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Chapter: 2000 Coverage Groups Program: MSSI, SFP 14 eligible for SSI, Medicaid entitlement always results from SSI entitlement (verified through the SDX system), rather than from entitlement under the other program.

There are situations in which an individual receives Medicaid due to SSI eligibility but is not entitled to an SSI check. These individuals are eligible for Medicaid and are identified as if they were an SSI eligible individual on SDX. An example of this type of individual is someone who participates in SSA’s Work Incentive Program known as 1619(b), which allows SSI beneficiaries to keep their Medicaid coverage when their earnings, along with other income, become too high for an SSI cash payment. Although these persons do not receive an SSI cash payment, they retain their SSI recipient status, which allows them to retain their rights to Medicaid eligibility.

In the following situations, the special emergency Medicaid certification procedure must be used to issue SSI-DA individuals Medicaid assistance:

1. When the individual is receiving SSI-DA but is not on the FMMIS, some reasons this would occur include: delay or error on FMMIS or SDX, or individual is new to the state.

2. When the individual has not received or does not have his Medicaid card, some reasons for this are: delay or error on FMMIS or SDX, individual has moved and the FMMIS has not been updated by the SDX, or individual lost or destroyed his Medicaid card.

The emergency Medicaid procedures for SSI-DA recipients are in the desk guide. 2040.0801.04 Date of Entitlement for SSI Individuals (MSSI) The initial date of entitlement for Medicaid benefits is the first day of the month for which the individual's application for SSI benefits is approved.

An exception to this occurs when an individual who is receiving SSI benefits moves to Florida. The date of entitlement for Medicaid benefits is the first day of the month in which the individual moved to the state even though the individual does not yet appear on the Medicaid Eligibility file. 2040.0801.05 Institutional Care SSI Eligible Except for Income (MSSI) Any Florida resident who has been determined eligible for "SSI Eligible Except for Income" is entitled to Florida Medicaid. Any Florida resident who would be eligible for SSI in the institution except for the amount of their income and who meets all additional eligibility criteria under the Institutional Care Program is also entitled to full Medicaid benefits.

The initial date of entitlement for ICP Medicaid benefits is the first day of the month in which the individual files an application, provided the individual meets all factors of eligibility for that month, including placement in a Title XIX facility. 2040.0802.01 Protected Medicaid (MSSI) Protected Medicaid is a categorical Medicaid coverage group that is extended to certain eligible individuals. There are five Protected Medicaid coverage groups.

Passages 2040.0802.02 through 2040.0802.05 give the technical criteria for Protected Medicaid eligibility.

Passages 2040.0804.01 through 2040.0809 describe Protected Medicaid coverage groups and give the special eligibility criteria for each group. 2040.0802.02 Aged Criteria for Protected Medicaid (MSSI) Eligibility due to aged criteria must be verified. The individual must be age 65 or older. Acceptable verification of age would include verification that the individual received SSI or is