Module 2: Medicaid (MFAM/MSSI) Technical Study Guide
Terminology Crosswalk: AMS to Management Portal
The Florida ACCESS Management Portal was launched in Summer 2025 as a comprehensive workload management component designed to track both electronic and paper applications throughout the eligibility process. This new portal serves as a replacement for the legacy ACCESS Management System (AMS) and incorporates several components previously housed in the FLORIDA eligibility system. It is important for users to note that transmittals linked within instructional materials may still reference outdated legacy terminology. The transition to the Management Portal should be executed based on the current system release. Key terminological updates include: the shift from "ACCESS Number" to "Work Item Number / Application Number"; "ACCESS Summary" is now "Application Summary"; "Application Number" is referred to as the "Client Registration #"; "CLRC" corresponds to "Case Notes"; "CRAD" matches "Client Registration"; "Document Imaging / ADI / DVS" is now "Document Management"; the "FLORIDA ID (FLA Z#)" is now the "RACF ID"; and the "Interview template" is replaced by "New Application Notes."
Social Security Number (SSN) Requirements and Verifications
As a condition of eligibility for both Family Medicaid (MFAM) and Supplemental Security Income Related Medicaid (MSSI), eligibility specialists must obtain a Social Security Number (SSN) for every individual or proof that the individual has applied for one. There are specific exceptions to this requirement: presumptively eligible newborn children and pregnant women, noncitizens eligible for the Refugee Assistance Program (RAP), noncitizens eligible for Emergency Medicaid for Noncitizens, and individuals who do not wish to apply for assistance (ineligible noncitizens). SSN verification is primarily conducted through Data Exchange in the FLORIDA system. Customer statements are exchanged with various data sources to identify assets and income. Verification is finalized through NUMIDENT (number identification) files within the Social Security Administration (SSA). Additionally, the Department receives files from the Office of Vital Statistics (OVS) stored in the MNOV database, which can be used to update missing SSNs in the Management Portal. The OVS Timesaving Innovation Process (TIP) automatically identifies individuals with missing SSNs on the AIID screen, matches them with MNOV data, and updates case records, AIID screens, and AIIA screens accordingly.
SSA Data Sources and Application Assistance
For MFAM, the primary source for SSN verification is the Federal Data Services Hub (FDSH). For MSSI, staff may also use verification from the Hub for Community SSI-Related Medicaid, Long-Term Care Programs, and Medicare Savings Plans. If validation fails through Data Exchange, acceptable verification includes a physical Social Security card or official correspondence from the SSA containing the individual’s name and account number. If an SSN has never been obtained, individuals must apply through a local SSA office or the Florida enumeration at birth process. Eligibility specialists are instructed to assist noncitizens by providing form CF-ES 2275 to potentially eligible qualified noncitizens only AFTER determining Medicaid eligibility. An alert must be set on the AWEC screen for following an SSN application. A new application for an SSN should not be submitted within of a prior application. Failure to provide or apply for an SSN results in the individual or child being excluded from the assistance group. In MFAM, because individuals are in separate assistance groups, the individual assistance group will be denied. Children in facilities or with nonrelative caretakers are ineligible if the official fails to apply for their SSN.
Good Cause Exemptions for Social Security Numbers
Good cause for not obtaining an SSN is acceptable based on specific conditions where a customer’s statement is sufficient. These conditions include: the SSA denying an application because the individual is ineligible for an SSN, the customer only being able to receive an SSN for valid non-work reasons, or a well-established religious objection. A well-established religious objection is defined as the applicant being a member of a recognized religious sect or division that adheres to tenets conscientiously opposed to national identification numbers. In such cases, the individual must provide an explanation of the objection. No additional verification beyond the statement and explanation is required, though the justification must be narrated in case notes and reassessed at each eligibility review. On the AIIA screen, code "E" (Emergency Med-Alien) is used in the Exempt Code field for these individuals.
SSN and Demographic System Screens (AIID and AIIA)
The AIID (Individual Demographics) screen is a read-only display of household member data including names, dates of birth, and SSNs. Additions or corrections must be performed in the Management Portal using the Edit Household function. It is vital to list all residents on AIID to ensure correct assistance group composition. Before adding new individuals, specialists must perform system inquiries (IQIS for names, CRPC for SSNs) to avoid duplicate PIN numbers. The AIIA (Individual Attributes) screen captures verification for identity, residency, and SSN status. Specific fields include: "ID VR," required for all U.S. citizens; "SSN APPL DATE and VR," for those with pending applications; "EXEMPT CODE," using "E" for ineligible noncitizens; "US CIT," requiring verification; "DEC CIT," representing the declaration of citizenship; "POB" (Place of Birth), where code represents the U.S.; "FL RES," indicating Florida residency; and "FLAGS" for special disabilities or Waiver program codes (e.g., WB for iBudget, MC for SMMC LTC).
