Florida Medicaid Program Benefits
Florida Medicaid is the state and Federal partnership that provides health coverage for selected categories of people in Florida with low incomes. Its purpose is to improve the health of people who might otherwise go without medical care for themselves and their children.
Since the beginning of the Public Health Emergency (PHE), as a requirement to receive additional funding from the federal government, Florida has provided continuous Medicaid coverage and has not disenrolled ineligible recipients. As a result of this policy, Florida saw a significant increase in the number of individuals and families seeking Medicaid assistance, from 3.8 million enrolled in March 2020 to 5.5 million in November 2022.
Medicaid eligibility in Florida is determined either by the Department of Children and Families (DCF) or the Social Security Administration (for SSI recipients) while the Agency for Health Care Administration (AHCA) administers the Medicaid Program. Each month the Department processes, on average, 220,658 Medicaid applications, redeterminations, or requests for additional assistance. As a result of legislative changes in the Consolidated Appropriations Act, 2023, the continuous coverage provision will end on March 31, 2023, and is untied from the end of the PHE.
The Department will follow federal guidance to restore Medicaid eligibility through normal processing while working to ensure eligible recipients remain enrolled. The Centers for Medicare and Medicaid Services (CMS) allows state agencies up to 12 months to complete Medicaid reviews once the continuous coverage period ends. Florida will undertake this task by scheduling and conducting redeterminations in a manner that will meet federal regulatory requirements while minimizing the impact on families.
Florida’s economy has rebounded quickly and continues to outperform the nation in economic and labor market metrics. With our robust economic environment, many families have had an increase in income and the ability to obtain insurance through employment. This is welcome news for many families, and the Department will work with them to ensure a smooth transition. Over the next 12 months, the Department will work to notify and communicate to all current Medicaid recipients their redetermination timeframes and next steps.
The Florida Medicaid Redetermination Program Objectives
- Ensure continuity of Medicaid coverage for eligible individuals while promoting access to alternative health coverage providers.
- Prioritize exceptional customer service through strong communication and community collaboration.
- Leverage technology solutions to enhance operational efficiencies while being compliant with federal guidelines.
Who is eligible for Florida Medicaid?
To be eligible for Florida Medicaid, you must be a resident of the state of Florida, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be one of the following:
- Pregnant, or
- Be responsible for a child 18 years of age or younger, or
- Blind, or
- Have a disability or a family member in your household with a disability, or
- Be 65 years of age or older.
Florida Medicaid Income Limits
In order to qualify, you must have an annual household income (before taxes) that is below the following amounts:
|Household Size||Maximum Income Level (Per Year)|
For households with more than eight people, add $6,836 per additional person. Always check with the appropriate managing agency to ensure the most accurate guidelines.Supplemental Nutrition Assistance Program Benefits
How does the federal PHE affect eligibility for Florida Medicaid?
The Families First Coronavirus Response Act requires that states maintain continuous Medicaid coverage for enrollees during the PHE. Florida has allowed individuals to remain on Medicaid throughout the PHE even though their household situation may have changed. As a result of federal legislative changes in the Consolidated Appropriations Act, 2023, the continuous coverage provision will end on March 31, 2023. Once the continuous coverage ends, some Medicaid recipients may no longer be enrolled in Medicaid.
What will happen when the continuous coverage ends?
Over the course of 12 months the Department will review all Medicaid cases to ensure recipients are eligible for benefits. Many individuals will be the beneficiary of an automatic review and approval to continue Medicaid eligibility (also called passive renewal or ex parte renewal). In this case, individuals will receive a notice that their Medicaid case has been approved and their Medicaid coverage will continue.
If the Department cannot automatically review an individual's Medicaid coverage because additional information is required, the Department will send a notice 45 days prior to the renewal date with instructions on how to complete the renewal process. Individuals will have the opportunity to provide updated information to Department staff who will evaluate their eligibility for Medicaid. Upon receipt of this notice, it is important that individuals act timely to provide requested information to ensure they do not experience a disruption in Medicaid coverage.
