Florida Medicaid FAQs

We know readers have various questions regarding the Florida Medicaid benefits program. Previously, we wrote detailed posts about Income limits for Florida Medicaid, eligibility requirements, and how to read Florida Medicaid customer service. We decided to set up this third Florida Medicaid FAQs page to address the most common questions we get from our readers.

Florida Medicaid FAQs

Here are the top questions we get about Florida Medicaid from our readers. For each question, we have provided detailed answers below.

If you cannot find the answer to your question, please ask us in the comments section below.

Questions about who is eligible and how to to get Florida Medicaid

How do I qualify for Florida Medicaid?

To be eligible for Florida Medicaid, you must be:

• A resident of the state of Florida
• U.S. national, citizen, permanent resident, or legal alien
• Must be in need of health care/insurance assistance
• Your Financial situation must be characterized as low income or very low income.

In addition, 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.

For further details, see our complete post on Florida Medicaid Eligibility Criteria, including what documents you need to apply and what happens after you apply.

What is the income limit for Medicaid in Florida?

The Florida Medicaid Income Limit is calculated as a percentage of the Federal Poverty Line.

To qualify, you must meet the Florida Medicaid Income limits for the Medicaid Group you fall under as shown below:

• Children up to age 1 with family income up to 206 percent of FPL
• Any child age 1-5 with a family income up to 140 percent of FPL
• Children ages 6- 18 with family income up to 133 percent of FPL
• CHIP for children with family income up to 210 percent of FPL
• Pregnant women with family income up to 191 percent of FPL
• Parents of minor children with family income up to 28 percent of FPL
• Individuals who are elderly, blind, and disabled with family income up to 88% of the FPL

For further details, see our complete post on Florida Medicaid Income Limit Charts, including how much you have to make to qualify by Medicaid group.

How do I apply for Medicaid in Florida?

There are THREE options available to you to apply for Medicaid in Florida:

Online: www.myflorida.com/accessflorida

By Phone: 1-866-762-2237

In-Person: At a Department of Children and Families (DCF) office near you. Click here to locate a DCF office.

What is the Florida Medicaid Phone Number?

Here’s how to reach Florida Medicaid by phone:

For the Florida Department of Children and Families, call 1-866-762-2237.

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.

What documents will I need when I apply for Medicaid in Florida?

When you apply for Medicaid in the state of Florida, you must fill out an application form and provide the following documents:

• 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 by your caseworker

LINK

Questions about how Florida Medicaid works and what services are covered 

How does Medicaid in Florida Work?

In the state of Florida, most Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program.

The program has three parts: Managed Medical Assistance, Long-Term Care, and Dental. People on Medicaid will get services using one or more of these plan types:

Managed Medical Assistance (MMA)

Provides Medicaid-covered medical services like:

• Doctor visits
• Hospital care
• Prescribed drugs
• Mental health care
• Transportation to the above services

Most people on Medicaid will receive their care from a plan that covers MMA services.

To find out what MMA provider covers your area or county and the services they offer, click here.

Long-Term Care (LTC)

Provides Medicaid LTC services like care in a nursing facility, assisted living, or at home.

To get LTC, you must be at least 18 years old and meet the nursing home level of care (or meet hospital level of care if you have Cystic Fibrosis).

To find out what LTC provider covers your area or county and the services they offer, click here.

Dental

Provides all Medicaid dental services for children and adults. All Florida residents on Medicaid must enroll in a dental plan.

To find Florida Medicaid Dental providers and what they cover, click here.

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,
and the type of services determined medically necessary by the beneficiary’s Primary Care
Provider.

Generally, Florida Medicaid services covered may include:

• Physician
• Hospital
• Family planning (birth control, pregnancy, and birth care)
• Home health care
• Nursing home
• Hospice
• Transportation
• Dental and visual
• Community behavioral health
• Services through the Child Health Check-Up program
• Other types of services

Additionally, 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.

Does Florida Medicaid Cover Dental?

What dental services are covered by Florida Medicaid depends on whether you are under age 21 or not.

For those under age 21, Florida Medicaid Dental coverage is more extensive.

Those over 21 years of age get more limited services.

Additionally, some services for those 21 or older must receive prior approval (Expanded Dental Benefits).

For a list of what the Florida Medicaid Dental plan covers, click here.

How do I find a Florida Medicaid health care provider?

If you are trying to locate a Florida Medicaid provider, here’s what you need to know:

First, if you are covered by regular Medicaid, contact your local Medicaid office for a list of primary
care doctors, dentists, and specialists.

See below for the list of Medicaid office phone numbers. 

Second, if you are in a Medicaid health plan, contact the plan for a list of Medicaid providers.

Call the health plan customer service number listed on your medical card or other paperwork the health
plan gave you.

Also, to see a medical specialist, a dentist, or to receive certain services you may be required to ask
your primary care doctor for a referral.

Additionally, to make an appointment with a Medicaid provider you need to contact the doctor’s office and
ask if they are accepting new Medicaid patients.

However, doctors, medical specialists, and dentists who serve Medicaid patients might serve only a certain number of patients at a time.

Questions about Medicaid Plans and Florida Medicaid Providers 

What is Florida Medicaid open enrollment 2021?

You can enroll in Marketplace health coverage through August 15 due to the coronavirus disease 2019 (COVID-19) emergency.

