who applicants that have been interviewed, but do not failed to return the requested verification by the deadline, can may be denied prior to the 30th day. Under approved federal Food Stamp Program waivers Fface-to-face interviews are not required.
(8) The following forms, incorporated by reference, can be used in the eligibility determination process: Verification of Employment/Loss of Income, CF-ES 2620, 03/2009; Verification of Dependent Care Expenses, CF-ES 2621, 03/2010; Verification of Shelter Expenses, CF-ES 2622, 03/2010; School Verification, CF-ES 2623, 10/2005; and Work Calendar, CF-ES 3007, 10/2005. Copies of materials incorporated by reference the CF-ES 2337, CF-ES 2930 and CF/PI 165-107 are available from the ACCESS Florida Headquarters Office, 1317 Winewood Boulevard, Tallahassee, Florida 32399-0700 or on the Department’s website at http://www.dcf.state.fl.us/dcfforms/Search/DCFFormSearch.aspx. The CF-ES 2353 is available on the Department’s web site at http://www.myflorida.com/accessflorida/.
Rulemaking 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, 9-11-08,________.