Fla. Admin. Code Ann. R. 65A-2.033 - Optional State Supplementation Coverage Groups
To be determined eligible for Optional State Supplementation (OSS), an individual must qualify under one of the following coverage groups.
(1) The individual must be
eligible for and receiving a check from the Supplemental Security Income (SSI)
Program administered by the Social Security Administration. The Department
accepts receipt of SSI as meeting all factors of OSS eligibility criteria in
Rule 65A-2.032, F.A.C., except age
and placement need as specified in subsections
65A-2.032(1) and
(7), F.A.C., which must be verified by
Department staff.
(2) The
individual must meet all SSI and OSS eligibility criteria, except for income
which must be equal to or less than the OSS income standard established by the
Department. These individuals must meet eligibility criteria in Rule
65A-2.032, F.A.C.
(3) The individual must have been eligible
for and receiving Aid to the Aged, Blind or Disabled from the state as of
December 1973. This federally mandated coverage group did not qualify for the
same level of benefits under SSI in 1974. For this coverage group, the special
living facility criteria at subsection
65A-2.032(7),
F.A.C., does not apply.
(4) The
individual must: reside in an Assisted Living Facility or Mental Health
Residential Treatment Facility; have been eligible for and receiving OSS
payments for August 2001; have become ineligible for OSS as of September 2001
solely because their income exceeds the applicable OSS income standard of
$609.40; and, not be categorically eligible for full Medicaid benefits as of
September 2001. Additionally, in regard to an Adult Family Care Home (AFCH),
the individual must: reside in an AFCH; have been eligible for and receiving
OSS payment for December 2001; have become ineligible for OSS as of January
2002, solely because their income exceeds the applicable OSS income standard of
$623.40; and, not be categorically eligible for full Medicaid benefits as of
January 2002. As long as the individual continues to meet all OSS eligibility
criteria and the income standard test in paragraph
65A-2.036(3)(b),
F.A.C., they will remain eligible for payment under the provider rates in
paragraph 65A-2.036(4)(b),
F.A.C. Once an OSS recipient no longer meets all OSS eligibility criteria or
the income standard in paragraph
65A-2.036(3)(b),
F.A.C., they will no longer be eligible under this coverage
group.
Notes
Rulemaking Authority 409.212(7) FS. Law Implemented 409.212 FS.
New 1-1-77, Formerly 10C-2.33, Amended 9-30-86, 2-9-88, Formerly 10C-2.033, Amended 12-16-01, 5-14-02.
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