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Table of Contents Coverage Groups iii 2040.0813.01 Medicaid Designated by SOBRA - MEDS-AD (MSSI) ................................... 20 2040.0813.02 Financial Requirements for MEDS-AD (MSSI) .............................................. 20 2040.0813.03 Technical Requirements for MEDS-AD (MSSI) ............................................. 20 2040.0813.04 Date of Entitlement for MEDS-AD (MSSI) ...................................................... 21 2040.0813.05 Benefits Received through MEDS-AD (MSSI) ............................................... 21 2040.0814.01 Hospice (MSSI) .............................................................................................. 21 2040.0814.02 Additional Criteria for Hospice Eligibility (MSSI) ............................................ 21 2040.0814.03 Hospice for Institutionalized Individual (MSSI) ............................................... 21 2040.0814.04 Medically Needy Hospice (MSSI) ................................................................... 21 2040.0815.01 Home and Community Based Services (MSSI) ............................................. 21 2040.0815.03 Additional Criteria - HCBS Familial Dysautonomia Waiver (MSSI) ................. 22 2040.0815.04 Additional Criteria - HCBS Individual Budgeting Florida (iBudget) Developmental Disabilities (MSSI) ............................................................................................ 22 2040.0815.05 Additional Criteria - HCBS Model Waiver (MSSI) .......................................... 22 2040.0815.07 Additional Criteria HCBS Statewide Managed Medicaid Care Long Term Care (SMMC LTC) ……………………………………………………………………………………..22 2040.0816 Working Disabled (MSSI) ............................................................................... 22 2040.0817 Qualified Medicare Beneficiaries Medicaid (MSSI) ........................................ 23 2040.0818 Special Low Income Medicare Beneficiary (MSSI) ........................................ 23 2040.0819 Qualifying Individuals 1 (QI1) (MSSI) .............................................................. 23 2040.0821 Breast and Cervical Cancer Treatment Program (MSSI) ............................... 24 2040.0822 Optional State Supplementation Program (SFP) ........................................... 24 2040.0823 Program of All-Inclusive Care for the Elderly (MSSI) ..................................... 25 2050.0000 Child In Care .............................................................. 26 2050.0100 CATEGORY CODES (CIC) .................................................................................... 26 2050.0104 Child in Care Category Codes (CIC) .............................................................. 26 2050.0500 CHILD IN CARE (CIC)............................................................................................ 26 2050.0501 Children in Emergency Shelter (CIC) ............................................................. 26 2050.0502 Title IV-E Foster Care (CIC) ........................................................................... 26 2050.0503 Title IV-E Foster Care Medicaid (CIC) ............................................................ 27 2050.0504 Medicaid for Foster Care Youth in Independent Living Situations (CIC) ....... 27 2050.0505 Title IV-E Adoption Subsidy (CIC) .................................................................. 27 2050.0506 Non-Title IV-E Foster Care Medicaid (CIC) .................................................... 27 2050.0507 Adoption Subsidy Medicaid (CIC) .................................................................. 28 2050.0508 Medicaid for Delinquent Youth (CIC) .............................................................. 28 2050.0800 RETROACTIVE MEDICAID (CIC) ........................................................................... 28 2050.0812.01 Retroactive Medicaid (CIC) ............................................................................ 28 2050.0812.02 Requirements for Retroactive Coverage (CIC) .............................................. 28 2050.0812.03 Date of Entitlement for Retroactive Medicaid (CIC) ....................................... 29 2060.0000 Refugee Assistance Program ................................... 30 2060.0100 CATEGORY CODES (RAP) ................................................................................... 30 2060.0103 Refugee Assistance Program Category Code (RAP) .................................... 30 2060.0106 RAP Medicaid Category Codes (RAP) ........................................................... 30 2060.0400 REFUGEE ASSISTANCE PROGRAM (RAP) ....................................................... 30 2060.0401 Refugee Assistance Program (RAP) .............................................................. 30 2060.0700 RAP MEDICAID COVERAGE GROUPS (RAP) .................................................... 31