Item D25
BOARD OF COUNTY COMMISSIONERS
AGENDA ITEM SUMMARY
Meeting Date: July 19. 2006
Division:
Community Services
Bulk Item: Yes --X- No
Department: Social Services
Staff Contact Pe~on: Susan Hawxhurst
AGENDA ITEM WORDING: Approval to rescind Resolution No. 115-1976 and adopt a new
Resolution establishing new policy regarding the provision of Social Services; providing for classes of
services available; providing criteria for eligibility determination; and providing for an effective date.
ITEM BACKGROUND: The rules, regulations and guidelines established in Resolution No. 115-
1976 have become obsolete or inappropriate due to the passage of state and federal legislation, and
changes in socioeconomic circumstances of Monroe County and its citizens.
PREVIOUS RELEVANT BOCC ACTION: On July 13, 1976, the Board approved Resolution No.
115-1976, authorizing certain services to indigent citizens of Monroe ~ounty.
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CONTRACT/AGREEMENT CHANGES: N/A
STAFF RECOMMENDATIONS: Approval.
REVENUE PRODUCING: Yes
No-X
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BUDGETED: tes _ No
SOURCEOFF~S: N/A
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AMOUNTPERMONTH_ Year
TOTAL COST: N/A
COST TO COUNTY: N/A
APPROVED BY: County Atty _ OMBlPurchasing _ Risk Management_
DIVISION DIRECTOR APPROVAL:
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DOCUMENTATION:
Included X
n, Acting Director)
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Not Required~
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AGENDA ITEM #
DISPOSITION:
Revised 2/05
RESOLUTION NO.
-2006 i
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A RESOLUTION OF THE BOARD OF i COUNTY
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COMMISSIONERS OF MONROE COUNTY,
FLORIDA, RESCINDING RESOLUTION NO. 115-
1976 AND ESTABLISHING NEW! POLICY
REGARDING THE PROVISION OF i SOCIAL
SERVICES; PROVIDING FOR CLASSES. OF
SERVICES AVAILABLE; PROVIDING CRITERIA
FOR ELIGIBILITY DETERlVIINA TION; AND
PROVIDING FOR AN EFFECTIVE DATE. !
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WHEREAS, the Board of County Commissioners of Morvoe County, Florida, through
its County social services program (hereinafter referred to as "~gency"), has been rendering
certain services to indigent citizens of Monroe County, Florida, pursuant to Resolution No. ll5-
1976,and i
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WHEREAS, the rules, regulations and guidelines establi~hed in Resolution No. 1l5-
1976 have become obsolete or inappropriate due to the passage of state and federal legislation,
and changes in socioeconomic circumstances of the County and its citizens;
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NOW THEREFORE BE IT RESOLVED ~y the Board of County
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Commissioners of Monroe County, Florida that: i
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Section l. Resolution No. l15-l976 is hereby repealed. I
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Section 2. The County social services program has the ~eneral purpose of caring and
providing for the elderly, disabled, and indigent people of the Cqunty who require assistance
until it is provided by private, state and federal economic, social hnd medical programs. The
County cannot provide assistance for anything covered by existing federal, state, or
municipal government, or private (profit or non-profit) programs or by insurance coverage
of any individual. The County does not provide any assistance for ,transplant or for any elective
medical procedure. i
Section 3. The County social services agency staff s~all determine eligibility of
applicants for assistance and balance the needs of eligible applicants with its annually budgeted
resources in order to maximize assistance to meet minimum need~ consistent with health and
decency standards and fostering of the applicant's responsibility for maximum self-support,
maximum self-direction, and active participation in plans fori rehabilitation. Where the
agency staff is specified in this Resolution as the entity to take action, the program director, or
hislher designee, has authority to act.
Section 4. The County social services agency staff i shall offer emergency or
temporary assistance while assistance of a more permanent natur1 is pending pursuant to the
following policies.
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I. ELIGIBILITY
A) GENERAL: The agency staff shall determine from documents and information
provided by each applicant if an applicant meets eligibility g~idelines for state or federal
programs. An applicant shall not be eligible for interim County *ssistance unless it appears to
the agency staff that the applicant would qualify for a municipill, state or federal assistance
program, or the applicant can affirmatively show the applicant is qualified for a private program,
and the applicant can show he/she has filed applications for said programs.
However, if the applicant is permanently disabled and has received no income for at least
ninety (90) days prior to application for assistance, this requiremen~ may be waived. Waiver can
be decided only by the program director of the agency and shall be Idetermined on a case-by-case
basis. Waste of one's resources for purposes other than modest shblter, food and transportation,
and necessary medical expenses shall preclude the applicant from eligibility for assistance.
