How to Apply for Medicaid If You Live in Florida
Key takeaways:
You may apply for Medicaid in Florida online, in person, or via telephone.
Florida did not implement the Medicaid expansion program. That means those who are not age 65 or older don’t qualify for Medicaid based on income alone.
To be eligible for Medicaid in Florida, your income must generally be below a certain percentage of the federal poverty level. Some adults must also meet certain non-financial eligibility conditions.
In the U.S., uninsured individuals who can’t afford private health insurance turn to Medicaid. This government-run program provides health insurance to individuals with low income. Nearly 5 million people were enrolled in Medicaid and Children’s Health Insurance Program (CHIP) in Florida as of June 2022.
Florida’s Medicaid application is free, and you can apply online, in person, or via telephone. It may take a few weeks to process the application, but the good news is that your Medicaid application also screens for other programs for which you may qualify, such as food stamps and temporary cash assistance.
How does Medicaid work in Florida?
The Agency for Health Care Administration (AHCA) runs the Medicaid program in Florida, but eligibility is determined by the Department of Children and Families (DCF). If you’re receiving Supplemental Security Income (SSI), then Medicaid eligibility is determined by the Social Security Administration (SSA).
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In 2010, the Affordable Care Act (ACA) called for the nationwide expansion of Medicaid to cover more people and make sure that qualifications are based on income alone. However, the Supreme Court later ruled that it was up to each state to choose whether or not to expand Medicaid.
So far, 38 states and Washington, D.C. have adopted the Medicaid expansion. Florida is among the 12 states that opted out of the expansion.
What is covered under Florida Medicaid?
Florida Medicaid covers a range of services, including:
Behavioral health
Hearing services
Dental care
Prescription medications
Currently, most people eligible for Medicaid in Florida receive coverage through the Statewide Medicaid Managed Care (SMMC) program, which includes the Managed Medical Assistance (MMA) plan. With MMA, you’re enrolled in a privately managed care plan, meaning you no longer have “standard” or “straight” Medicaid. Some MMA plans offer extra benefit coverage, like pet therapy and cellular services.
A copayment or coinsurance of $1 to $15 may apply if you’re in the regular Medicaid program. But, if enrolled in an MMA plan, your copayment may be waived.
How do I apply for Medicaid in Florida?
You can apply for Medicaid in Florida in three easy steps.
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Step 1: Determine if you want to apply online or in person
The quickest way is using the Automated Community Connection to Economic Self Sufficiency (ACCESS) online portal. You’ll be asked to create a MyACCESS account. There, you can also find out if you’re eligible before applying. You can also apply in person at a DCF customer service center. Use their website to find a location near you.
Another option is to go to a DCF community partner agency for assistance. The application is also available to print, complete, and return to a DCF customer service center.
If you don’t have access to a computer or can’t go in person, you can request a paper application to be mailed to you by calling 1-850-300-4DCF (4323). An agent may also be available to take your application information over the telephone.
Step 2: Gather important documents and information
Regardless of how you apply, you’ll need to give many details about yourself and the people in your home to complete the application.
Be prepared to provide the following:
Full name
Social security number
Date of birth
Proof of citizenship
Income information
Expenses including housing, medical bills, and childcare
Assets information
Step 3: Complete the application
After you apply, take note of your ACCESS number or case number. It may take up to 30 days to process the application. If you created a MyACCESS account, you can check the status of your application anytime using the portal. If you opted for email notification, you’ll get an email alert when there is any update to your application.
Once the application is reviewed, you may be asked to schedule an interview with a DCF case worker and provide additional documentation.
If you qualify, you’ll receive a gold Medicaid card in the mail. If you’re not eligible, you’ll receive a notification on the portal and by mail. At this point, your application will be referred to the healthcare marketplace or CHIP for consideration for other types of assistance.
Who is eligible for Medicaid in Florida?
An essential qualification for Florida Medicaid is being a resident of the state of Florida and either a U.S. citizen or a qualified non-citizen.
You must also have low or very low income — generally a family income below 133% of the federal poverty level (FPL) — and meet one of the following circumstances:
Be pregnant
Be a parent or caretaker of a child under 19 years of age
Have a disability
Be blind
Be 65 years or older and are not receiving SSI (if you’re eligible for SSI, you’re automatically eligible for Florida Medicaid coverage through the SSA)
For example, for a family of 4 with a child under age 19, the yearly income cannot be more than $36,908 in 2022.
For certain groups, the maximum income limit may be up to 200% of FPL. Former foster care individuals under age 26 are eligible for Florida Medicaid without having to meet any financial requirements. Non-citizens who meet the Florida Medicaid eligibility criteria except for their citizenship status may qualify for Medicaid coverage of a medical emergency.
If your income is too high to qualify for Florida Medicaid, you may still be able to get help with your medical bills through the Medically Needy Share of Cost program. This plan works best if you have significant monthly healthcare expenses. You must first meet your determined share-of-cost amount each month — similar to a deductible — before Medicaid coverage begins for that month.
Who qualifies for CHIP in Florida?
Uninsured children whose family makes too much money to qualify for Medicaid but cannot afford private insurance may be eligible for CHIP. This program offers subsidized, low-cost health insurance for children through age 18. It’s also co-founded by the federal government and the state.
CHIP in Florida is called Florida KidCare and includes Medicaid for Children and three additional programs:
MediKids: This option provides low-cost insurance coverage to children ages 1 through 4. Expect to pay a monthly premium of $15 or $20, but there are no copayments for services.
Florida Healthy Kids: Children ages 5 through 18 can get health, dental, and vision coverage through this program. You’ll pay a monthly premium of $15 or $20 based on your income, plus a copayment of $5 to $10 for most services.
Children’s Medical Services Health Plan (through KidCare): This plan covers children with special health care needs from birth through age 18. A monthly premium of $15 or $20 is also required.
MediKids and Florida Healthy Kids also offer a full-pay premium option for children who don’t qualify for subsidized coverage because their family income is over 200% of FPL. In 2022, the full-pay monthly premium for MediKids was about $210 and approximately $244 for Florida Healthy Kids.
Do I need to renew Florida Medicaid?
Yes. Florida Medicaid is valid for 12 months and must be renewed every year. The renewal — also called recertification — verifies that you still meet the qualifications for Medicaid. You’ll receive a notification to complete the renewal before your Medicaid benefits expire.
However, due to the COVID-19 pandemic, Florida Medicaid renewal requirements are now on hold. That means you will not lose Medicaid eligibility or be disenrolled during the COVID-19 public health emergency.
If the COVID-19 public health emergency ends, you will get a letter in the mail notifying you that your coverage will expire. Keep your information, including your mailing address, updated on the ACCESS Florida website.
Even if it’s not time for your annual renewal, you must report any change in your income or assets that may affect your Florida Medicaid eligibility within 10 days.
Who do I contact if I have questions?
You may check your application status, upload documents, and report a change through the ACCESS portal. If you have additional questions, call the customer call center at 1-850-300-4DCF (4323) during business hours.
The bottom line
If you’re a Florida resident and don’t have health insurance, Medicaid may be an option. Since Florida did not adopt the ACA Medicaid expansion, adults under age 65 are generally not eligible for Medicaid even if their income is low unless they have certain circumstances.
The ACCESS online portal is the quickest way to apply for Medicaid in Florida. The portal also includes a tool to help you find out if you’re eligible before applying. But, even if you’re not eligible for Florida Medicaid, apply anyway. You may qualify for other assistance programs.
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References
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