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Medicaid Waiver Eligibility Maintained After Moving
The Florida Fifth District Court of Appeal holds that an individual does not have to reestablish his eligibility for the home- and community-based services (HCBS) waiver after moving back to the state. In M.N. v. Agency for Persons with Disabilities(Fla. Dist. Ct. App. Case No. 5D2024-0138, October 4, 2024).
M.N. was enrolled in the Florida HCBS Waiver program, qualifying because of severe autism. He moved out of state with his family and, upon moving back, sought to reenroll in the program. Instead of allowing him to re-enroll or placing him in the preenrollment category, the Agency for Persons with Disabilities (APD) denied his request for services, finding his autism was insufficiently severe. The hearing officer relied on the APD’s interpretation of Florida rule 65G–4.0215(7)(a) and found that M.N. had to reestablish medical eligibility because more than a year had passed since his move.
On appeal, the court considers whether Florida rule 65G–4.0215(7)(a) requires an individual to reestablish eligibility for the HCBS Waiver after moving away and then returning to the state.
The officer incorrectly deferred to ADP’s reading of Rule 65G–4.0215(7)(a) rather than its plain meaning. Rule 65G–4.0215(7)(a) sets forth two circumstances where coverage ends: when the individual chooses to disenroll, such as because of moving out of state, and when the individual loses medical eligibility. When a person reenrolls a year or more after voluntarily disenrolling, the client is added to the preenrollment category until a new vacancy occurs and funding is available. However, it is necessary to reestablish medical eligibility after losing it.
Here, M.N. voluntarily ended coverage by moving out of state and returned after a year. So, he should be added to the preenrollment category awaiting a spot in the program. Even if he had to reestablish eligibility, the principal of administrative finality dictates that he would need to prove a Florida domicile, not medical eligibility. Moving out of state is not a significant change of circumstances requiring him to reestablish medical eligibility.
The hearing officer erred by determining that M.N. needed to prove the severity of his autism once again to be put on the waiver list.
A roundup of elder law news and practice development articles culled from news sources across the nation during the week of January 28, 2025, to February 3, 2025.
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Medicaid Waiver Eligibility Maintained After Moving
The Florida Fifth District Court of Appeal holds that an individual does not have to reestablish his eligibility for the home- and community-based services (HCBS) waiver after moving back to the state. In M.N. v. Agency for Persons with Disabilities(Fla. Dist. Ct. App. Case No. 5D2024-0138, October 4, 2024).
M.N. was enrolled in the Florida HCBS Waiver program, qualifying because of severe autism. He moved out of state with his family and, upon moving back, sought to reenroll in the program. Instead of allowing him to re-enroll or placing him in the preenrollment category, the Agency for Persons with Disabilities (APD) denied his request for services, finding his autism was insufficiently severe. The hearing officer relied on the APD’s interpretation of Florida rule 65G–4.0215(7)(a) and found that M.N. had to reestablish medical eligibility because more than a year had passed since his move.
On appeal, the court considers whether Florida rule 65G–4.0215(7)(a) requires an individual to reestablish eligibility for the HCBS Waiver after moving away and then returning to the state.
The officer incorrectly deferred to ADP’s reading of Rule 65G–4.0215(7)(a) rather than its plain meaning. Rule 65G–4.0215(7)(a) sets forth two circumstances where coverage ends: when the individual chooses to disenroll, such as because of moving out of state, and when the individual loses medical eligibility. When a person reenrolls a year or more after voluntarily disenrolling, the client is added to the preenrollment category until a new vacancy occurs and funding is available. However, it is necessary to reestablish medical eligibility after losing it.
Here, M.N. voluntarily ended coverage by moving out of state and returned after a year. So, he should be added to the preenrollment category awaiting a spot in the program. Even if he had to reestablish eligibility, the principal of administrative finality dictates that he would need to prove a Florida domicile, not medical eligibility. Moving out of state is not a significant change of circumstances requiring him to reestablish medical eligibility.
The hearing officer erred by determining that M.N. needed to prove the severity of his autism once again to be put on the waiver list.
Medicaid Waiver Eligibility Maintained After Moving
<p><span style="font-size:14.0pt"><span style="color:black"><img alt="Case summary for Academy of Special Needs Planners." src="https://cdn.elderlawanswers.com/common/uploads/photos/19452-ASNP%20Badge%20Case%20Summary.jpg" style="float:right; height:200px; width:356px" />The Florida Fifth District Court of Appeal holds that an individual does not have to reestablish his eligibility for the home- and community-based services (HCBS) waiver after moving back to the state. </span></span><em><span style="font-size:14.0pt"><span style="color:#1155cc"><a href="https://5dca.flcourts.gov/content/download/2441638/opinion/Opinion_2024-0138.pdf">In M.N. v. Agency for Persons with Disabilities</a> </span></span></em><span style="font-size:14.0pt"><span style="color:black">(Fla. Dist. Ct. App. Case No. 5D2024-0138, October 4, 2024).</span></span></p>
<p><span style="font-size:14.0pt"><span style="color:black">M.N. was enrolled in the Florida HCBS Waiver program, qualifying because of severe autism. He moved out of state with his family and, upon moving back, sought to reenroll in the program. Instead of allowing him to re-enroll or placing him in the preenrollment category, the Agency for Persons with Disabilities (APD) denied his request for services, finding his autism was insufficiently severe. The hearing officer relied on the APD’s interpretation of Florida rule 65G–4.0215(7)(a) and found that M.N. had to reestablish medical eligibility because more than a year had passed since his move. </span></span></p>
<p><span style="font-size:14.0pt"><span style="color:black">On appeal, the court considers whether Florida rule 65G–4.0215(7)(a) requires an individual to reestablish eligibility for the HCBS Waiver after moving away and then returning to the state.</span></span></p>
<p><span style="font-size:14.0pt"><span style="color:black">The officer incorrectly deferred to ADP’s reading of Rule 65G–4.0215(7)(a) rather than its plain meaning. Rule 65G–4.0215(7)(a) sets forth two circumstances where coverage ends: when the individual chooses to disenroll, such as because of moving out of state, and when the individual loses medical eligibility. When a person reenrolls a year or more after voluntarily disenrolling, the client is added to the preenrollment category until a new vacancy occurs and funding is available. However, it is necessary to reestablish medical eligibility after losing it. </span></span></p>
<p><span style="font-size:14.0pt"><span style="color:black">Here, M.N. voluntarily ended coverage by moving out of state and returned after a year. So, he should be added to the preenrollment category awaiting a spot in the program. Even if he had to reestablish eligibility, the principal of administrative finality dictates that he would need to prove a Florida domicile, not medical eligibility. Moving out of state is not a significant change of circumstances requiring him to reestablish medical eligibility. </span></span></p>
<p><span style="font-size:14.0pt"><span style="color:black">The hearing officer erred by determining that M.N. needed to prove the severity of his autism once again to be put on the waiver list. </span></span></p>
<p><span style="font-size:14.0pt"><a href="https://5dca.flcourts.gov/content/download/2441638/opinion/Opinion_2024-0138.pdf" target="_self"><span style="color:#1155cc">Read the full opinion</span></a>.</span></p>
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The Florida Fifth District Court of Appeal holds that an individual does not have to reestablish his eligibility for the home- and community-based services (HCBS) waiver after moving back to the state. In M.N. v. Agency for Persons with Disabilities (Fla. Dist. Ct. App. Case No. 5D2024-0138, October 4, 2024).
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