CurrentAgency for Health Care AdministrationPolicy 14-0003-MMS

Medicaid Eligibility — State Residency

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Establishes Florida Medicaid residency requirements for otherwise eligible individuals, including institutionalized individuals, children, temporary absences, and interstate residency agreements under 42 CFR 435.403.

Policy Summary

PayerAgency for Health Care Administration

PolicyMedicaid Eligibility — State Residency

Policy CodePolicy 14-0003-MMS

Change TypeNo material change

Effective DateFeb 1, 2014

Next Review DateNot specified

Key ActionApply Florida Medicaid residency criteria under 42 CFR 435.403 when determining eligibility.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

42 CFR 435.403Federal residency regulation referenced

0938-1148OMB control number

40 hoursEstimated time per response

21 yearsAge threshold used in multiple residency rules

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CurrentAgency for Health Care AdministrationPolicy 14-0003-MMS

Medicaid Eligibility — State Residency

Customize your policy alerts

Sign up for Agency for Health Care Administration Policy 14-0003-MMS alerts

Get alerted when Policy 14-0003-MMS changes without checking for updates manually.

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Policy Summary

PayerAgency for Health Care Administration

PolicyMedicaid Eligibility — State Residency

Policy CodePolicy 14-0003-MMS

Change TypeNo material change

Effective DateFeb 1, 2014

Next Review DateNot specified

Key ActionApply Florida Medicaid residency criteria under 42 CFR 435.403 when determining eligibility.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

42 CFR 435.403Federal residency regulation referenced

0938-1148OMB control number

40 hoursEstimated time per response

21 yearsAge threshold used in multiple residency rules

Florida Medicaid State Residency Criteria

Residency Rule Reference

Age threshold

Age threshold21 years

Applies toIndividuals age 21 and over

Under-21 exceptionIndividuals under age 21 who are capable of indicating intent and are emancipated or married

Residency Definitions

Temporary absence

Temporary absenceAn individual may be temporarily absent from Florida when the person intends to return after the purpose of the absence has been accomplished.

Return intentThe individual must intend to return when the purpose of the absence is completed.

LimitationThe temporary-absence rule does not apply if another state has determined that the individual is a resident there for Medicaid purposes.

Resident definition

Who qualifiesA non-institutionalized individual age 21 or older, or an individual under age 21 who is capable of indicating intent and is emancipated or married.

Florida residenceThe individual lives in Florida and intends to reside there, including without a fixed address.

Employment connectionThe individual entered Florida with a job commitment or while seeking employment, whether or not currently employed.

Resident definition

Who qualifiesAn individual age 21 or older who is not capable of indicating intent and is not living in an institution.

State of residenceThe individual is a resident of the state in which the individual lives.

Institutional statusThe rule applies when the individual is not living in an institution.

Resident definition

Who qualifiesA non-institutionalized individual under age 21 who is not otherwise described, including a non-IV-E beneficiary child.

Florida residenceThe individual resides in Florida, with or without a fixed address.

Parent or caretaker residenceThe individual has the residency of the parent or caretaker with whom the individual resides, in accordance with 42 CFR 435.403(h)(1).

Institutionalized individual

Institution definitionAn institutionalized individual is a person living in an institution as defined in 42 CFR 435.1010, including a foster care home.

Under age 21 or incapable before age 21Florida residency may apply regardless of the individual's state of residence when the parent or guardian applying on the individual's behalf resides in Florida, or resided in Florida at the time of placement.

Terminated parental rightsIf parental rights were terminated and no guardian was appointed, Florida residency may apply when the applicant resides in Florida and the individual is institutionalized in Florida.

Incapable at or after age 21An individual physically present in Florida is a Florida resident unless another state made the placement.

Other institutionalized individuals age 21 or olderThe individual is a Florida resident when living in Florida with intent to reside there and not placed in the institution by another state.