Florida Medicaid Eligibility & Coverage: An Ultimate Guide

Medicaid in Florida falls under the Agency for Health Care Administration (AHCA). Most recipients are enrolled through the Statewide Medicaid Managed Care (SMMC) Program, which has three parts: LTC (Long-Term Care), MMA (Managed Medical Assistance) program, and the Dental Program. Kids can get Medicaid coverage through Florida KidCare. At first glance, these acronyms and phrases can seem daunting, but we’re going to break it all down for you here. Medicaid is supposed to help you, so let’s make it simple.

What You Should Know about Florida Medicaid:

Florida Medicaid Eligibility Requirements

To meet Florida Medicaid eligibility, you must be a Florida state resident, a U.S. citizen (or legal alien) and be at least one of the following:

  • Pregnant
  • A parent or relative and caretaker of a child under 19
  • Blind or disabled
  • Someone in your household is blind or disabled
  • Over the age of 65

You also must meet the below income requirements:

Florida Medicaid Eligibility | Medicare Plan Finder

If you do not meet the income limits, but you find yourself below the income limits due to high health care spending, you can qualify for the Florida “Share of Cost” program. This means that even though you don’t technically meet Florida Medicaid eligibility, Medicaid will pay your costs once you spend a certain dollar amount on your monthly health care costs.

Florida Medicaid Nursing Home Eligibility

Within Medicaid is the “Medicaid for Aged and Disabled” (MEDS-AD) program. Those who are either disabled or above the age of 65 can apply. To qualify, you must either receive institutional care (like from a nursing home), receive hospice care, receive home care, or not be eligible for Medicare. Additionally, you must meet the following income requirements (2018):

  • Income cannot reach more than $2,250 per month
  • Asset value cannot reach more than $2,000 per month if single or $3,000 per month if married
  • Home equity cannot reach more than $572,000

Those who qualify for Aged and Disabled Medicaid can receive additional coverage for rehabilitation and skilled nursing care.

If you think you may be eligible for Medicaid (but you aren’t sure), you can go ahead and complete the Florida Medicaid application – applying is free!

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Cost and Coverage of Medicaid in Florida

Medicaid coverage can differ slightly by state. Be careful, because even if Medicaid Florida covers the care you need, you may need to get prior approval to get the coverage you need. The program typically covers:

  • Hospital services
  • Dental
  • Vision
  • Hearing
  • Chiropractic services
  • Podiatry
  • Radiology
  • Lab tests
  • Family planning and birthing
  • Mental health
  • Prescription drugs

Medicaid Florida works as a cost-sharing program. That means that at first, you will share your health care costs with Medicaid. Once you hit an out-of-pocket limit, Medicaid will cover the rest. This limit can differ based on the managed care plan you choose.

If you are in the Medicaid “Share of Cost” program, you’ll want to keep track of every penny you spend on health care each month. The second your health care expenses for the month reach your share of cost limit, your Medicaid coverage will kick in. For example, if your share of cost limit is $1,000 per month, but you only spend $10 on your health care services this month, Medicaid won’t cover that $10. However, if you spend $1,000, this month, Medicaid will reimburse you for that $1,000 service (as long as it is a Medicaid-covered service).

Florida Medicaid Dental Coverage

Florida Medicaid dental coverage is different for kids and adults. Those ages 20 and under can have coverage for:

  • Exams, cleanings, and fluoride
  • Screenings and x-rays
  • Sealants, fillings, and crowns
  • Space maintainers, orthodontics, prosthodontics, and periodontics
  • Root canals, extractions, and any required sedation

Adults ages 21 and over can have coverage for:

  • Limited dental exams
  • Limited x-rays
  • Extractions and related sedation/pain management
  • Dentures

If you are age 21 or over and need more dental services through Medicaid, you may qualify if you are pregnant or lack other options.

As of 2018, FL Medicaid dental plans are managed through a separate dental plan. Click here to find a dental plan that accepts Medicaid Florida.

