Florida Medicaid Eligibility and Enrollment

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  • Thinking of applying for Medicaid in Florida? This guide has everything you need to know, including what’s covered, eligibility requirements and how to apply.

As of September, 2020, there are more than 4 million people enrolled in Medicaid and CHIP in Florida. The program is administered by the Agency for Health Care Administration and helps a wide range of people access medical care, including eligible older adults who are struggling with health care costs. Florida also has pathways for people who would otherwise be ineligible, allowing them to access the program. 

What Is Florida Medicaid?

Florida Medicaid is also known as the Statewide Medicaid Managed Care (SMMC) Program. Regular Medicaid services are known as Managed Medical Assistance (MMA), while long-term care is called the Long-Term Care (LTC) program and encompasses both nursing home care and services previously provided under Home and Community Based Services waivers. The programs provide health care to eligible low-income residents including pregnant women, children and disabled people. Older adults aged 65 and above are included among the groups that Medicaid is targeted towards.

Medicaid in Florida was privatized in 2014, and services are now provided by private health insurance companies. Medicaid recipients join plans provided by these insurers, and the companies are paid by Medicaid funds. 

What Does Florida Medicaid Cover?

All plans provided through Florida Medicaid have certain services that they must cover. For MMA, this includes hospital visits, therapy, mental health services and emergency care. LTC plans cover long-term in-home care as well as care provided in nursing homes and assisted living facilities. Services include companion care, home modifications, care coordination and medical equipment and supplies. All Medicaid recipients must also enroll in a dental plan that includes exams, X-rays and dentures. 

Plans may also have extra benefits offered by the insurer. This can include alternative therapies such as acupuncture or art therapy and things like hearing services and nutrition counseling. Seniors should think carefully about which services they want to access before choosing a plan. Each county has different plans available, and the AHCA has counselors available to help people choose a plan.  

Who Is Eligible for Medicaid in Florida?

Medicaid in Florida is designed to help low-income residents access to medical care, so the primary factors for eligibility are financial. People who are eligible for the Supplemental Security Income (SSI) are automatically eligible for Medicaid, but everyone else must meet income and asset limits, along with other eligibility criteria. The criteria can change based on the type of Medicaid a person is applying for and whether they’re married. Financial eligibility for married couples also differs based on whether one or both spouses are applying. 

Financial Eligibility

For regular Medicaid, or MMA, the income limit for singles is $948 per month and the asset limit is $5,000. For married couples, the income limit rises to $1,281 per month and the asset limit is $6,000. This is the same whether one or both spouses are applying. 

Those applying for long-term care have higher income and asset limits. Whether single or married, the income limit is $2,382 per month. When both spouses are applying, this limit is per person, and when only one spouse is applying, the limit is for the applicant. Single applicants can have up to $2,000 in assets while married couples can have $3,000 of assets when both spouses are applying. 

When just one spouse is applying for LTC, the applicant spouse can have up to $2,000 worth of assets. In addition, the non-applicant spouse can keep up to $130,380 worth of assets, which is known as the Community Spouse Resource Allowance. Assets that are countable for Medicaid purposes include cash, stocks and real estate where the applicant doesn’t reside. Assets that aren’t counted include a vehicle, personal belongings and furniture. A house isn’t counted among assets if it’s the applicant’s primary place of residence or their spouse still resides there. 

Other Eligibility Criteria

Applicants must belong to one of the groups of people that Medicaid is designed to help. For older adults, this generally means they are aged 65 or older. People younger than 65 may be eligible in another category if they are blind or disabled. Applicants must also be a resident of Florida and be either a U.S. national, citizen, permanent resident or legal alien. Those applying for long-term care must require a nursing home level of care. 

What If I Don’t Qualify?

Florida has pathways that allow people who don’t meet financial eligibility to access Medicaid. These consist of the medically needy pathway and Qualified Income Trusts (QITs). Both options allow people to spend down the amount of income they receive that’s higher than the income limit. In the medically needy pathway, this excess income can be spent on medical expenses. Qualified Income Trusts allow people to put their excess income into a trust. Money in the trust can only be used for limited purposes, such as medical bills, and the state must receive any money remaining in the trust after the Medicaid recipient’s death. 

Neither of these solutions help people who don’t meet the asset limit. The state has a 5-year Medicaid look-back period, which means that they check to make sure applicants haven’t given away or sold assets for below fair market value in the last five years. If someone is found to have violated this rule, they will have a period of Medicaid ineligibility. Despite this, it is possible to spend excess countable assets in ways that don’t violate the rules. For example, money can be spent making a home accessible by adding wheelchair ramps, for example. Excess assets can also be used to pay off debt or prepay funeral expenses. 

How Do I Enroll in Medicaid in Florida?

People who are eligible for SSI do not need to file a separate application for Medicaid unless they require nursing home care. 

For those not eligible for SSI, there are a number of ways to apply for Medicaid. Older adults can apply online through ACCESS Florida. Alternatively, a paper application can be requested by calling 1-850-300-4323 and submitted. People can also apply in person at a local service center or through a member of the DCF Community Partner Network

Contact Information for Florida Medicaid

Older adults who want more information about Medicaid in Florida or their Medicaid plan can contact a Choice Counselor at 1-877-711-3662 or text their questions to 357662. Alternatively, messages can be sent through the Florida Medicaid Member Portal or the online form.