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Chapter: 0200 General Program Information Program: MSSI, SFP 11 Once an individual elects hospice, the individual waives the rights to Medicaid payment for the duration of the election for any services provided for the terminal illness for which the hospice was elected. However, the individual may continue to receive services for conditions totally unrelated to the terminal illness and to the related conditions for which hospice was elected. 0240.0111 Home and Community Based Services (MSSI) The purpose of the Home and Community Based Services (HCBS) Programs is to prevent institutionalization of individuals by providing for care in the community. These programs are considered Medicaid waiver programs because they waive certain Medicaid eligibility criteria and allow individuals to be eligible who would not otherwise be eligible, and they allow additional services that are not usually available under Medicaid.

Following are HCBS waivers for which you must determine eligibility:

1. Familia Dysautonomia (FD), 2. iBudget Florida Developmental Disabilities (DD), 3. Model Waiver, and 4. Statewide Medicaid Managed Care Long-Term Care (SMMC-LTC).

The individual must meet all technical criteria, have income and assets within the limits for ICP or MEDS-AD, meet the level of care for the particular program involved and be enrolled in the waiver as documented by form CF-ES 2515. (Individuals cannot qualify for HCBS under the Medically Needy Program).

Note: With the exception of the iBudget Florida and SMMC-LTC, spousal impoverishment policies do not apply to HCBS Programs. However, the transfer of assets policy does apply to all HCBS Programs. 0240.0112 SSI-Related Programs for Refugees (MSSI) Refugees who meet eligibility factors for RAP and for SSI-Related Medicaid may qualify for one of the following categories of assistance:

1. Protected Medicaid, 2. ICP, 3. Hospice, 4. MEDS, or 5. Medically Needy. 0240.0113 Qualified Medicare Beneficiaries (MSSI) This program entitles certain eligible individuals to receive Medicare cost savings benefits: payments of premiums, deductibles, and co-insurance. To be eligible for QMB an individual must meet all the following criteria:

1. Be enrolled or conditionally enrolled in Medicare Part A. 2. Meet all technical criteria, except being aged (65 or older requirement) or disabled.

Example: End stage renal disease patients are an example of individuals who may receive Medicare Part A but may not be aged or disabled.

3. Income Limit: 100% of Federal Poverty Level. 4. Asset Limit: Three times the SSI resource limit with annual increases based on the yearly Consumer Price Index. Refer to Appendix A-9.