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Chapter: 0200 General Program Information Program: MSSI, SFP 9 0240.0104 Medically Needy (MSSI) The Medically Needy Program coverage is for individuals who meet the technical requirements for the above coverage groups but whose income exceeds the income limit. If the household’s income is greater than the income limit, the exceeding amount is determined as the share of cost. The individual is enrolled but is not eligible until the share of cost is met. Medically Needy provides month to month coverage when individuals have incurred medical bills that meet their share of cost.

To be eligible, an individual must meet all technical criteria as well as the following:

1. Income Limit: $180 (Individual), $241 (Couple). 2. Asset Limit: $5000 (Individual), $6000 (Couple).

There is no income limit for this program. However, an individual or couple must have incurred medical bills (either paid or unpaid) equal to the amount of monthly income that exceeds the Medically Needy Income Limit (MNIL). This is referred to as meeting the share of cost. 0240.0105 Emergency Medicaid for Noncitizens (MSSI) This program provides emergency Medicaid coverage for noncitizens who would otherwise be eligible for Medicaid (either MEDS or Medically Needy) except for their noncitizen status. The noncitizen must meet all technical requirements except for citizenship status, CSE cooperation, possession of an SSN and the requirement to file for Social Security benefits.

To be eligible for emergency Medicaid benefits, the noncitizen must meet the income and asset requirements for whichever Medicaid coverage group the noncitizen is determined to be eligible.

Special Criteria: Medicaid coverage is for an emergency medical condition only, for the duration of the emergency as certified by a health professional. This includes emergency labor and delivery. 0240.0106 Supplemental Security Income (MSSI) Individuals who receive an SSI check from the Social Security Administration are automatically entitled to Florida Medicaid except for institutional care benefits. Eligibility for SSI is determined by the Social Security Administration. The following standards are given for informational purposes only and are included in Appendix A-9:

1. Income Limit: Federal Benefit Rate. 2. Asset Limit: $2000 (Individual), $3000 (Couple).

Special Criteria: SSI recipients who apply for Medicaid institutional care services must meet all of the following additional Title XIX criteria:

1. appropriate placement, 2. level of care, 3. requirement to file for other benefits, and 4. transfer of assets and spousal impoverishment (if applicable). 0240.0107 Institutional Care Program (MSSI) This program provides Medicaid benefits, which includes payment to nursing homes and certain other facilities, for aged and disabled individuals who are in need of institutional care. Once eligible, all of an individual's monthly income, except for an allowance for personal needs, a maintenance need allowance for a spouse (or a spouse and family members or dependents with no spouse) living in the community, and a deduction for unreimbursed medical expenses must be paid to the facility for patient responsibility. An individual must meet all of the technical requirements as well as the following: