Who is eligible
Children up to 1 year old with family income up to 206% of FPL; children 1-5 with family income up to 140% of FPL; children 6-18 with family income up to 133% of FPL; pregnant women with family income up to 191% of FPL; young adults 19-20 with family income up to 30% of FPL; adults with dependents with family income up to 30% of FPL.
People who qualify for Supplemental Security Income automatically qualify for Medicaid. For information: SSI-Related Programs Financial Eligibility Standards
- healthinsurance.org contributor
- October 2, 2016
More than half a million in coverage gap
Given Florida’s large overall population, it also has a large Medicaid population — more than 3.6 million as of July 2016. However, a family’s income must be quite low to qualify for the program. And most adults who don’t have children aren’t eligible for Medicaid in Florida, because the state hasn’t yet accepted federal funding to expand coverage — despite the fact that 68 percent of Florida residents support Medicaid expansion.
The ACA doesn’t provide subsidies for people with income below the poverty level, because the law called for them to have Medicaid instead. But in 19 states that have refused Medicaid expansion, people who aren’t eligible for Medicaid and whose income is too low for exchange subsidies are in what’s called the coverage gap. Unfortunately, they have little in the way of affordable access to healthcare. In Florida, 567,000 people are in the coverage gap; only Texas has more people in the coverage gap.
New district lines for Florida’s Senate “favor Democrats slightly,” and all of the seats in Florida’s legislature are up for re-election in 2016. But political watchers don’t think that Democrats will gain enough seats to be able to make Medicaid expansion a reality in the near future. If a Democrat is elected governor in 2018 however, that could be the push that Florida needs to rid itself of the coverage gap.
Medicaid expansion won’t be on the 2016 ballot
Although Governor Rick Scott and the legislature have thus far rejected Medicaid expansion (although Scott has flip-flopped on the issue), one lawmaker tried to take the issue to the state’s voters. U.S. Rep. Corrine Brown (D, Florida’s 5th District) worked with the Florida Health Solutions Political Action Committee to push for a ballot initiative to expand Medicaid in Florida starting in July 2017.
Brown has long been vocal in her support for Medicaid expansion, and has repeatedly called on Scott and the state’s legislature to accept billions of dollars in federal funding to expand Medicaid so that it would cover people with incomes up to 138 percent of poverty.
To successfully get the measure on the 2016 ballot, supporters of Medicaid expansion needed to gather nearly 700,000 valid signatures by February 1, 2016. But by February 1, supporters only had 2,056 valid signatures — only a tiny fraction of the number they needed. Thus, the measure is not on the 2016 ballot.
Do you qualify for Florida Medicaid?
To qualify for federal funding, state Medicaid programs are required to cover certain populations, such as low-income children and pregnant women. States can also choose to cover optional coverage groups, like low-income adults without dependents.
Each state sets its own income limits for qualification, based on minimum levels set by the federal government. Florida has set below-average limits for the mandatory coverage groups, and since the state has not accepted federal funding to expand Medicaid, the eligibility rules have not changed with implementation of the ACA. Able-bodied, non-elderly adults who don’t have dependents are not eligible for Medicaid in Florida, regardless of how low their income is.
Florida’s eligibility standards as of July 1, 2014 are:
- Children up to 1 year old: 206 percent of the federal poverty level (FPL)
- Children ages 1-5: 140 percent of FPL
- Children ages 6-18: 133 percent of FPL
- Pregnant women: 191 percent of FPL
- Young adults, ages 19 and 20: 30 percent of FPL
- Adults with dependents: 30 percent of FPL
People who qualify for Supplemental Security Income (SSI) automatically qualify for Medicaid in Florida. See more information in the SSI-Related Programs Financial Eligibility Standards.
How to you sign up for Medicaid?
If you’re eligible for Medicaid, you can enroll at Healthcare.gov.
You can also apply online at ACCESS Florida, or fill out a paper form. Use this application for low-income children, pregnant women, families, and aged or disabled individuals who are not currently receiving Supplemental Security Income (SSI).
Use this application to apply for food or cash assistance in addition to Medicaid. You should also use this form if you currently receive SSI or if you are applying for home based and community services, hospice care, or nursing home care.
Paper applications can be submitted by mail, fax or in person to a local service center.
For help with the application process, call 1-866-762-2237.
No ACA Medicaid expansion
As originally written, the Affordable Care Act included Medicaid expansion as a key strategy to reduce the number of uninsured people in the U.S. The ACA allowed the federal government to reduce funding for states’ existing Medicaid programs if they did not expand Medicaid to cover adults with household income up to 138 percent of the federal poverty level.
