Florida Share of Cost: Medicaid provides Medical coverage to low income individuals and families. The state and federal government share the costs 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:
- Low income families with children
- Children only
- Pregnant women
- Non-citizens with medical emergencies
- Aged and/or disabled individuals not currently receiving Supplemental Security Income (SSI)
Medicaid for Low Income Families With Children
Children up to age 18 and their parents or caretaker relatives may be eligible for Medicaid if the family’s countable income does not exceed the income limits and countable assets are not above $2,000.
- 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 12 additional months of Medicaid, if they meet certain requirements.
- Families that lose Medicaid eligibility due to child support or alimony may be eligible for 4 additional months of Medicaid.
Additional information about Medicaid for low income families is available in the Family-Related Medicaid Fact Sheet.
Information regarding the income and asset limits for Medicaid for low income families and children can be found on the Family Related Medicaid Income/Asset Limits.
Medicaid for Children Only
Parents and caretakers may apply for Medicaid on behalf of their children under age 19 living in their home, if the family income is under the limit for the age of the child.
Children eligible for the 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 Administrations information page at: http://www.fdhc.state.fl.us/medicaid/childhealthservices/chc-up/index.shtml.
Families may also apply for medical assistance for children only with the Florida KidCare program. Medicaid is one of the components of the Florida KidCare Program. If children do not qualify for Medicaid due to family income, the application will be sent electronically to Florida Healthy Kids (FHK).
FHK covers otherwise eligible children with income less than 200% of the Federal Poverty Level. A separate application is not necessary.
To find information or apply for the Florida KidCare Program, visit their website at: http://www.floridakidcare.org/.
Medicaid for Pregnant Women
There are three ways to apply:
1. Presumptively Eligible Pregnant Women (PEPW): A temporary coverage for prenatal care only by local clinics. The same application will be sent to DCF for an ongoing Medicaid determination. For more information, please see the Family-Related Medicaid Factsheet. (Page 9)
2. Simplified Eligibility for Pregnant Women (SEPW): A simplified “full coverage” for pregnant women only. To apply, please complete the one page application linked below. Print the application and mail, fax or return it in person to the nearest ACCESS office: (English) (Español) (Kreyòl).
3. ACCESS application: This is an application for “regular” Medicaid, including other family members, cash assistance and/or food assistance. Please visit this link to begin: http://www.myflorida.com/accessflorida/. For more information see the Family-Related Medicaid Factsheet. (Page 10)
Women with family income over the limit for Medicaid, may qualify for the Medically Needy Program. For more information see the Family-Related Medicaid Factsheet. (Page 12)
For pregnant women who do not meet the citizenship requirements for Medicaid, see the information below about Emergency Medicaid for Aliens.
Emergency Medical Assistance (EMA) For Non-Citizens
Noncitizens, 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 dates of the emergency.
Medicaid for Aged or Disabled
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 full 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 couples 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. 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.
Permanent gold Medicaid cards are issued for each individual who is eligible for Medicaid. The Medicaid card should be presented to medical providers when medical care is being requested. To request a replacement card, call 1-866-762-2237. Those on Medicaid can print a temporary Medicaid card from their ACCESS Account. Further information on Medicaid services is available from the Agency for Health Care Administration.
Medically Needy (Share of Cost)
Individuals who are not eligible for “full” Medicaid because their income or assets are over the Medicaid program limits may qualify for the Medically Needy program. Individuals enrolled in Medically Needy must have a certain amount of medical bills each month before Medicaid can be approved. This is referred to as a “share of cost” and varies depending on the household’s size and income.
Once an individual meets the share of cost for the month, the individual must contact DCF to complete bill tracking and approve Medicaid for the remainder of the month. Information about this program can be found in the Medically Needy Brochure (Español) (Kreyòl).
Medical Help for Those Who Are Not Eligible for Full Medicaid
Note: The following programs are not under the Department of Children & Families.
Individuals who are not eligible for Medicaid may get help with the cost of prescription drugs through the Florida Discount Drug Card Program.