If you are interested in applying for Medicaid in Florida, you’ve come to the right place. In this post, we will provide information about Florida Medicaid eligibility criteria for the children and family, pregnancy, the elderly, the blind, and the disabled.
We will explain in detail everything you need to know to successfully apply for Florida Medicaid.
In addition, we will show you the various ways you can apply, including how to login to ACCESS Florida portal, and how to contact Florida Medicaid.
Finally, we will answer some of the most frequently asked questions about Florida Medicaid Eligibility.
This article on Florida Medicaid eligibility will cover:
- What is Florida Medicaid?
- Who is Eligible for Medicaid in Florida?
- Florida Medicaid Eligibility Guidelines
- 2021 Florida Medicaid Income Limit
- How to Apply for Medicaid in Florida
- What does Medicaid Cover in Florida?
- Florida Medicaid Phone Number
- Medicaid Expansion in Florida
- Florida Medicaid Card
- Emergency Medical Assistance for Non-citizens
- FAQs about Medicaid in Florida
What is Medicaid?
Medicaid is a federal and state health insurance program for people with a low income.
It provides free or low-cost health coverage to millions of Americans, including families and children, pregnant women, the elderly, and people with disabilities.
The Children’s Health Insurance Program (CHIP) offers health coverage to children in families with incomes too high to qualify for Medicaid, but who can’t afford private coverage.
Medicaid in Florida
The Florida Medicaid program provides medical coverage to low-income individuals and families.
As of 2020, the program, along with the Children’s Health Insurance Program (CHIP) covered 3.9 million people.
This includes 2.5 million children as shown by the image below.
Medicaid services in Florida are administered by the Agency for Health Care Administration (AHCA).
However, Medicaid eligibility in Florida is determined either by the Department of Children and Families (DCF) or the Social Security Administration (for SSI recipients).
Who is Eligible for Medicaid in Florida?
The following people may qualify for Florida Medicaid if they meet certain financial
- Low-income families with children
- Pregnant women
- Infants and children under the age of 21
- People who are aged 65 or older
- People who are blind or expected to be disabled for at least a year
- Recipients of Supplemental Security Income (SSI)
- People who need nursing home care or home and community-based care
- People who are on Medicare
- Aliens and refugees under a special assistance program (Emergency Medicaid)
- Individuals who are medically needy
Florida Medicaid Eligibility Guidelines
To qualify for Medicaid in Florida, an individual must meet the eligibility requirements of the program.
There are several Medicaid programs that people in Florida can be eligible for. Each program has its own income and asset requirements.
However, all applicants must meet the general requirements below in order to qualify for Florida Medicaid.
Proof of Identity
Identity can be verified by a driver’s license, state identification card or another piece of identification.
Social Security Number (SSN)
A SSN must be provided for each person applying for Medicaid.
Your county Medicaid Office staff can help you apply for an SSN for anyone who does not have one.
Medicaid assistance is available to individuals who are residents of Florida if all other eligibility requirements are met.
There is no requirement regarding the length of time that a person must live in Florida in order to be eligible.
Medicaid is available to United States citizens, refugees, and certain lawfully admitted aliens. Other aliens may be eligible for limited Medical Assistance benefits if an emergency medical condition exists.
Additionally, U.S. citizens, refugees and legal aliens must submit documentation proving U.S. citizenship or legal alien status.
County Assistance Office staff will determine who are mandatory or optional budget group members in the Medical Assistance application based upon household relationships and individual needs for Medical Assistance.
The income requirements for Florida Medicaid is perhaps the most important eligibility criteria. See below for details about Medicaid income limits by group. and household size.
2021 Florida Medicaid Income Limit
The FL Medicaid eligibility income limit charts are divided by groups.
For example, the first chart is focused on income limits for children who qualify for Medicaid.
Similarly, the second chart below focuses on the Medicaid income limits for adults in Florida who qualify for Medicaid.
Florida Medicaid Income Limit for Children
Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.
|Florida Medicaid Income Limit – Children|
|Children Medicaid Ages 0-1||For Children Medicaid Ages 1-5||Children Medicaid Ages 6-18||Children Separate CHIP|
Next is the income limit for adults by category. Find the category you fall into and you will see the income limit by household size.
