Who is eligible for Medicaid in Florida?
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, and can exceed minimum levels set by the federal government. Since Florida has not expanded Medicaid, non-disabled adults under age 65 who don’t have dependents are not eligible for Medicaid in Florida, regardless of how low their income is.
Florida’s eligibility standards are:
- Children up to 1-year-old: 200% of the federal poverty level (FPL)
- Children ages 1-18: 133% of FPL
- Children under age 19 can qualify for Florida Healthy Kids, with modest monthly premiums, if household income is between 133% and 200% of FPL (legislation enacted in 2023 will increase this cap to 300% of FPL starting in 2024)
- Pregnant women: 196% of FPL (this coverage continues for 12 months after the baby is born)
- Adults with minor children: 26% of FPL (note that this percentage changes as the federal poverty level changes, because Florida uses a flat dollar limit for Medicaid eligibility for parents, so it doesn’t keep pace with the poverty level)
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 do I enroll in Medicaid in Florida?
Review Florida’s eligibility criteria, and if you believe you are eligible to enroll in Medicaid you have several options:
- Enroll at Healthcare.gov (if you’re under 65 and don’t have Medicare).
- 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.
- Submit a paper application submitted by mail, fax or in person to a local service center.
For help with the application process, call 1-866-762-2237.
How is Florida handling post-pandemic Medicaid renewals?
Medicaid disenrollments were paused nationwide throughout the COVID pandemic. But that ended in April 2023, and states resumed regular eligibility redeterminations and disenrollment of people who are no longer eligible for Medicaid (as well as those who fail to respond to renewal information requests). And the additional federal Medicaid funding that states received during the pandemic is being phased out over the course of 2023.
During the pandemic, Medicaid enrollment in Florida grew from 3.8 million in March 2020 (when the pause on Medicaid disenrollments began) to nearly 5.8 million by April 2023. Eligibility redeterminations must be conducted for all of these enrollees during a 12-month window referred to as the “unwinding” period. Florida’s plan for the return to normal Medicaid protocols is available here.
The state has clarified that in many cases, they will be able to automatically determine whether a person is still eligible for Medicaid, using available data and integrated systems that work with SNAP and TANF eligibility. (Florida also plans to, whenever possible, align renewal dates for Medicaid with other social services programs like TANF and SNAP.) But if they cannot confirm that a person is still eligible for Medicaid, they will send a renewal packet with a request for the information they need in order to determine eligibility.
Florida continued to process renewals and eligibility redeterminations throughout the pandemic. But if a person was found to be ineligible or didn’t reply to a request for information, their coverage did not end. As of late 2022, Florida Medicaid estimated that they had 900,000 cases in which at least one person in the household was no longer eligible for Medicaid, and 850,000 cases in which the enrollee didn’t respond to eligibility redetermination information requests during the pandemic. But these individuals are still enrolled, due to the pandemic-related rules.
Starting in April 2023, Florida began prioritizing eligibility redeterminations for enrollees who were already flagged in the system as likely ineligible, and who had not used Medicaid services in the past 12 months (indicating that they may already have other coverage in place). After that, the state will process eligibility redeterminations for the rest of the people who have been flagged as likely ineligible. Vulnerable populations, including those under 21 with complex medical conditions and low-income people who are institutionalized or in hospice care will have their eligibility redetermined later on, towards the end of the 12-month “unwinding” period.
Medicaid enrollment in Florida peaked in April 2023, at nearly 5.8 million people. The state began disenrolling people at the end of April, and as of May 2023, enrollment had dropped by more than 234,000 people. By June, about two-thirds of the people who had been disenrolled from Florida Medicaid had lost their coverage for procedural/administrative reasons, while about a third had been determined ineligible (procedural disenrollments happen when the state is unable to confirm eligibility, often because the enrollee didn’t respond to a renewal packet or submit requested documentation).
