(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,3. May only be issued an SSN for a valid non-work reason in accordance with 20 C.F.R. § 422.104, or4. 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.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.