Guide to Medicaid in Florida

At the beginning of 2023, the state of Florida had more than 3.9 million children and families enrolled in its Medicaid coverage plans. This vital program aims to assist individuals with low incomes who may struggle to afford health insurance independently. Understanding the complexities of Florida Medicaid and its related program, Florida KidCare, can be daunting.

This guide will provide you with essential information about these programs but also simplify the intricate Medicaid process to make it easier for you to navigate. Whether you are considering applying for yourself or someone you know, the information below will equip you with the knowledge and guidance you need to successfully navigate the Medicaid system in Florida.

Eligibility for Florida Medicaid

Unlike other states, Florida has not expanded Medicaid coverage to include most adults younger than the age of 65. However, the state does offer a children’s health insurance program (CHIP) to provide coverage to kids without other forms of health insurance. While Florida’s Medicaid eligibility criteria differ from those in other states, the availability of CHIP ensures that many children can still access the necessary healthcare support they require.

Income requirements

Generally speaking, Florida uses the modified adjusted gross income (MAGI) of an applicant and compares it to the federal poverty level (FPL) for their household size. Examples of Medicaid eligibility based on income include:

• 206% for ages 0-1
• 140% for ages 1-5
• 133% for ages 6-18
• 201% for children under the separate CHIP program
• 191% for pregnant women
• 27% for parents or related caregivers of eligible children

There is no income requirement for those under the age of 26 who were receiving Florida Medicaid at the time they aged out of a Florida foster care program. They will continue to qualify until they turn 26.

Age requirements

Florida’s Medicaid program is focused on providing coverage for adults older than 65 and children under 18. To be considered for coverage in the years between these demographics, applicants must be blind, disabled, previously in foster care, pregnant, or caring for a qualified child.

Those older than 65 have access to programs for the elderly, including Medicaid, which can work with Medicare to pay for out-of-pocket expenses for those with limited incomes.

Disability requirements

Currently, only those adults younger than 65 with a disability and receiving Supplemental Security Income (SSI) will be automatically eligible for Medicaid and won’t need to file a separate application unless they need nursing home or long-term care services. However, income limits may still apply.

It’s important to note that Florida doesn’t offer a Medicaid option for nondisabled, non-elderly adults unless they are the caretaker of a related child and earn 27% of the FPL.

Citizenship or immigration status

Florida Medicaid provides coverage for residents of the state who are U.S. citizens, as well as some legal noncitizens. Non-citizens may also receive coverage for emergency services despite their citizenship disqualification. Applicants have to provide documentation that the treatment they received was for an emergency, usually through a doctor’s statement.

Florida Medicaid benefits

Florida’s Medicaid program covers a range of medically necessary treatments and services, with even more options for covered children.

Medical services covered

While just a sample of what Medicaid members can receive under the state plan, here are some of the more notable services:

• Allergy services
• Behavioral analysis
• Birth and midwife services
• Chiropractic services
• Dialysis
• Early childhood intervention
• Home health services
• Hospital stays and services
• Labs and blood work
• Pain management
• Occupational and physical therapies
• Transplants

Medicaid also often covers both emergency and non-emergency transportation services, such as rides to a doctor’s appointment and ambulance services.

Prescription drug coverage

Prescription drug coverage varies by the health plan chosen under Medicaid. Since insurers may cover different medications, it’s important to know what prescriptions you will take and if they will be covered. Fortunately, Medicaid will pay for most, if not the entire cost of covered medications. It’s important to choose a pharmacy within the Medicaid plan network that accepts Medicaid payments before having a prescription drug filled.

Dental coverage

Florida provides comprehensive dental coverage through its Medicaid program for adults and children younger than 21 years of age. Services include:

• Cleaning
• Crowns
• Dentures
• Exams
• Oral surgery
• Orthodontics
• X-rays

Adults aged 21 and up may get coverage only for emergency dental services to deal with infection or pain. This may include dentures.

It’s important to note that individuals enrolled in Medicaid in Florida usually need to select a dental plan.

Vision coverage

All Medicaid patients get access to vision care plans that cover basic eye exams, corrective lenses, and treatment for eye-related conditions or diseases.

Services include:

• Contact lenses
• Eyeglasses: two pairs a year for those younger than 21; one frame every two years and two lenses every year
• Eyeglass repair
• Prosthetic eyes

Limits on the type of eyeglass frames and contact lenses may apply.

