Florida Medicaid Program Eligibility

Eligibility Team
Researcher & Writer
October 30, 2017

Medicaid is a program for medical assistance that gives low-income individuals and families access to health care that they wouldn’t otherwise have. Medicaid also assists people with disabilities and the elderly with the costs of expenses like care in nursing facilities and other long-term medical bills.

The agency responsible for Medicaid in Florida is the Agency for Health Care Administration, also known as simply the Agency. The Agency has successfully completed implementing the SMMC (Statewide Medicaid Managed Care) program. Under this program, most of the recipients of Medicaid are enrolled into one of a variety of health plans. These health plans are accredited nationally and selected by a competitive procurement process.

Florida’s Requirements for Medicaid Qualification

In order to get Medicaid in Florida, you have to meet certain eligibility requirements. You have to be a certain type of patient for one thing. These include:

  • Pregnant women
  • Parents or relatives who are caretakers
  • Families who might have lost Medicaid because of an increase in income or alimony (for a specific time)
  • Florida residents who receive SSI (Supplemental Security Income) through the Social Security Administration
  • Patients who are disabled or over the age of 65
  • Children under 21
  • Those who are eligible to receive Temporary Cash Assistance
  • People under age 26 who were in a foster home
  • People in nursing homes or those who receive community or home-based care.

You also have to be a Florida resident who has a valid social security number and a citizen of the U.S.

How to Apply for Medicaid in in Florida

People can apply for Florida Medicaid in a variety of ways. This allows people the opportunity to apply even if they don’t have access to transportation to go and get an application from one of the ACCESS Service Centers.

Florida Medicaid Application

Many people choose to apply online, due to the fact that it is quick and easy. You can do this at the website for Florida Medicaid. Be prepared to answer a list of questions that have to do with your health, where you live, your legal status, your income, and your household.  You will also need your basic information such as your name, address, phone number, age, and SSN. If you work, you will need verification of your income. You will need this information for everyone in your household.

You might also choose to apply by phone. You can do this by calling 866-762-2237. Be prepared to be on the phone for a while and be sure you have all of the necessary information as listed above.

Some people choose to apply by mail. This can be done by downloading and printing the online application for Florida Medicaid or by picking an application up at one of the ACCESS service centers. Complete as much of the form as you can. If there is a question you don’t understand or are not quite sure how to answer, leave it blank.  Then, send it to:

ACCESS Central Medicaid Center P.O. Box 1770
Ocala, FL 34478-1770

If you want to apply in person, you can do so at any of the ACCESS Service Centers.

What Does Medicaid Cover in Florida?

The amount and type of services that will be covered by Medicaid will depend on things like how old the beneficiary is, which program the beneficiary is actually enrolled in, and even the type of services that will be necessary medically. These services might include community behavioral health, prescription medications, visual, dental, transportation, hospice, nursing home, home health care, family planning, hospital, doctor visits, and more.

Income Requirements for Florida Medicaid

There are income requirements for Medicaid in Florida. You need to earn an income that is within the federal poverty level for your group. This is calculated by a specific system that is known as the Modified Adjusted Gross Income, or MAGI.

Basically, before taxes, income needs to be under these amounts, according to Benefits.gov:

Household Size   Maximum Income Level (Per Year)

1                            $15,000

2                            $21,307

3                            $26,813

4                            $32,319

5                            $37,826

6                            $43,331

7                            $48,851

8                            $54,384

How Much Does Medicaid Cost in Florida?

Medicaid cost estimates for Florida vary and can depend on things like the income of the household, the patient eligibility group, and other things.

Cost and Coverage of Medicaid in Florida

Some of the services that are covered by Florida Medicaid include:

  • Family planning and birthing services
  • State mental health, inpatient and outpatient hospital services
  • Nuclear medicine and radiology
  • Transplants and surgeries
  • Pathology and laboratory services
  • Behavioral health services
  • Podiatric, chiropractic, hearing, vision, and dental services
  • Drug services
  • Speech-language pathology, respiratory, physical, and occupational therapy services

Prescription Drugs with Medicaid in Florida?

Prescription drugs are covered by Florida Medicaid according to a formulary that will be set by the program the recipient chooses. Most of the time, prescriptions will have no cost for children as long as they are covered. Many of the adult prescriptions will also be free or have a low copay.

Which Medicaid plan is best in Florida?

Each Medicaid plan in Florida comes with the same core benefits which are listed here. You can also compare the performance data for the various plans in your area by using what is known as the Medicaid Health Plan Report Card. You will also have to consider things like the types of services that might be needed along with how many doctor visits that will be necessary, the plan that is accepted by your doctors, the types of doctors you will need, and what extra benefits will meet your needs.

Eligibility Team
Written by
Eligibility Team
We are a team of experts dedicated to finding the right government programs for you. Our mission is simple: help people quickly and easily understand which programs they might be eligible for—all in one place. Our team is dedicated to researching and providing you with the most relevant information. We compile only the most trusted information from government sources into one place so you can find the facts you need and skip what you don’t.
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