Fla. Admin. Code R. 65A-1.716

Current through Reg. 50, No. 244; December 17, 2024

Section 65A-1.716 - Income and Resource Criteria

(1) The monthly federal poverty level figures based on the family size are as follows:

Family Size	88% of Poverty Level	100% of Poverty Level	120% of Poverty level	133% of Poverty Level	135% of Poverty Level	185% of Poverty Level	200% of Poverty Level
1	$945	$1,074	$1,288	$1,428	$1,449	$1,986	$2,147
2	$1,278	$1,452	$1,742	$1,931	$1,960	$2,686	$2,904
3		$1,830		$2,434		$3,386	$3,660
4		$2,208		$2,938		$4,086	$4,417
5		$2,587		$3,441		$4,786	$5,174
6		$2,965		$3,944		$5,486	$5,930
7		$3,344		$4,447		$6,186	$6,687
8		$3,722		$4,950		$6,886	$7,444
9		$4,100		$5,453		$7,585	$8,200
10		$4,478		$5,957		$8,285	$8,957
11		$4,857		$6,460		$8,985	$9,714
12		$5,235		$6,963		$9,685	$10,470
For each addtl. person	$329	$374	$448	$497		$691	$747

(2) Monthly income levels for Family-Related and SSI (Supplemental Security Income)-Related Medically Needy Income Levels (MNIL) are by family size as follows:

Family Size	Monthly Income Level	Family-Related MNIL	SSI-Related MNIL
1	$180	$289	$180
2	$241	$387	$241
3	$303	$486
4	$364	$585
5	$426	$684
6	$487	$783
7	$549	$882
8	$610	$981
9	$671	1079
10	$733	1179
Add for each addtl. person	$62	$100

Exception: In determining eligibility for a pregnant woman, the income limits for Monthly Income Level and MNIL used shall be increased to the higher limit corresponding to the applicant's actual family size. Family size shall include each anticipated unborn child as a family member.

(3) The resource limits for the Medically Needy program are as follows:

(a) Family-Related Medicaid: $0

(b) SSI-Related Medicaid:

1. $5,000 per individual; and

2. $6,000 per couple

Family Size	Monthly Asset Level
1	$5,000
2	$6,000
3	$6,000
4	$6,500
5	$7,000
6	$7,500
7	$8,000
8	$8,500
9	$9,000
10	$9,500

For each additional person add $500.

Exception: In determining eligibility for a pregnant woman, the resource limit used shall be increased to the higher limit corresponding to the applicant's actual family size, including each anticipated unborn child as a family member.

(4) The maximum resource limit is $2,000 for those individuals receiving Temporary Cash Assistance (TCA):

(a) Whose Medicaid coverage is based on payment standard income criteria. Refer to subsection 65A-1.716(2), F.A.C.; or

(b) Children living with their parent(s) and who, as children, would qualify for cash assistance except for their age. The maximum resource limit of $2,000 also applies to those coverage groups indicated in Rule 65A-1.703, F.A.C. However, there is no asset limit for the coverage groups specified in paragraphs 65A-1.703(3) through (5), F.A.C.

(5) The SSI-Related Medicaid Program Standards:

(a) SSI (42 U.S.C. §§ 1382 - 1383c) Resource Limits:

1. $2,000 per individual.

2. $3,000 per eligible couple, or per eligible individual with an ineligible spouse who is living together.

(b) The income limit which applies to an individual in Home and Community-Based Services (HCBS) Waivers, Institutional Care Programs (ICP), and Hospice is 300 percent of the Federal Benefit Rate (FBR) for individuals. For an individual enrolled in HCBS Working People with Disabilites (WPwD) who is employed and age 21 years or older, the financial standards are:

1. Income limit of 550 percent of the FBR, $4,367 for an eligible individual or $8,734 for an eligible couple.

2. Asset limit of $13,000 for an eligible individual or $24,000 for an eligible couple.

(c) Spousal Impoverishment Standards.

1. Resource Allocation. The amount of the couple's total countable resources which may be allocated to the community spouse of an institutionalized person is equal to the maximum allowed by 42 U.S.C. § 1396r-5(f)(2)(A).

2. Minimum Monthly Maintenance Needs Allowance (MMMNA). The minimum monthly maintenance needs allowance the Department recognizes for a community spouse is equal to 150 percent of the federal poverty level (FPL) for a family of two as set forth in 42 U.S.C. § 1396r-5(d)(3)(A)(i) and (ii).

3. Excess Shelter Allowance. The community spouse's shelter expenses must exceed 30 percent of the MMMNA to be considered excess shelter expenses to be included in the maximum income allowance: MMMNA x 30% = Excess Shelter Allowance, as defined in 42 U.S.C. § 1396r-5(d)(3)(A)(ii). This standard changes July 1 of each calendar year.

