ACCESS Florida

Medicaid

Medicaid provides medical coverage to low-income individuals and families.  The state and federal government share the cost 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:

• Parents and caretakers relatives of children
• Children
• Pregnant women
• Former Foster Care Individuals
• Non-citizens with medical emergencies
• Aged or disabled individuals not currently receiving Supplemental Security Income (SSI)

Individuals may apply for assistance online at:  http://www.myflorida.com/accessflorida/ Additional information about Medicaid for low income families is available in the Family-Related Medicaid Fact Sheet.  Information regarding income limits can be found on the Family-Related Medicaid Income Limits Chart.

If an individual wants to apply using a paper application, the Family-Related Medical Assistance Application is for individuals who desire to apply for medical assistance only.  If the individual wants to apply for other programs, such as Temporary Cash Assistance and/or food assistance the individual must complete the ACCESS Florida Application.  Two paper applications will be required if the individual is requesting Family-Related Medicaid in addition to other programs.

Applications for individuals not determined eligible for Medicaid will be referred electronically to the Federally Facilitated Marketplace or Florida KidCare.  For more information about the Federally Facilitated Marketplace and Florida KidCare, visit these websites: www.healthcare.gov  and www.floridakidcare.org

Florida Medicaid enrolled hospital providers may elect to make presumptive eligibility determinations in accordance with federal law and state policy.  Qualified hospitals (QH) may make presumptive eligibility determinations for: pregnant women, infants and children under age 19, parents and other caretaker relatives of children, and individuals under age 26 receiving Medicaid when they aged out of Florida foster care.  Medicaid providers may access the Agency for Health Care Administration’s website at http://ahca.myflorida.com/Medicaid/QHPE/index.shtml for additional information about the provider enrollment process.

Medicaid for Parents and Caretaker Relatives of Children

Parents and other caretaker relatives of children up to age 18 who live with them may be eligible for Medicaid if the family’s countable income does not exceed certain income limits.

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 twelve (12) additional months of Medicaid, if they meet certain requirements.

Families that lose Medicaid eligibility due to the receipt of alimony may be eligible for four (4) additional months of Medicaid.

Medicaid for Children

Parents and caretakers may apply for Medicaid on behalf of children under age 21 living in their home, if the family income is under the limit for the age of the child.  There is no requirement for a child to reside with an adult caretaker to qualify for Medicaid.

Children eligible for 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 Administration’s information page at http://www.fdhc.state.fl.us/medicaid/childhealthservices/chc-up/index.shtml

Families may also apply for medical assistance for children through Florida KidCare.

Medicaid for Pregnant Women

A pregnant woman may qualify for Medicaid if her family’s countable income does not exceed income limits.  For pregnant women who do not meet the citizenship requirements for Medicaid, see the information below about Emergency Medical Assistance for Non-Citizens.

Presumptively Eligible Pregnant Women (PEPW) is temporary coverage for prenatal care only and eligibility is determined by Qualified Designated Providers (QDP) based on limited information from the pregnant woman.  During the temporary coverage period, the pregnant woman will need to submit an application to have her ongoing Medicaid eligibility determined.

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.

Former Foster Care Individuals

Individuals who are under age 26 may receive Medicaid if they were in foster care under the responsibility of the State and receiving Florida Medicaid when they aged out of foster care.  There is no income limit for this program.

Emergency Medical Assistance (EMA) For Non-Citizens

Non-citizens, 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 date(s) 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 regular 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 couple’s 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. Information for Medicaid providers who need to communicate with DCF about SSI-Related Medicaid eligibility status is contained in the SSI-Related Provider Communication Guide.

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.

Medicaid Cards

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 MyACCESS 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 Not Eligible for 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:

• Florida Discount Drug Card Program, or
• FloridaRXCard.com.

For information about other assistance programs, visit the links for Food Assistance and Temporary Cash Assistance Program.