What is Medicaid?

Medicaid is a joint federal and state program that provides health coverage to eligible low-income adults, children, pregnant women, elderly adults, and people with disabilities. In Florida, Medicaid is administered by the Agency for Health Care Administration (AHCA) in partnership with the Department of Children and Families (DCF).

Covered Services

Florida Medicaid covers a wide range of health care services, including:

Eligibility Requirements

To qualify for Medicaid in Florida, you must meet certain requirements related to residency, citizenship, and income. Florida Medicaid primarily covers:

• Children under age 19
• Parents and caretakers of children
• Pregnant women
• Former foster care individuals up to age 26
• Elderly individuals (age 65 and older)
• Individuals with disabilities
• Individuals who need nursing home care

Residency and Citizenship

• You must be a Florida resident
• You must be a U.S. citizen or have qualified immigration status

Income Limits

Income limits for Medicaid vary depending on your category of eligibility. Below are the general income limits as a percentage of the Federal Poverty Level (FPL):

Note: These percentages are approximate and subject to change. The actual dollar amounts depend on the current Federal Poverty Level guidelines and your household size.

Florida Medicaid Programs

Florida offers several Medicaid programs to serve different populations:

Statewide Medicaid Managed Care (SMMC)

Most people who qualify for Medicaid in Florida receive their health care services through the Statewide Medicaid Managed Care program. Under this program, you enroll in a health plan that coordinates your care. The SMMC program has two components:

• Managed Medical Assistance (MMA): Provides medical services like doctor visits, hospital care, and prescriptions.
• Long-term Care (LTC): Provides services for people who need nursing facility level of care, including home and community-based services.

Medically Needy Program

The Medically Needy Program helps people who don't qualify for Medicaid due to income but have high medical expenses. After you "spend down" your income on medical bills to a certain level, you may qualify for Medicaid coverage for the remainder of the month.

Emergency Medicaid for Aliens (EMA)

This program provides emergency medical services to non-citizens who meet all Medicaid eligibility requirements except for citizenship status.

Required Documentation

When applying for Medicaid in Florida, you may need to provide the following documents:

Identity and Citizenship

• Birth certificate
• Driver's license
• U.S. passport
• Social Security card
• Medicare card (if applicable)

Immigration Status (if applicable)

• Immigration papers/forms/cards
• Certificate of naturalization
• Other proof from immigration (USCIS)

Florida Residency

• Driver's license
• Utility bill
• Rent or mortgage receipt
• Any document showing a Florida address

Income Verification

• Pay stubs from the last 4 weeks
• Self-employment records
• Social Security award letters
• Pension statements
• Unemployment compensation

Medical Information

• Medical bills (for Medically Needy Program)
• Proof of disability (if applicable)
• Medicare card (if applicable)
• Other health insurance information

How to Apply

You can apply for Medicaid in Florida through several methods:

After You Apply

After submitting your application, the following steps will occur:

1. Interview: You may be required to complete an interview, which can be done by phone or in person.
2. Verification: DCF will verify the information provided in your application.
3. Decision: You will receive a notice of eligibility determination, typically within 45 days of your application date (90 days for disability-related applications).
4. Plan Selection: If approved, you will need to select a Medicaid health plan (if enrolled in SMMC).