Florida has not expanded Medicaid to include adults without dependents.
Therefore, adults without dependents do not qualify for Medicaid in Florida.
For an update on the Medicaid expansion debate and timeline in Florida, see our Florida Medicaid Expansion update below.
Florida Medicaid Income Limit for Adults
|Florida Medicaid Income Limit – Adults|
|Pregnant Women Medicaid||Adults (Medicaid) Parent/ Caretaker||Seniors & People w/ Disabilities (Medicaid)||Adults (Medicaid) Expansion to Adults|
How to Read the Florida Medicaid Income Limits Charts Above
You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.
Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.
For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 191% of the Federal Poverty Level – which for a family of two is $33,272 as shown in the chart above.
How to Apply for Medicaid in Florida
There are 3 ways you can apply for Medicaid in Florida.
Option 1 – Apply online
You can apply online through the Florida ACCESS account (as shown in the image below). If you have an account, you can log in or create your MyACCESS Account. Click here to be taken to the website.
Option 2 – Apply at DCF Office Near You
You can apply in person at the Florida Department of Children and Families (DCF) office near you. Click here to locate a DCF office.
Option 3 – Download Application
You can download an application, complete it and mail it to your county DCF office or submit it in person.
Medicaid eligibility for some is also determined using resource and household size in comparison to resource limits.
However, the resource limits do not apply to the following groups:
- Adults Age 19-64
- Pregnant women
- Families with children in the household – under their care and control
- Children under the age of 21
Examples of resources counted in determining eligibility include:
- Checking accounts
- Savings accounts and certificates
- Christmas or vacation clubs
- Stocks and bonds
- Some trust funds
- Life insurance
- Revocable burial funds
- Non-resident property
Examples of resources not counted in determining eligibility include:
- Your home
- Revocable and irrevocable burial reserves subject to specified limits
- Burial space and marker
- One motor vehicle
As mentioned above, some Medicaid eligibility groups have resource limits. This includes:
- Seniors ages 65 and above
- People with Disabilities
- SSI Recipients
For details on Florida Medicaid resources limits for these group of applicants, check with your county Medicaid office.
Documents you need to apply
During the application process for Medicaid in Florida, you will need to have various documents to support your application.
Here’s the list of documents you may have to provide:
- Information about household members (name, date of birth and Social Security number)
- Rent or mortgage information
- Expenses (utilities, daycare, etc.)
- Vehicle information
- Bank statements
- Income (pay stubs)
- Proof of disability or medical records showing a lasting medical condition
- Recent medical bills
- Proof of citizenship
- Additional information as requested
What happens after I apply for Medicaid in Florida?
After you submit your Florida Medicaid application, you may be required to attend an interview with a Department of Children & Families (DCF) case worker.
Whether you will required to attend an interview depends on your situation:
If you are applying for Medicaid for your child(ren) alone, then no interview will likely be required.
If you are applying for any other benefits at the same time, then an interview will likely be required.
During this interview, you will be required to bring documents that prove the information that you provided on your initial Florida Medicaid application.
See above for the list of documents that may be required during the interview.
Once you complete this interview, you will receive a call or a letter in the mail that will tell you whether you were approved or denied.
If you are denied benefits, you have the right to appeal but that appeal must be filed within a certain timeframe. As your caseworker for details.
What does Medicaid Cover in Florida?
Florida Medicaid covers a variety of medical services. However, the type and amount of services depends on the age of the beneficiary, the type of Medicaid program in which the beneficiary is enrolled.
Additionally, coverage depends on the type of services determined medically necessary by the beneficiary’s Primary Care Provider.
Medicaid services may include:
- Family planning (birth control, pregnancy and birth care)
- Home health care
- Nursing home
- Dental and visual
- Community behavioral health
- Services through the Child Health Check-Up program
Furthermore, the Florida Medicaid program pays the cost of prescription drugs for those who qualify for this coverage.
However, if you are covered by both Medicaid and Medicare, most of your prescription drugs may be provided under the Medicare Part D Prescription Drug benefit.
There are a few drugs not covered by Medicare Part D plans, but these may be covered by Medicaid for
persons with full Medicaid coverage.