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FL Medicaid Vision Coverage

Medicaid Florida can provide reimbursements for:

  • Two pairs of glasses per year for those under 21
  • One frame every two years and two lenses every year for those over 21
  • Polycarbonate or thermoplastic lenses when necessary
  • Metal frames when necessary
  • Fittings, adjustments, and repairs
  • Contact lenses and related fittings, care, and 90-day follow up visits
  • Prosthetic eyes

Prescription Drug Coverage

Medicaid Florida provides reimbursements for most prescription outpatient drugs and some over-the-counter medications if a valid prescription is given. Reimbursements will only be provided for medically necessary prescriptions. In some cases, you may need to get prior approval from the Medicaid program before getting your prescription to receive coverage.

Click here to download the preferred drug list.

Finding Florida Medicaid Providers Near You

To find a hospital, doctor, pharmacy, dentist, or specialist near you who accepts Medicaid in Florida, use the MMA provider locator. Once you are enrolled in your managed care plan under  Florida Medicaid, your specific plan will provide a provider network. Ask your plan for more information about what doctors you can see.

Free Prescription Discount Card | Medicare Plan Finder

Florida KidCare and Medicaid Child Health Check-Ups

Florida KidCare provides free or low-cost health coverage for Florida kids through the age of 18. Most families won’t pay a premium; some will pay up to $20 per month per household. The program is split into four programs: Medicaid, MediKids (for ages one through four only), Florida Healthy Kids (for ages five through 18), and the Children’s Medical Services Managed Care Plan (for kids with special needs). Coverage includes doctor visits, hospital stays, immunizations, surgeries, prescriptions, dental, vision, hearing, and mental health. To be eligible for MediKids, Florida Healthy Kids, or the Children’s Medical Services Managed Care Plan, your child must not be eligible for the regular Florida Medicaid program.

Medicaid in Florida also has a Medicaid Child Health Check Up available to eligible kids at birth, 3-5 days, one month, two months, four months, six months, nine months, one year, 15 months, 18 months, 24 months, 30 months, and then yearly. Included are physical exams, growth measurements, immunizations, vision, hearing, and dental screenings, and treatment referrals. There is no copayment for these services until age 20.  

Florida KidCare Payments

If you have to make Florida KidCare payments, you can do so online from HealthyKids.org. You can also sign up for auto pay or scheduled payments, or pay by phone by calling 1-800-821-5437. You can also make a cash payment at a Fidelity Express location, but there will be a $2 service fee. Click here to find a location near you.

Florida KidCare Application

The Florida KidCare application is separate from the Florida Medicaid application. Click here to apply for KidCare online.

Florida Medicaid Login (with FL Medicaid ACCESS)

ACCESS, the Automated Community Connection to Economic Self Sufficiency, acts as a Florida Medicaid login and allows you to access your benefit programs online. Aside from Medicaid, your MyACCESS account can help you determine your eligibility for food, cash, and other medical assistance. You can also use FL Medicaid ACCESS to view your application status, information about your benefits, or report any changes, such as a change in address or income. If you lose or misplace your Medicaid card, you can also use FL Medicaid ACCESS to print a temporary card.

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Florida Medicaid Application: Download & Proceed

To apply for Medicaid in Florida, call 866-762-2237 or click here to apply through ACCESS. You can also mail or fax in an application or visit a local Florida Department of Children and Families service center.

Get both Medicare and Medicaid in Florida

Did you know that you can get benefits from both programs? If you enroll in both, Medicaid can cover your Medicare costs.

If you meet the Florida Medicaid eligibility requirements but are also either over the age of 65 or diagnosed with ALS or ESRD, you can get both Medicare and Medicaid benefits in the form of a special needs plan. Dual special needs Medicare Advantage plans are exclusively for those eligible for both Medicare and Medicaid. Take advantage of the benefits available to you and enroll today!

Turning 65 Checklist | Medicare Plan Finder

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