Any homestead or other statutory exemption from attac~ent by creditors is excluded
from property in determining eligibility. 1
Transfers of property within the three (3) years prior to application shall be presumed to
have occurred with intent to concoct a state of indigence. Unless the applicant can show
evidence of a bona fide reason for transfer related to good :Qlanagement of one's assets,
assistance will be denied. I
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B) RESIDENCY: Residency or intent to domicile must be !established through evidence
such as a Declaration of Domicile, registration with a job service, a ~ong-term lease, or the like.
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C) EMPLOYMENT: The applicant must be registered with the South Florida Work
Force (or equivalent) employment service and be actively seekirtg employment if physically
able. 'Actively seeking employment' is defined as a person who checks in at least once a week
with the employment service, and who does not refuse any employment that they are physically
and mentally able to perform, which would enable them to pr~vide for their basic needs.
Inability to find work does not make a person unemployable. f-gency staff is able to help
employable persons to a limited degree only in hardship and emergency situations. In no
instance shall County assistance be rendered in the following situatibns:
1. Applicant married, with either spouse adequate~y employed or employable,
whether or not the applicant's spouse lives in the home or contribllites financial resources to the
family; or i
2. Applicant left job for reasons other than illness or' accident, except when other
government benefits, public assistance or private benefits (such as pensions and widow's
benefits) are scheduled to be received but are not yet being disbursed, in which case
determination of assistance shall be made on a month-to-month basi~.
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D) INCOME: Determining income eligibility. In the absenqe to the contrary, the Florida
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Health Care Responsibility Act (HCRA) income guidelines for th~ current fiscal year will be
used to determine eligibility for financial assistance. The income $uidelines may be revised at
the discretion of the Monroe County Board of County Commissione~s.
E) ASSETS: Determining asset eligibility. In the absence to the contrary, the Florida
Health Care Responsibility Act (HCRA) asset guidelines and excluded asset guidelines will be
used to determine eligibility for financial assistance. The asset guidelines may be revised by
resolution at the discretion of the Momoe County Board of County qommissioners.
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F) RESTRICTIONS: An applicant receiving assistance frpm any other public assistance
program(s) is ineligible for County assistance under this Resolutiob, unless a specific need exists
that is of an emergency nature and assistance is not otherwise av~ilable. If the applicant bases
the request for assistance on disability, medical proof of disability is required. If an individual
does not meet these guidelines, the program director may consHler extenuating circumstances
which are not contained within the guidelines and approve assistance on a month-by-month
basis. Any general assistance such as personal care items! or food provided prior to
determination of eligibility does not impact or affect eligibility.
G) OTHER:
1. Applicants must verify their place of residence and living situation by
producing either a rent receipt, a notarized statement from the land~ord or head of household, or a
statement with two (2) witnesses and a photo ID. .
2. Applicants must sign medical and financial information releases so that the
agency can verify an applicant's disability and financial status.' Applicants must also sign
reimbursement agreement forms. Disabled or aged recipients livil!lg on fixed incomes and with
no real property other than a homestead property will be ~xc1uded from the agency's
reimbursement requirements.
3. Applicants must show two (2) forms of personal identification such as a Social
Security card, driver's license, voter registration, immigration status identification card, passport,
or other forms of identification. Applicants who are aliens must provide original documentation
for the agency to photocopy to show that they are not illegally in the United States. Illegal aliens
are not entitled to assistance.
4. A home visit will be required in most cases before assistance is granted. The
home visit shall be made by a social worker to verify the honie situation and to assist an
applicant in making efficient use of their own resources. A hOrrle visit is required for rental
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assIstance.
5. Applicants must apply for aid from, and pursue all referrals to, other
organizations with assistance programs appropriate to their needs. !
6. Anyone who is disabled due solely to drugs and/br alcohol usage is ineligible
for assistance. An applicant who is disabled and unable to work due to any other condition is
eligible for assistance under other guidelines herein, plus the applicant must meet the following
conditions to continue eligibility, determined on a quarterly basis: !,
a.) If the applicant/recipient has a substance iabuse problem, he/she must
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enroll in and fully participate in a treatment prbgram;
b.) If the applicant/recipient is a legal alien }Vho has not become a U.S.
citizen, he/she must follow all requirements to become a naturalized
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citizen; I
c.) If the applicant/recipient immigrated to the u.s. prior to August 22,
1996, he/she must rely on family or spon~or and is not eligible for
assistance unless verifiable documentation est,ablishes that the family and
sponsor are no longer able to provide assistance because of absence of
assets and income. '
d.) A legal alien who immigrated on or subsfquent to August 22, 1996,
must reside in the country for five (5) yeatfs with a sponsor, or have
documents to show that asylum without a sronsor was granted by the
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United States, in addition to all other requirements before becoming
eligible for assistance under this Resolution.