Mental health and substance abuse coverage

Florida Medicaid covers substance abuse services and treatment, as well as therapy and behavioral health services. It’s important to note that the specific healthcare coverage offered may differ based on the Medicaid plan chosen. Some services, such as inpatient treatment, may require pre-approval. Check with your service provider to see what you may need to do before reaching out to a provider for service, but don’t delay seeking help in emergency situations.

How to apply for Florida Medicaid

Florida has made it easy to apply for all health benefits in one place, and you’ll also be able to sign up for other services and programs with the same application. Choose from online (ACCESS Florida), in-person, or paper applications. Florida also has a questionnaire on the ACCESS Florida site to help you know if you’re likely to be eligible for programs, and what programs you might want to apply for in addition to Medicaid. 

Required documents for application

Florida will need you to document who you are and how much you make, so expect to provide documentation that supports both of these things. Your ID or driver’s license, birth certificate, or another form of identification is required, as well as knowing your Social Security Number (SSN). Documentation of disability or SSI benefits and your tax records or pay stubs will be required, if applicable.

Some offices may want to see documentation of your liabilities and assets. Any children or qualifying adults in the home will need to have their own documentation, as well.

Online application process

ACCESS Florida’s online application lets you apply for all the programs in one place. First, you’ll need to set up an account that you can securely access later. You’ll need this account to check on your application progress, upload supporting documentation, and make changes to your application.

This is the simplest and fastest way to get the application process started, and it’s free.

Paper application process

If you prefer mailing a paper application, you can choose from two options: Medicaid only or Medicaid with other benefits, such as SNAP (Supplemental Nutrition Assistance Program) benefits. When you click the link for your preferred form, it will automatically download to your computer for printing. Simply fill it out and mail it to the address on the form.

In-person application process

You can also visit your nearest Florida Department of Children and Families office to get a paper application and start the process. This won’t get you an intake interview right away but will provide you the opportunity to consult with an in-person representative about which forms to fill out and help answer any questions you may have. 

Cost of Florida Medicaid

Medicaid is free for most individuals who qualify for coverage. However, there is a version of Florida Medicaid called “share of cost” that those with higher incomes may have access to. Under “share of cost” plans, patients are responsible for a portion of their healthcare expenses, including copays and deductibles. Be sure to know what the cost is for each of the Medicaid services with this “share of cost model” so you aren’t left with any expensive surprises.

Additional Florida Medicaid resources

• Florida Department of Children and Families Office Locator
  • Find the nearest office to ask questions or submit an application.
• Florida Office of Healthcare Administration
  • Find out more about Medicaid policy, what’s covered, and how programs are run and managed.

Florida Medicaid FAQ

How do I find a doctor who accepts Medicaid?

To find Medicaid-accepting doctors in Florida, refer to your coverage plan’s benefits guide, use the insurer’s doctor finder online tool, or contact the number on your Medicaid card. Alternatively, directly contacting the provider is advisable, as their Medicaid affiliation status may not be promptly updated on the health insurer’s website or in the directory.

How often do I need to renew my Florida Medicaid coverage?

While emergency policies that took effect during the pandemic allowed Medicaid members to have continual coverage, Florida has returned to its original policy of renewing coverage every 12 months. Covered individuals need to look for letters or emails from their case works and respond promptly with new information and application materials to see if they qualify for coverage again. Not responding could cause coverage to terminate and result in no coverage until a new application is filed.

Can I apply for more than Medicaid benefits on the same application? 

If you apply online through ACCESS Florida, you can apply for several services at once. Mail-in applications come in two forms: one for Medicaid only and one for Medicaid and other services. Understand which services you may qualify for or want before you start the application process.

How do I report Medicaid fraud?

If you suspect someone is misusing the Medicaid program or impersonating someone to get their benefits, you can report them to the Medicaid Fraud Control Unit (MFCU) within the Attorney General’s office online or by calling 1-866-966-7226. The process is confidential, although giving them your contact information allows them to follow up with important details about the case.

You may be asked to provide the dates of the suspected fraud, where it happened, and who was involved, as well as additional information after you first report the incident.

To help reduce fraud in your state, keep your Medicaid card near you at all times and report it if it’s lost or stolen. Don’t share your Medicaid number or other personal information with others.