4. Food Assistance Program Standard Utility Allowance. The amount specified in subsection 65A-1.603(2), F.A.C.

5. Cap of Community Spouse Needs Allowance. The MMMNA plus excess shelter allowance cannot exceed the maximum amount allowed under 42 U.S.C. § 1396r-5(d)(3)(A)(C). This needs allowance changes January 1 of each year.

(d) The average monthly private pay nursing facility rate is $9,703.

(e) The average monthly Medicaid rate is $7,224.

(f) The following life expectancy tables are compiled from information published by the Office of the Chief Actuary of the Social Security Administration:

AGE	MALE LIFE EXPECTANCY	FEMALE LIFE EXPECTANCY	AGE	MALE LIFE EXPECTANCY	FEMALE LIFE EXPECTANCY
0	75.97	80.96	60	21.58	24.56
1	75.45	80.39	61	20.83	23.72
2	74.48	79.42	62	20.08	22.90
3	73.50	78.43	63	19.35	22.07
4	72.52	77.45	64	18.62	21.26
5	71.53	76.46	65	17.89	20.45
6	70.54	75.47	66	17.18	19.65
7	69.55	74.47	67	16.47	18.86
8	68.56	73.48	68	15.77	18.07
9	67.57	72.49	69	15.07	17.30
10	66.57	71.50	70	14.39	16.54
11	65.58	70.50	71	13.71	15.79
12	64.59	69.51	72	13.05	15.05
13	63.60	68.52	73	12.40	14.32
14	62.61	67.53	74	11.76	13.61
15	61.63	66.54	75	11.14	12.92
16	60.66	65.55	76	10.53	12.23
17	59.70	64.57	77	9.94	11.57
18	58.74	63.59	78	9.37	10.92
19	57.79	62.61	79	8.82	10.29
20	56.85	61.63	80	8.28	9.68
21	55.91	60.66	81	7.76	9.09
22	54.98	59.69	82	7.26	8.52
23	54.06	58.72	83	6.79	7.98
24	53.14	57.75	84	6.33	7.45
25	52.22	56.78	85	5.89	6.95
26	51.31	55.82	86	5.48	6.47
27	50.39	54.85	87	5.08	6.01
28	49.48	53.89	88	4.71	5.57
29	45.86	52.93	89	4.37	5.16
30	47.65	51.97	90	4.05	4.78
31	46.74	51.01	91	3.75	4.43
32	45.83	50.06	92	3.48	4.11
33	44.92	49.10	93	3.23	3.81
34	44.01	48.15	94	3.01	3.55
35	43.10	47.20	95	2.81	3.31
36	42.19	46.25	96	2.64	3.09
37	41.28	45.30	97	2.49	2.90
38	40.37	44.36	98	2.36	2.73
39	39.47	43.41	99	2.24	2.58
40	38.56	42.47	100	2.12	2.42
41	37.65	41.53	101	2.01	2.28
42	36.75	40.59	102	1.90	2.14
43	35.85	39.66	103	1.80	2.01
44	34.95	38.73	104	1.70	1.88
45	34.06	37.80	105	1.60	1.76
46	33.17	36.88	106	1.51	1.65
47	32.28	35.96	107	1.42	1.54
48	31.41	35.04	108	1.34	1.44
49	30.54	34.13	109	1.26	1.34
50	29.67	33.23	110	1.18	1.24
51	28.82	32.33	111	1.10	1.15
52	27.98	31.44	112	1.03	1.06
53	27.14	30.55	113	0.96	0.98
54	26.32	29.68	114	0.90	0.91
55	25.50	28.81	115	0.84	0.84
56	24.70	27.94	116	0.78	0.78
57	23.90	27.09	117	0.72	0.72
58	23.12	26.24	118	0.66	0.66
59	22.34	25.39	119	0.61	0.61

Fla. Admin. Code Ann. R. 65A-1.716

Rulemaking Authority 409.919 FS. Law Implemented 409.902, 409.903, 409.904, 409.906, 409.919 FS.

New 10-8-97, Amended 12-9-99, 2-15-01, 11-25-01, 7-28-02, 4-1-03, 9-10-03, 8-30-04, 8-10-06, 4-15-12, 10-16-12, 11-4-12, 9-18-13, Amended by Florida Register Volume 46, Number 028, February 11, 2020 effective 2/26/2020, Amended by Florida Register Volume 47, Number 174, September 8, 2021 effective 9/22/2021.

New 10-8-97, Amended 12-9-99, 2-15-01, 11-25-01, 7-28-02, 4-1-03, 9-10-03, 8-30-04, 8-10-06, 4-15-12, 10-16-12, 11-4-12, 9-18-13, 2-26-20, 9-22-21.