Medicaid Age Requirements
For Family Medicaid (MFAM), eligibility is restricted to children under age . A child is defined as unmarried, not legally emancipated, and under the age limit. Infants under age may be eligible up to of the Federal Poverty Level (FPL). Children ages through are eligible up to FPL, while children ages and are capped at FPL. Eligibility ends the birth month unless the child is born on the first day of the month, in which case it ends the last day of the prior month. For MSSI, individuals must be or older. Verification methods for MSSI include SSA (RSHDI) determinations, public or religious records created prior to age , or two sources of verification established at least prior to application (e.g., passports, marriage records). Specialists can use State Online Query (SOLQ) through the DES0 transaction to access SSA data; a screenshot of the DES4 screen must be scanned into Document Imaging as SOLQ does not store historical snapshots.
Living Arrangements and Institutional Settings
Primary MFAM child eligibility does not require living with a parent or caretaker. However, for a parent or relative to be eligible, they must have a child under age living in the home. Residents of public institutions (prisons, correctional schools, psychiatric facilities) are technically eligible but their coverage is suspended. State-sponsored maternity homes where care is paid for by the state render individuals ineligible as they are not "living in the home." Temporary absence policy allows parents/relatives to remain eligible for more than if they exercise care and control and have a definite plan to return. Since September 19, 2019, parents of children removed by DCF may remain eligible for MFAM if the family's FSFN Primary Case Plan goal is reunification. If the goal changes (e.g., to adoption), eligibility must be reviewed. The code "TR – Temp Removed by the Department" is used on the AIIC screen. AIIC (Individual Living Arrangements) also tracks types such as (Independent), (Nursing Home), (Battered Woman Shelter), and (Homeless).
Identity Verification Requirements for U.S. Citizens
Medicaid requires proof of identity for every eligible U.S. citizen in the household. As of July 1, 2021, Customer Authentication requirements do not apply to Medicaid applications. Exceptions to identity verification include individuals receiving SSI, Medicare, or Social Security Disability, children in Department care, and presumptively eligible newborns (PENS). Acceptable documents include state driver’s licenses, school IDs with photos (for children under , records without photos suffice), U.S. military cards, and Native American tribal documents. Attestation under penalty of perjury is accepted for children under or disabled adults in residential facilities, provided it was not also used for citizenship verification. Staff must not accept Social Security cards, birth certificates, or Canadian driver’s licenses as proof of identity specifically for Medicaid. Identity theft is handled through specific codes: code is used on AWAA to deny or close cases for confirmed identity theft.
Florida Residency Standards
All Medicaid recipients must reside in Florida. There is no minimum duration requirement or need for a fixed mailing address. Residency is maintained during temporary absences if there is intent to return. For MFAM/MSSI, an individual must intend to remain in Florida or be in the state for employment purposes (with a job commitment or actively seeking work). Residency is lost when a household leaves the state to establish a home elsewhere. Undeliverable mail triggers a verification process: if contact cannot be established, ongoing groups not eligible for continuous coverage are closed using reason code . Medicaid groups eligible for continuous months (e.g., pregnant women and newborns) remain open. There is no U.S. residency requirement for Medicaid programs.
Citizenship and Noncitizen Categories
Every Medicaid applicant must declare their citizenship or lawful immigration status in writing via the Member Information section of the application. U.S. citizenship is verified through the Federal Data Services Hub (FDSH). If the Hub is unavailable, a "reasonable opportunity period" is provided for MFAM. Verification follows a four-level hierarchy: Level 1 (Primary) includes U.S. passports and Certificates of Naturalization; Level 2 includes birth certificates issued before age ; Level 3 includes religious or school records dated prior; and Level 4 includes census records or signed attestations by two people (one non-relative). Noncitizens are categorized as Immigrants (potentially eligible) or Non-Immigrants (tourists/students, ineligible). Qualified noncitizens include Lawful Permanent Residents (LPRs), Asylees, Refugees, Parolees (admitted for at least ), and Victims of Human Trafficking. Many noncitizens entering on or after 8/22/96 face a wait period, but children under age are exempt from this wait if they have a lawfully residing status as of July 1, 2016.
