JAWAID v. FLORIDA DEPARTMENT OF CHILDREN AND FAMILIES (2020)

Asra Jawaid (“Jawaid”) appeals the entry of a Final Order affirming the denial of her Medicaid Application Based on Disability Criteria.

Jawaid applied for disability through the Social Security Administration and was denied. Within one year of that denial, and for the same reasons, she applied for disability to the Department of Children and Families. Jawaid's answers to questions in the application admitted that her disability had not been established, that she had been denied disability through the Social Security Administration within the year, and that her health condition had not changed since that denial.

As required by law, the Department adopted the Social Security Administration's determination and denied Jawaid's Disability Application. 42 C.F.R. § 435.541; § 435.912, Fla. Stat. Following an administrative evidentiary hearing, the Final Order, affirming the Department's denial of Jawaid's application, was entered.

This Court reviews a public benefits matter for whether the Final Order is supported by competent, substantial evidence. § 120.68, Fla. Stat.; Smith v. Dep't of Children & Families, 188 So. 3d 81, 82 (Fla. 3d DCA 2016) (citing McMillan v. Dep't. of Children and Families, 868 So. 2d 1286 (Fla. 1st DCA 2004)).

A disability determination by the Social Security Administration is binding on a State agency. 42 C.F.R. § 435.541. An applicant, like Jawaid, who is under 65 years of age with no minor children, must meet certain disability criteria. See 20 C.F.R. § 416.905. Specifically, the federal regulation provides, in pertinent part:

(2) The agency may not make an independent determination of disability if SSA has made a disability determination within the time limits set forth in § 435.912 on the same issues presented in the Medicaid application. A determination of eligibility for SSI payments based on disability that is made by SSA automatically confers Medicaid eligibility, as provided under § 435.909.

(b) Effect of SSA determinations. (1) Except in the circumstances specified in paragraph (c) (3) of this section—

(i) An SSA disability determination is binding on an agency until the determination is changed by SSA.

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(2) The agency must refer to SSA all applicants who allege new information or evidence affecting previous SSA determinations of ineligibility based upon disability for reconsideration or reopening of the determination, except in cases specified in paragraph (c) (4) of this section.

(c) Determinations made by the Medicaid agency. The agency must make a determination of disability in accordance with the requirements of this section if any of the following circumstances exist:

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(4) The individual applies for Medicaid as a non-cash beneficiary, whether or not the State has a section 1634 agreement with SSA. and—

(i) Alleges a disabling condition different from, or in addition to, that considered by SSA in making its determination; or

(ii) Alleges more than 12 months after the most recent SSA determination denying disability that his or her condition has changed or deteriorated since that SSA determination and alleges a new period of disability which meets the durational requirements of the Act, and has not applied to SSA for a determination with respect to these allegations.

(iii) Alleges less than 12 months after the most recent SSA determination denying disability that his or her condition has changed or deteriorated since that SSA determination, alleges a new period of disability which meets the durational requirements of the Act, and—

(A) Has applied to SSA for reconsideration or reopening of its disability decision and SSA refused to consider the new allegations; and/or

(B) He or she no longer meets the nondisability requirements for SSI but may meet the State's nondisability requirements for Medicaid eligibility.

42 C.F.R. § 435.541.

Here, the Final Order is supported by competent, substantial evidence. Jawaid is under the age of 65 with no minor children, was denied disability by the Social Security Administration within the last year for the same reasons sought in her application to the Department, and failed to assert a new or worsening condition. That is not to say Jawaid is precluded from utilizing any appeal process available to her through the Social Security Administration, or that she could not, at some future time, meet one of the abovementioned exceptions that could allow her to obtain a disability determination. However, on the record before us at this time, the Final Order is supported by competent, substantial evidence and consistent with federal and Florida law.

Affirmed.

PER CURIAM.