You can also still get 2021 health insurance these 2 ways:

• If you qualify for a Special Enrollment Period due to a life event like losing other coverage, getting married, moving, or having a baby, you can enroll any time.
• If you qualify for Florida Medicaid or the Children’s Health Insurance Program (CHIP), you can apply at any time.

How do I get the List of Medicaid Providers in Florida?

To find doctors, dentists, and specialists in your community that serve Medicaid patients, go to www.flmedicaidmanagedcare.com or call 1-877-711-3662 to talk to a Choice Counselor.

Click here for Humana Medicaid Plan.

What’s the Florida Medicaid Providers portal?

To visit the Florida Medicaid Provider Portal, click here

For provider enrollment forms, click here.

What is the Florida Medicaid provider manual for 2021?

For the Florida Medicaid Provider Manual for 2021, click here.

What’s the Florida Medicaid Provider Phone Number?

If you have questions about Medicaid Providers in Florida, call the number below:

Florida Medicaid Provider Phone Number:

Call 1-877-711-3662, TDD 1-866-467-4970

Agents are available Monday through Thursday from 8 a.m. to 8 p.m.; Friday from 8 a.m. to 7 p.m.

The call is free.

How do I change my Floria Medicaid plans?

If you have to change your Florida Medicaid plan for any reason, here’s how:

You are allowed to change your Medicaid plan during the first 120 days of your enrollment.

However, 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 Phone Number to change my Floria Medicaid plans?

You can change your Florida Medicaid plans by Phone.

Here is the number to call:

Call 1-877-711-3662, TDD 1-866-467-4970

Agents are available Monday through Thursday from 8 a.m. to 8 p.m.; Friday from 8 a.m. to 7 p.m.

The call is free.

What is Florida Medicaid “Open Enrollment”?

The Florida Medicaid Open Enrollment is the 60-day period each year when you can change plans without state approval.

Your Open Enrollment occurs yearly on the anniversary date of your first enrollment into the Florida Medicaid plan.

What is the Florida Medicaid “No Change period”?

The Medicaid 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.

No change period also exists between your 60-day open enrollment periods going forward.

The Florida Department of Children and Families will send you reminder letters about all the important dates regarding Medicaid enrollment.

If you have moved or changed your address, make sure they have your correct address on file so that you will not miss important program notices.

What is “Good Cause” for Changing a Medicaid Plan?

Generally, you are not allowed to change your Florida Medicaid plan during the no-change period.

However, a “Good Cause” is when you are able to change your Medicaid plan during the no-change period with a State-approved reason.

What happens to my Medicaid plan if I relocate or my address changes?

If you move or your address changes, you may be required to select another Florida Medicaid plan if your region has changed.

Contact the Florida Department of Children and Families (DCF) at 1-866-762-2237 to report a change in address.

If you are receiving SSI benefits, contact the Social Security Administration (SSA) at 1-800-772-1213 to report a change in address.

Florida Medicaid Office Phone Number by County

Here is the list of Florida Medicaid Offices by area.

Look for your county in the following list, to find the office which serves your area of the state.

You may contact the Medicaid office for information on:

• Medicaid services
• List of Medicaid providers
• Medicaid health plans
• Consumer education
• Information for Medicaid providers

Area 1

Escambia, Okaloosa, Santa Rosa, and Walton
(850) 595-5700
(800) 303-2422 (toll free)

Area 2a

Bay: (850) 872-7690
Franklin, Gulf, Holmes, Jackson, and Washington: (800) 226-7690 (toll free)

Area 2b

Calhoun, Gadsden, Jefferson, Leon, Madison, and Wakulla: (850) 487-2272
Liberty and Taylor: (800) 248-2243 (toll-free)

Area 3a

Alachua, Bradford, Columbia, Dixie, Gilchrist, Hamilton, Lafayette, Levy, Putnam,
Suwannee, and Union
(386) 418-5350
(800) 803-3245 (toll free)

Area 3b

Citrus, Hernando, Lake, Marion, and Sumter
(352) 732-1349
(877) 724-2358 (toll-free)

Area 4

Baker, Clay, Duval, Flagler, Nassau, St. Johns, and Volusia
(904) 353-2100
(800) 273-5880 (toll free)

Area 5

Pasco and Pinellas
(727) 552-1191
(800) 299-4844 (toll free)

Area 6

Hardee, Highlands, Hillsborough, Manatee, and Polk
(813) 871-7600
(800) 226-2316 (toll free)

Area 7

Brevard, Orange, Osceola, and Seminole
(407) 317-7851
(877) 254-1055 (toll free)

Area 8

Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota
10(239) 338-2620
(800) 226-6735 (toll free)

Area 9

Indian River, Martin, Okeechobee, Palm Beach, and St. Lucie
(561) 616-5255
(800) 226-5082 (toll free)

Area 10

Broward
(954) 202-3200
(866) 875-9131 (toll free)

Area 11

Miami-Dade and Monroe
(305) 499-2000
(800) 953-0555 (toll free)

We hope this post on the Florida Medicaid FAQs was helpful.

If you have further questions about Florida Medicaid benefits, please let us know in the comments section below.

Be sure to check out our other articles about Medicaid.
How to Apply for Coverage by State
Medicaid Income Limits by State
Difference between Medicare and Medicaid