Emergency Medicaid for Noncitizens (EMA)
Noncitizens who meet all technical and financial requirements but lack a qualified immigration status may receive Emergency Medicaid for Noncitizens. This group includes undocumented individuals and those pending status. Coverage is limited to the duration of an emergency medical condition, defined as a life-threatening condition, emergency labor and delivery, or dialysis. Verification requires a statement from a medical professional specifying the start and end dates of the emergency. EMA recipients are not required to provide an SSN, cooperate with child support, or apply for Social Security benefits. Eligibility is granted for a period, but benefits are only authorized for the specific emergency dates. Postpartum coverage is not available for EMA pregnant women.
Pregnancy and Postpartum Coverage Extension
MFAM provides Medicaid to pregnant women based on self-attestation of pregnancy and the number of unborn children. Women eligible for at least one month of Medicaid (including retroactive months) remain eligible through the pregnancy and until the end of the postpartum period, regardless of income changes. This extension was implemented on March 3, 2022. The FLORIDA system automatically determines eligibility for other groups at the end of the postpartum period through an ex-parte process. Closure reason code is used. Specialists must accurately enter pregnancy begin and due dates on the AIIM screen to ensure correct system calculations. For example, if the due date is May 20th, the pregnancy begin date should be August 20th of the prior year. Presumptively Eligible Newborn (PEN) coverage is established by listing the unborn on the case member screen to create a child Medicaid number.
Household Relationships and the Specified Degree
Household Relationships (AIHH) screen collects data to determine whose income and assets are counted. MFAM requires a child to be within a specific degree of relationship to a parent or caretaker for the adult to be eligible. The specified degrees include parents (legal or biological), blood relatives within the fifth degree (siblings, first cousins, nephews, nieces, aunts, uncles, and preceding generations with "grand" or "great" prefixes), stepparents/siblings, and adoptive relatives. Legal spouses of these individuals are also included. In same-sex marriages, both individuals are coded as "WIF" or "HUS." A "non-judicial determination of paternal relationship" is used for biological fathers to establish relationship eligibility without granting legal paternity. AIHH also captures whether individuals are tax filers (), joint filers (), or have out-of-the-household tax dependents ( screen).
Child Support Enforcement (CSE) Cooperation
Medicaid applicants must cooperate with CSE unless good cause exists. Cooperation requires providing the Non-Custodial Parent's (NCP) first and last name, race, sex, and date of birth and/or SSN. For MFAM, signing the application indicates intent to cooperate. Sanctions are applied via code (refusal to cooperate informed to DCF) or code (CSE notified DCF of non-compliance). Sanctions for teen parents are applied against the Major Parent's Medicaid. CSE referrals are not required for: mutual children with both parents in home, children over , pregnant women with no other children, child-only cases, or EMA/Family Planning cases. AIAP screen targets NCP demographics. Good cause claims (e.g., fear of harm, incest, pending adoption) result in a "U" (Undetermined) status while CSE evaluates the claim. If CSE denies good cause and the parent still fails to cooperate, Medicaid for the adult is denied or closed.
Retroactive and Posthumous Medicaid
Medicaid may be authorized for up to prior to the month of application. Effective February 1, 2019, retroactive coverage is strictly limited to pregnant women and children under age . Non-pregnant adults age and older are no longer eligible for retroactive months. Eligibility for each month is determined separately. Posthumous Medicaid is handled as a retroactive application for children or pregnant women if the individual was alive during the retroactive period. AFMQ and AFME screens track medical expenses. Income, assets, and living arrangements must be verified for each specific retroactive month requested.
Blindness and Disability Requirements (MSSI)
Individuals under age must be blind or disabled to qualify for SSI-related programs (excluding Medicare Savings Plans). Blindness is visual acuity of or less. Disability is the inability to engage in substantial gainful activity due to an impairment expected to last at least or result in death. Determinations are made by the SSA, the Division of Disability Determinations (DDD), or the Regional Medical Review Team (RMRT). MEDS-AD and EMA cases go to DDD; ICP and HCBS cases go to RMRT. Specialist must ensure the patient has applied for SSA benefits as a condition of eligibility. SSA decisions generally override State decisions. If a State decision is favorable but SSA finds the individual not disabled, Medicaid must be closed unless an appeal is filed with SSA within .
Third Party Liability (TPL) and Quality Control
Recipients must assign rights to third-party payments (e.g., private insurance, court-ordered medical support) to the state. Refusal to cooperate results in adult ineligibility, though the individual’s income and assets still count toward the household. Children remain eligible regardless of caretaker cooperation. AFMD screens capture insurance policy details, and AFEM tracks employer-provided health insurance, including whether the plan meets the Minimum Value Standard (MVS) of paying of costs. Unlike other programs, Medicaid recipients are not required to cooperate with Quality Control (QC) reviewers, and refusal does not affect Medicaid eligibility.