What is Florida Medicaid?

Florida Medicaid is a state-federal collaboration that offers low-income individuals in Florida who qualify for it access to health insurance. Its goal is to help those whose health could otherwise suffer from a lack of access to healthcare for both themselves and their children.

Who is eligible for Florida Medicaid?

You must be a resident of Florida, a national or citizen of the United States, a permanent resident, or a legal alien, in need of medical treatment or insurance, and have a low or very low income in order to qualify for Florida Medicaid.

You also need to fit one of the following criteria:

  • Pregnant, or
  • Be in charge of a youngster who is younger than 18 years old or
  • Have a disability or a family member in your household with a disability.

Annual Household Income Limits (before taxes)

Household Size* Maximum Income Level (Per Year)
1 $18,075
2 $24,353
3 $30,630
4 $36,908
5 $43,186
6 $49,463
7 $55,741
8 $62,018

*For households with eight or more members, add $6,277 for each additional member.

How do I contact Medicaid in Florida?

Phone

(866) 762-2237

Website

Statewide Medicaid Managed Care

Mailing Address

Agency for Health Care Administration

2727 Mahan Drive, MS 62

Tallahassee, FL 32308

What are the Medicaid plans in Florida?

For services under its two risk-based programs, the state of Florida hired twenty MCOs, the majority of which were for-profit and connected to large insurance companies.

In the nursing home diversion program, the state entered into contracts with 17 plans; however, under the Statewide Medicaid Managed Care (SMMC) Long-term Care (LTC) program, this number is anticipated to fall to seven plans, including American Elder Care, Amerigroup, Coventry, Humana, Molina, Sunshine, and United.

There are currently 14 standards, non-specialty MCOs and 5 specialty health plans participating in the statewide managed Medical Assistance program.

  • Florida Medicaid Pilot (formerly known as Florida Medicaid Reform, operating under Section 1115 waiver authority)
  • Long-term Care Managed Care Program (also known as Nursing Home Diversion, operating under the authority of combined 1915(b)(c)waivers)
  • Managed Medical Assistance Program

What is covered by Florida Medicaid?

The following services are covered by Florida Medicaid

Assistive care services Hospital services
Behavioral services Laboratory services
Birth center and midwife services Neurology
Cardiovascular services Orthopedic services
Chiropractic services Pain management services
Dental services Podiatry services
Dialysis services Prescribed drug services
Durable medical equipment and supplies Radiology services
Family planning services Therapy services
Hearing services Transplant services
Home health services Transportation services
Hospice services Visual care services

 

Copayments

Hospital outpatient services $3 for each hospital outpatient visit
Physician services $2 for each visit
Prescription drugs 2.5% of Medicaid cost (max $7.50 each)

Copays are not charged for the following:

  • Children under age 21
  • Pregnant people up to six weeks after giving birth
  • Any individual who is enrolled in a Medicaid prepaid health plan or HMO

Who is not eligible for Medicaid in Florida?

No matter how low their income, able-bodied, non-elderly persons without dependents are not eligible for Medicaid in Florida. Florida’s requirements for eligibility are: 206 percent of the federal poverty threshold applies to children under 1-year-old (FPL).

How long does it take to get Medicaid in Florida?

Your application may be processed in up to 30 days (longer if you need a disability determination).

Which Florida Medicaid plan is best?

There seem to be no clear winners according to the NCQA Health Insurance Plan Ratings 2019-2020 – Summary Report (Medicaid). 

They all seem pretty average.

Rating Plan Name
3.5 Coventry Health Care of Florida, Inc. d/b/a Aetna Better Health of Florida
3.5 Humana Medical Plan, Inc. (Florida)
3.5 Molina Healthcare of Florida, Inc. Special Project: Managed Medical Assistance
3.5 Simply Healthcare Plans, Inc.

What is the maximum income to qualify for free health care in Florida?

The applicant’s gross monthly income cannot now exceed $2,523.00 (it was formerly $2,382.00) as of January 1, 2022. $130 can be kept back by the applicant each month for personal expenses.

Can you have Medicare and Florida Medicaid?

If you have a very low income, Medicaid is a state and federal program that provides health coverage. Having both Medicare and Medicaid is possible if you are dual-eligible. They will work together to provide you with health coverage and lower your costs.

How do I qualify for Medicare and Medicaid in Florida?

If a person or their spouse has paid FICA taxes for at least 40 calendar quarters, they or their spouse are generally eligible for free Medicare Part A for hospitalization and emergency. 

Those who are not eligible for Part A hospital insurance at no cost might be able to obtain it by making a small monthly payment.

What is the maximum income to qualify for Medicaid in Florida?

The applicant’s gross monthly income cannot now exceed $2,523.00 (it was formerly $2,382.00) as of January 1, 2022. $130 can be kept back by the applicant each month for personal expenses. 

Even so, being ineligible for Medicaid does not necessarily depend on having an excess of money.

How much money can you have in the bank on Florida Medicaid?

The most stringent requirement for Medicaid eligibility may be the asset cap. In Florida, your total allowable assets cannot exceed $2,000.

Does the disabled person get Florida Medicaid?

SSI-Related Medicaid refers to Medicaid for low-income people who are either elderly (65 or older) or disabled. Medicaid insurance from the Social Security Administration is automatically available to Floridians who qualify for Supplemental Security Income (SSI).

What is the best Medicaid in Florida?

The companies with the worst ratings were Vivid Health and Magellan Complete Care. According to the “report cards” presented on Wednesday by the National Committee on Quality Assurance, Molina Healthcare of Florida is the best Medicaid HMO in the state, garnering four stars overall.

How do I apply for Florida Medicaid?

Online at ACCESS Florida, or in person at a nearby service center with a paper application. Call 866-762-2237 for support with the application process.

What documents do I need to apply for Florida Medicaid?

Before applying for Medicaid you will need to make sure you have all of the following information at hand.

– Proof of age and citizenship

– Proof of all income sources, including

  • Paystubs
  • Tax Returns
  • Social Security
  • Supplemental Security Income
  • Veteran’s Benefits

– Proof of all assets, including

  • Bank accounts
  • Retirement Accounts
  • Trusts
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