7. Specific programs have additional conditions as noted herein.
8. In absence of any specificity to the contrary of the above guidelines, the Florida
Health Care Responsibility Act (HCRA) eligibility guidelines will be used to determine the look
back period oftime to be considered to be used in determining eligibility for financial assistance.
II) APPEALS: An applicant who is dissatisfied with the decision of the social worker
may request a review of the case by the agency's program director. A request for review of the
program director's decision may be made to the Community Services Division Director. Each
review must be requested within five (5) working days after the decision was rendered. A
review shall be conducted within five (5) working days after receipt of the request from the
applicant. If the program director or the Community Services Division Director is on leave for
the five (5) working days following receipt of the request, a designee may conduct the review. If
the Community Services Division Director's review does not resolve the applicant's complaint,
the applicant has the right to request a fair hearing.
Fair Hearing Procedure: The applicant has ten (10) calendar days after receiving the
decision resulting from the Community Services Division Director's review to file a complaint
and petition for hearing. The purpose of the hearing is to provide the applicant a forum before a
hearings officer to explain the reasons the applicant feels the decision should be altered.
The hearing shall be recorded and may be transcribed at the expense of the party
requiring the transcript. The hearing need not be conducted according to technical rules relating
to evidence and witnesses. Any relevant evidence shall be admitted if the hearings officer finds
it competent and reliable, regardless of the existence of any common law or statutory rule which
might make improper the admission of such evidence in a court of law. Hearsay evidence may
be used for the purpose of supplementing or explaining any direct evidence, but shall not be
sufficient in itself to support a finding unless it would be admissible in civil actions. The
hearings officer may exclude irrelevant and unduly repetitious evidence.
Each party shall have these rights: to call and examine witnesses; to introduce exhibits; to
cross-examine opposing witnesses on any matter relevant to the issues, even though that matter
was not covered in the direct examination; to impeach any witness, regardless of which party
first called that witness; and to rebut the evidence against the party.
A decision shall be made by the hearings officer within five (5) days after the close ofthe
hearing. The decision shall be mailed, postage prepaid, or transmitted by facsimile to the
applicant at the address designated by the applicant for purposes of notice.
II. SERVICES TO BE DELIVERED OR RENDERED TO INDIGENTS
A) GENERAL ASSISTANCE:
1. Food and Dietary - Food may be provided by agency staff on an emergency
basis with food orders through participating local grocery stores for sufficient supplies to last
the time period necessary to obtain food stamps. A recipient who is not eligible for food stamps
may obtain one (1) week's food supply no more than twice in any calendar year unless an
exception is approved by the program director.
2. Clothing and personal care items - Clothing and toiletries may be provided
for victims of disasters or individuals who have pending other assistance or employment.
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3. Transportation - Eligible individuals may obtain non-refundable bus tickets
to medical facilities, their families' homes, or to support networks as is in the best interests of
the client and the County. Transportation vouchers for the transportation disadvantaged may be
provided. Alternate transportation assistance may be approved by the program director to
resolve a critical situation.
4. Lodging Assistance
a. General - Shelter and utilities assistance are limited to three (3)
months, unless extended for an additional three (3) months based on the agency's quarterly
evaluation of the recipient's circumstances. No individual shall receive more than a total of
twelve (12) months of non-reimbursed assistance during their lifetime. No assistance can be
provided to pay deposits for last month's rent, security, or utilities.
b. Shelter - Emergency payment of rent may be provided on a temporary
basis for extensively disabled or aged individuals who are not receiving assistance from any
other organization and who have depleted any bank and/or savings accounts and have no care
provider. An extensive disability is defined as any medical or psychiatric condition which has
or will incapacitate the applicant for at least six (6) weeks. Applicants must furnish the agency
staff with written verification from a doctor to establish their disability status. An aged person
is defined as any person over the age of sixty (60). Age must be verified by either proper
identification, documents, or by verification from other public organizations, such as the Social
Security Administration.
c. Utilities - Emergency payment may be made for utilities (electricity,
water, sewer, gas, and trash) for extensively disabled or aged individuals who are not receiving
assistance from any other organization. Assistance may be provided for basic telephone service
if a telephone is medically necessary.
