Section 1634(a) of the Social Security Act outlines that when a disabled person in Florida is awarded Supplemental Security Insurance (SSI) benefits by the Social Security Administration (SSA), SSA sends an email to the Florida Agency for Health Care Administration (AHCA). In this letter, SSA requires that Florida provide free Medicaid as a condition of SSI.

Additionally, Section 1634(c) and state statutes and regulations also require that Florida must continue to provide free state Medicaid to Disabled Adult Children (DAC) who lose SSI benefits, often due to the death of a parent and becoming eligible for a larger monthly amount based one the parent’s Social Security Retirement Income (RIB) benefit.  This can result in too much countable income to be eligible for SSI. However, Section 1634(c) maintains that as long as the claimant is “otherwise eligibility for SSI” (low countable income and countable assets of less than $2,000 each month) then they will continue to be eligible to receive Medicaid from the state in which they reside.

In this situation, when the formerly-eligible SSI recipient loses SSI, they must file a new application with the Florida Department of Children and Families (DCF) for an eligibility determination for Medicaid.  If the application is handled by DCF correctly, DCF would regard the DAC check as “exempt” and award completely free Medicaid benefits as “Protected Medicaid for Disabled Adult Children”.

Unfortunately, the DCF staff routinely count the DAC check as “countable income,” and deny these applications for Medicaid on the basis of “too much countable income.” Instead, they issue a determination stating that the only option for the formerly-eligible SSI recipient is to buy into Medicaid at a monthly premium amount almost equal to the DAC check (all but $180).

If you receive one of these determination letters, know that there is a recourse and appeal options.  This is not the proper handling of this situation, and we have seen an influx of these cases coming to us recently. Please call us as soon as you receive the letter, and we will help you through the process.

We appeal DCF denials by requesting a Fair Hearing before the DCF Hearing Office if your application for Protected Medicaid is denied.  We have never lost an appeal to date. When we win, DCF awards Protected Medicaid for DAC retroactively to the month of application.

If you’d like us to discuss restoring your free Medicaid, please pick a time below from my schedule when we can have a $650 Zoom conference to discuss your Medicaid application, the documents we will need if it is denied, and our appeal flat fee of $3,500 if you should decide you wish to hire us to win your appeal.

https://scheduler.zoom.us/rbrja41zrvxkmpuumirhjlfr40/legal-consult-with-david-lillesand