What should I do when the continuous coverage ends?
You should make sure your address on file is updated by logging in to your MyAccess account. Additionally, be on the lookout for a mailed or emailed notice from the Department to complete your renewal. Upon receipt of that notice, you should renew as quickly as possible by going to https://www.myflorida.com/accessflorida/ to update your Medicaid information. The Department may ask for additional information from you while your case is being reviewed.
What should I do if I am no longer eligible for Medicaid when the continuous coverage ends?
If you are no longer eligible for Medicaid coverage, the Department will send you a notification through your MyACCESS account, and by sending a letter or an email to you. To ensure continuing coverage, applications for individuals not determined eligible for Medicaid, but eligible for a different healthcare coverage program, will automatically be referred to Florida KidCare, the Medically Needy Program, and other subsidized federal healthcare programs. You can check your MyACCESS account to see if your application has been forwarded to one of these agencies.
Florida KidCare provides low-cost health coverage for children based on family income. You can learn more about this program at the following link: www.floridakidcare.org. The Medically Needy Program allows Medicaid coverage after a monthly “share of cost” is met, determined by household size and family income. You can learn more about the Medically Needy program at the following link: Medically Needy Brochure.
If your application is transferred to the Federal Marketplace, you will receive a letter from the United States Department of Health and Human Services with instruction on how to complete an application for healthcare insurance. You can learn more about the Federal Marketplace at the following link: www.healthcare.gov.
What additional information or documentation may the Department need to complete my Medicaid redetermination?
Current Medicaid recipients have already provided verification of some eligibility factors, such as identity, Florida residence, citizenship or eligible immigration status. Example of additional information that may need to be provided includes but is not limited to, information about the members of your household, income and, for certain coverage, asset information.
How long will it take for the Department to review my Medicaid redetermination?
Once all the information needed to make a determination is available, the Department will make a decision on eligibility within 45 days. The Department will review your application to determine if you are eligible for Medicaid and the level of Medicaid coverage you are eligible to receive. If it is determined that you are not eligible for Medicaid, your application will be automatically referred electronically to Florida KidCare, the Medically Needy Program, and other subsidized federal health programs. You can check your MyACCESS account to see if your application has been forwarded to one of these agencies.
What if I think the determination that I am ineligible is wrong?
If the Department determines that you are not eligible for Medicaid and you think the determination is wrong, you have a right to appeal and should do so within 10 days of the date on the denial letter. You can initiate an appeal by making a request to the Office of Inspector General (OIG). While your appeal is in process, you have the choice to retain your Medicaid coverage.
Disaster Assistance and Emergency Relief Program Benefits
Medicaid Florida Eligibility
Medicaid provides medical coverage to low-income individuals and families. The state and federal government share the cost of the Medicaid program. Medicaid services in Florida are administered by the Agency for Health Care Administration. Medicaid eligibility in Florida is determined either by the Department of Children and Families (DCF) or the Social Security Administration (for SSI recipients).
DCF determines Medicaid eligibility for:
Parents and caretaker relatives of children
Parents and other caretaker relatives of children up to age 18 who live with them may be eligible for Medicaid if the family’s countable income does not exceed certain income limits. Individuals who receive Temporary Cash Assistance (TCA) are eligible for Medicaid. Individuals who are eligible for TCA, but choose not to receive it, may still be eligible for Medicaid.
Families who lose Medicaid eligibility due to earned income may be eligible for up to twelve (12) additional months of Medicaid, if they meet certain requirements. Families that lose Medicaid eligibility due to the receipt of alimony may be eligible for four (4) additional months of Medicaid.
Parents and caretakers may apply for Medicaid on behalf of children under age 21 living in their home, if the family income is under the limit for the age of the child. There is no requirement for a child to reside with an adult caretaker to qualify for Medicaid. Children eligible for Medicaid may enroll in the Child Health Check-up Program. This program provides regularly scheduled health checkups, dental screenings, immunizations and other medical services for children.