Medicare Part D is an insurance benefit to help people with Medicare pay for prescription drugs
and is provided through Medicare approved private health plans.
For more detailed information about services covered by Florida Medicaid and the programs
providing these services, click here.
Florida Medicaid Phone Number
Here’s how to contact Florida Medicaid:
Call the Florida Department of Children and Families
at 1-866-762-2237 for:
- Medicaid eligibility requirements and
applying for Medicaid benefits
- Medicaid eligibility requirements and
applying for Medicaid benefits
- Denial or termination of
- Share of Cost/Medically Needy Program
- Reporting lost Medicaid Gold Cards
- Medicare Buy-in Programs
To reach Florida KidCare, call 1-800-821-5437.
For Medicaid Applicant & Member Services, call 1-877-711-3662, TDD 1-866-467-4970.
Customer Service is available Monday through Thursday from 8 a.m. to 8 p.m.; Friday from 8 a.m. to 7 p.m.
If you are not enrolled in a health plan, call the Medicaid Helpline at 1-877-254-1055.
Also, if you need help finding contact information for your Medicaid plan, call our
Medicaid Helpline at 1-877-254-1055. You can get help with:
- Locating a doctor
- The services your plan covers
- Transportation to access covered services
- Other general questions you may have
Medicaid Expansion in Florida
Florida is one of 12 states that, as of August 2020, has not expanded Medicaid eligibility as allowed under the Affordable Care Act (ACA).
This means that adults without dependents who have low income cannot qualify for Medicaid, like residents in the 38 states that have expanded Medicaid.
In Florida, if Medicaid had been expanded under the ACA, some 391,000 people who do not currently have coverage would gain coverage.
Republicans control Florida’s House and Senate as well as the governor’s office.
Democrats in the Florida legislature have been pushing for Medicaid expansion for years, but have consistently been blocked by Republicans.
Florida Medicaid Card
Most people on Medicaid must enroll in a health plan. If you are one of those people, you will get a letter telling you the names of Medicaid providers in the state.
You will be given a timeframe to choose a health plan.
Additionally, once you are approved for Medicaid in Florida, you will be issued a permanent Medicaid gold card, like the image below.
Furthermore, If you are enrolled in a health plan, you will also receive a
membership card from your plan.
FAQs about Medicaid in Florida
Here are the most frequently asked questions about Medicaid in Florida:
What is Florida KidCare?
Florida KidCare is the State of Florida’s health insurance program that covers children ages 0-18. The program is made up of Florida Healthy Kids, Medicaid, MediKids and Children’s Medical Services.
How do I sign up my child for health coverage?
You can apply online or call us at 1-888-540-KIDS (5437) to have an application mailed to you. After you are approved, Florida KidCare will place your child in the program that best meets your child’s needs.
How much does Florida KidCare cost?
Many families pay $15 or $20 per month, but most families pay nothing at all. A full-pay option is available for families with higher household incomes.
How do I change Medicaid plans in Florida?
If you have been approved for Medicaid in Florida, you may change your plan during the first 120 days of your enrollment.
After the 120 days, you will only be able to change your plan during your open enrollment period or with a State-approved good cause reason.
What is the “No Change period” for Florida Medicaid?
The no change period is the time period between the end of your initial first 120 days of enrollment and your 60-day annual open enrollment period.
The No change period also exists between your 60-day open enrollment periods going forward.
What services does my Florida Medicaid Dental plan cover?
Here are the services covered by the Florida dental plan based on who is covered:
For children, the following is covered:
- Comprehensive dental care
- Medically necessary dental services
For adults services include:
- Dental exams
- Dental screenings
- Dental X-rays
What dental plans are available under Florida Medicaid?
The Florida Medicaid dentals plans are DentaQuest, Liberty, and MCNA Dental.
Florida Medicaid Eligibility Summary
We hope this post on Florida Medicaid Eligibility was helpful to you.
If you have any questions about Medicaid in the state of Florida, you can ask us in the comments section below.
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Be sure to check out our other articles about Medicaid.
Difference between Medicare and Medicaid Programs
How to Apply for Coverage by State
Medicaid Income Limits by State
Medicaid Phone Number for Florida
Humana Medicaid In Florida