B) PAUPER BURIALS/CREMA TIONS:
Burial or cremation services may be provided through a contracted participating funeral
home for remains of individuals with no identifiable source of payment for burial expenses,
except that the existence of family members within two (2) degrees of sanguinity shall be
considered an identifiable source of payment of the burial expenses, unless the relative(s) can
show proof of inability to pay the cost of the burial expenses. If a decedent is unclaimed by any
relative, a release must be obtained from the Sheriffs Department or other appropriate law
enforcement agency when the cause of death warrants, and the Medical Examiner, before a
County pauper burial or cremation can be approved by agency staff.
C) MEDICAL ASSISTANCE:
1. Physician's Services - The County may pay for medical treatment of certain
chronic or emergency medical conditions if the physician's services are provided by local
participating physicians who accept as payment in full for County indigents at an amount no
greater than that established by the current Physician Terminology code or similar
establishment of customary fees.
2. Drugs - The agency may allow a monthly medicine allowance at participating
drug stores for the purchase of prescription medications. Only aged and disabled individuals
and persons with extenuating circumstances who require temporary assistance may obtain
prescription medication through this program. The maximum monthly medication allowance
may change yearly based upon availability of funds. When extenuating circumstances can be
verified, a larger allowance would be limited to only one (I) month or such other temporary
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basis as the extenuating circumstances are deemed by the program director to warrant an
exception.
3. Medical Supplies and Equipment - Agency staff may pay for the purchase of
medical supplies such as bandages, dressings, syringes, etc., which are not prescribed
medications, and for prescribed equipment and prosthetic devices only for those persons
eligible for assistance under some other provision of this Resolution.
4. Out-Patient Services - Agency staff may pay for out-patient treatment at
participating local hospitals for eligible individuals for critical care services, including X-ray
and laboratory services, but only if no other assistance is available and only at or less than the
Medicare or Medicaid approved rate for such services.
5. Ambulance - Agency staff may pay for ambulance services provided by local
participating ambulance companies for persons eligible for other services under this Resolution,
and only for emergency ambulance service to treatment centers or transfers from one facility to
another.
6. In-Patient Hospital Services - The County may pay for emergency or urgent
hospitalization of County indigents at participating local or out-of-county hospitals.
Hospitalization services shall be provided only for the acutely ill or injured person with an
urgent illness who may respond to short-term remedial treatment, the postponement of which
may constitute a hazard to the patient's life or would cause undue suffering. The County may
pay for a maximum hospital stay of twelve (12) days per admission, at the Medicaid per diem
rate for which the County has contracted with the hospital, or at the current Medicaid per diem
rate if there is no County hospital contract. Agency staff may consider extending the
hospitalization services upon verification of the medical necessity for such an extended period.
No case requiring more than forty-five (45) days in-patient care within a twelve (l2) month
period can be approved. Individuals certified for Medicare or Medicaid or any other
hospitalization coverage through insurance, Veteran's Assistance (V A), or other programs are
excluded from this program.
D) MEDICAREIMEDICAID BILLING:
Agency staff shall process all paperwork requiring the County to pay a share of Medicare
and Medicaid nursing home and hospital billing for county residents.
III. HCRA AND OTHER FEDERAL OR STATE PROGRAMS
Participation in the Health Care Responsibility Act programs shall be governed by HCRA
rules promulgated by the State of Florida. In participating in or administering other federal or
state programs, the County shall abide by the federal or state rules established for the particular
programs, except when the County has specifically established a rule which differs from the
federal or state rule.
IV. AGENCY PROCEDURES
County social services agency staff shall supervise the administration of the above
services. The staff shall be responsible for cooperating and coordinating with other
organizations, defining and determining the basic needs of the clients, and making every effort
to adequately provide such needs. The use of existing public service organizations shall be
exhausted before the agency expends any County funds. The County agency's services listed
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herein are available to individuals who are determined eligible by agency staff according to
their income and ability to pay, giving consideration to the person's family circumstances.
Applicants must provide agency staff with all information and documents necessary to verify
that they meet the income, asset, and neediness requirements to obtain assistance under this
Resolution.
Decision and actions taken shall be based on the date of application. Where prior time
periods are listed, the time period is gauged by the application date. Where limitations exist on
procedures, they run from the date of application.
Section 5. The effective date of this Resolution shall be August l, 2006.
PASSED AND ADOPTED by the Board of County Commissioners of Monroe County,
Florida, at a regular meeting of said Board held on the _ day of
AD, 2006.
Mayor Charles "Sonny" McCoy
Mayor Pro Tem Dixie Spehar
Commissioner George Neugent
Commissioner David Rice
Commissioner Glenn Patton
(SEAL)
Attest: DANNY L. KOLHAGE, Clerk
BOARD OF COUNTY COMMISSIONERS
OF MONROE COUNTY, FLORIDA
By:
By:
Deputy Clerk
Mayor/Chairman
c/
. Date
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