For information on the Child Health Check-up Program, visit the Agency for Health Care Administration’s information page at https://ahca.myflorida.com/ Families may also apply for medical assistance for children through Florida KidCare.
A pregnant woman may qualify for Medicaid if her family’s countable income does not exceed income limits. For pregnant women who do not meet the citizenship requirements for Medicaid, see the information below about Emergency Medical Assistance for Non-Citizens.
Presumptively Eligible Pregnant Women (PEPW) is temporary coverage for prenatal care only and eligibility is determined by Qualified Designated Providers (QDP) based on limited information from the pregnant woman. During the temporary coverage period, the pregnant woman will need to submit an application to have her ongoing Medicaid eligibility determined. Women with family income over the limit for Medicaid may qualify for the Medically Needy Program.
Former Foster Care Individuals
Individuals who are under age 26 may receive Medicaid if they were in foster care under the responsibility of the State and receiving Florida Medicaid when they aged out of foster care. There is no income limit for this program.
Non-Citizens with Medical Emergencies
Non-citizens, who are Medicaid eligible except for their citizenship status, may be eligible for Medicaid to cover a serious medical emergency. This includes the emergency labor and delivery of a child. Before Medicaid may be authorized, applicants must provide proof from a medical professional stating the treatment was due to an emergency condition. The proof also must include the date(s) of the emergency.
Aged or Disabled Individuals not Currently Eligible
Medicaid for low-income individuals who are either aged (65 or older) or disabled is called SSI-Related Medicaid. Florida residents who are eligible for Supplemental Security Income (SSI) are automatically eligible for Medicaid coverage from the Social Security Administration. There is no need to file a separate ACCESS Florida Application unless nursing home services are needed.
Individuals may apply for regular Medicaid coverage and other services using the online ACCESS Florida Application and submitting it electronically. If long-term care services in a nursing home or community setting are needed, the individual must check the box for HCBS/Waivers or Nursing Home on the Benefit Information screen. HCBS/Waiver programs provide in-home or assisted living services that help prevent institutionalization.
Medicare Savings Programs (Medicare Buy-In) help Medicare beneficiaries with limited finances pay their Medicare premiums; and in some instances, deductibles and co-payments. Medicare Buy-In provides different levels of assistance depending on the amount of an individual or couple’s income. Individuals may apply for Medicare Buy-In coverage only by completing a Medicaid/Medicare Buy-In Application. Print the form, complete it and mail or fax it to a local Customer Service Center.
Individuals eligible for Medicaid or a Medicare Savings Program are automatically enrolled in Social Security's Extra Help with Part D (Low Income Subsidy) benefit for the remainder of the year. An individual may also apply directly with Social Security for the Medicare Extra Help Program. Individuals who do apply directly for the Medicare Extra Help Program have the option of having the same application consideration for the Medicare Savings Program.
If the individual takes the option of having the Medicare Extra Help Program application considered for the Medicare Savings Program, the Social Security Administration will send information electronically to Florida and the individual will be contacted. More information about Medicaid programs for aged or disabled individuals is available in the SSI-Related Fact Sheets.
Information for Medicaid providers who need to communicate with DCF about SSI-Related Medicaid eligibility status is contained in the SSI-Related Provider Communication Guide. Income and asset limits may be found on the SSI-Related Programs Financial Eligibility Standards. Important information for individuals seeking Medicaid for long-term care services in a nursing home or community setting is available in the Qualified Income Trust Fact Sheet.
How can I contact someone?
To learn more about Florida Medicaid, please go to the Florida Medicaid website. Medicaid has eleven area offices that serve Medicaid providers and recipients. To find your local office, please visit the Recipient Information page. More detailed information on who is potentially eligible for Medicaid is available at the Medicaid Eligible Reports page, (866) 762-2237.