However, the U.S. Supreme Court ruled in 2012 that the withholding of funds for existing Medicaid programs was unconstitutional. Medicaid expansion was left as an option for states, and Florida did not implement it. As of October 2016, Florida is one of 19 states that have not yet expanded Medicaid.
According to the Kaiser Family Foundation, Florida’s decision not to expand Medicaid means about 948,000 Floridians don’t qualify for Medicaid, despite having incomes under 138 percent of the poverty level. 567,000 of them are in the coverage gap — ineligible for Medicaid and also ineligible for tax subsidies to help them afford private health insurance.
Florida’s economy is negatively impacted by not expanding Medicaid. According to an analysis by the Robert Wood Johnson Foundation and the Urban Institute, Florida is projected to lose out on $66.1 billion in Medicaid funding — more than any other state — over the decade beginning in 2014 as a result of their decision to not expand Medicaid.
But Medicaid enrollment grows
Although Florida has not expanded Medicaid under the ACA, enrollment in the state’s program has continued to grow. Enrollment stood at 2.2 million in 2005, and had grown to 3.1 million by the end of 2013. By July 2016, it had surpassed 3.6 million.
Part of the reason Medicaid enrollment has grown is the extensive outreach on the part of ACA navigators; some residents were already eligible for Medicaid or CHIP prior to 2014 (and still are), but weren’t aware of their eligibility until enrollment outreach efforts under the ACA. But since Florida hasn’t expanded Medicaid, the newly-insured population is covered according to the normal state/federal split.
If Florida had expanded Medicaid, coverage for the newly-eligible population would be fully funded by the federal government through the end of 2016. The state’s portion would then gradually increase to ten percent by 2020, remaining at that level going forward.
Florida wins temporary LIP funding
According to a Kaiser Family Foundation analysis, Florida still had 2.8 million uninsured residents by the end of 2015 — the third highest in the country. And since the state hasn’t expanded Medicaid, they continue to have a significant problem with hospitals having to provide uncompensated care. Since 2005, Florida’s Low Income Pool (LIP) program has relied on federal funding to help fund care for uninsured residents in the state. But because the ACA expanded Medicaid, funding for LIP had been scheduled to end on June 30, 2015.
In April 2015, Governor Scott announced that his administration was suing CMS in order to continue to receive LIP funding. Scott’s argument was that the termination of the federal LIP funding amounted to coercion to try to get Florida to expand Medicaid. Governor Scott’s lawsuit cost Florida taxpayers $175,000.
The suit was withdrawn in June 2015 after CMS announced in May that Florida would receive $1 billion in LIP funding for the 2016 fiscal year. CMS notified the state at that point that LIP funding would drop to $600 million for the 2017 fiscal year, and that LIP funding would end altogether in mid-2017. The LIP funding that was awarded in 2015 couldn’t be directly used for expenses that would have been covered by Medicaid if Florid had expanded Medicaid.
As part of the agreement with CMS for the LIP funding, Florida had to use $400 million in state funds to increase Medicaid provider reimbursement rates, which generated an extra $600 million in federal matching funds from CMS. In addition to the $1 billion in federal funding for LIP in the 2016 fiscal year, the total amount of money to fund hospital indigent care in Florida is about $2 billion, the same as it was in the 2015 fiscal year.
If Florida expands Medicaid, the need for the LIP program would diminish, since there would be far fewer uninsured, low-income residents in the state. Medicaid expansion is also the reason that Disproportionate Share Hospital (DSH) payments are being phased out across the country.
History of Florida’s Medicaid program
Florida was one of the later states to implement a Medicaid, not adopting the program until January of 1970 (the first states to implement Medicaid did so in early 1966).
Florida Medicaid spending grew 13.5 percent on average every year between 1980 and 2004. In an effort to slow that trend, Florida applied for and received approval for an 1115 waiver for its Medicaid Reform pilot. The pilot implemented managed care in two counties in 2006 and added three more counties in 2007; the waiver was extended several times.
In 2013, the federal government approved an amendment for statewide expansion of managed care; the amendment also renamed Medicaid Reform as Managed Medical Assistance (MMA). Nearly all Florida Medicaid beneficiaries are now enrolled in managed care plans, like health maintenance organizations (HMOs). The state hopes to improve quality through better coordination of care and save money through smaller networks of providers.