[Original Post on June 4, 2024]

The solution of the DAC being illegally counted by Florida Medicaid could be remedied by SSA.  We have started the process to petition SSA to change its rules to do that.

However, that process is going to take much, much longer than we anticipated.

Therefore, we are suggesting to all families in the interim that they appeal the denial of continuing eligibility for Medicaid after receipt of DAC benefits (their statutory right) to the Florida Medicaid agency, requesting a Fair Hearing before a DCF Hearing Office, and using the Medicaid Manual provision below:

2040.0808 Protected Medicaid for Disabled Adult Children  (MSSI)

Effective July 1, 1987, disabled adult children who lose their SSI benefits because of an increase in or receipt of Social Security disability benefits under one of their parent’s work records, may continue to be eligible for Medicaid if the disabled adult child meets all SSI criteria except for income; and has income equal to or below the SSI FBR when, beginning July 1, 1987, any increase in SSA benefits or receipt of SSA benefits is subtracted from other income.

The phrase “except for income” means that Medicaid is NOT to count the DAC income.  The child has to remain “otherwise eligible for SSI but not the SSI check”.  So keep the countable assets under the $2,000 limit.  Put any excess assets into an ABLE account.

The phrase “Otherwise eligible” is from the state statute on Mandatory Medicaid below and the federal SSI statute.

409.903 Mandatory payments for eligible persons.—The agency shall make payments for medical assistance and related services on behalf of the following persons who the department, or the Social Security Administration by contract with the Department of Children and Families, determines to be eligible, subject to the income, assets, and categorical eligibility tests set forth in federal and state law. 

(2) A person who receives payments from, who is determined eligible for, or who was eligible for but lost cash benefits from the federal program known as the Supplemental Security Income program (SSI). This category includes a low-income person age 65 or over and a low-income person under age 65 considered to be permanently and totally disabled.

We have not lost a case for a Disabled Adult Child appealing on the above basis.  If you want us to represent your child, our fee is $3,500.