If a person is no longer eligible for Medicaid, they should understand what their coverage options are once their Medicaid coverage terminates (note that this might not come for several months, as the eligibility redeterminations will be spread over several months). Other coverage options might include an employer-sponsored plan, Medicare, or a plan purchased through the exchange/marketplace. Florida’s integrated eligibility system will also be able to determine whether a person might now be eligible for Florida KidCare (CHIP) or a subsidy in the exchange/marketplace (HealthCare.gov), and will transfer the enrollee’s application to those resources when applicable.
For people who end up needing to purchase their own replacement coverage (ie, they aren’t eligible for Medicare or an employer’s plan), HealthCare.gov is offering an extended enrollment opportunity, through July 31, 2024, for anyone who loses Medicaid at any time during the “unwinding” process. Since Florida does still have a coverage gap due to the state’s refusal to expand Medicaid under the ACA, it’s important for low-income residents to be aware of how to avoid this coverage gap.
As noted above, Florida has enacted legislation that will extend Children’s Health Insurance Program coverage (with modest premiums) up to 300% of the poverty level starting in January 2024.
People who are eligible for Medicare will have a special enrollment window during which they can sign up for Medicare without a late enrollment penalty it continues for six months after the person’s Medicaid ends. People who are eligible for an employer’s plan will generally only have 60 days to sign up for that plan after their Medicaid ends (enrollments can also be submitted prior to the termination of Medicaid, and that’s generally necessary in order to avoid a gap in coverage).
Is Medicaid enrollment growing in Florida?
Although Florida has not expanded Medicaid under the ACA, enrollment in the state’s program continued to grow over the years. But it is starting to decline in 2023, due to the end of the pandemic-era pause on disenrollments. Enrollment stood at 2.2 million in 2005, and had grown to 3.7 million by the end of 2013. By April 2023, total Florida Medicaid and CHIP enrollment stood at nearly 5.8 million people, but it dropped to 5.5 million in May 2023, the first month that post-pandemic disenrollments took effect.
How does Medicaid provide financial help to Medicare beneficiaries in Florida?
Many Medicare beneficiaries receive Medicaid financial assistance that can help them with Medicare premiums, lower prescription drug costs, and pay for expenses not covered by Medicare – including long-term care.
Our guide to financial assistance for Medicare enrollees in Florida includes overviews of these programs, including Medicaid nursing home benefits, Extra Help, and eligibility guidelines for assistance.
Did Florida implement ACA's Medicaid eligibility expansion?
Florida is one of 11 states that has not expanded Medicaid eligibility as allowed under the Affordable Care Act (ACA). 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 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.
[fpl_calculator]Unfortunately, people in the coverage gap have little in the way of affordable access to healthcare. In Florida, an estimated 415,000 people are in the Medicaid coverage gap. Only Texas has more people in the coverage gap.
Republicans control Florida’s House and Senate as well as the governor’s office. Democrats in the Florida legislature have been pushing for Medicaid expansion for years, but have consistently been blocked by Republicans. Health officials joined Democrats in a renewed push for expansion of Medicaid in Florida in 2020 amid the coronavirus pandemic, but those efforts have thus-far been unsuccessful.
Florida has not accepted federal Medicaid expansion
- 4,521,012 – Number of Floridians covered by Medicaid/CHIP as of July 20231
- 1,463,000 – Number of additional Florida residents who would be covered if the state accepted expansion2
- 547,530 – Number of FL residents disenrolled from Medicaid as of July 20233
- $5 billion – Federal money Florida is leaving on the table by not expanding Medicaid in 2023 (plus additional American Rescue Plan funding)4
History of Florida’s Medicaid program
Florida was one of the later states to implement 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% 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). Almost nine out of ten 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.
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% 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 has not implemented it. As of mid-2023, Florida is one of 11 states that have not expanded Medicaid.
Florida’s decision not to expand Medicaid leaves nearly 400,000 people in the state in the coverage gap — ineligible for Medicaid and also ineligible for tax subsidies to help them afford private health insurance (people with income over 100% of the poverty level are currently eligible for premium subsidies in the exchange, but those with income between 100% and 138% of the poverty level would switch to Medicaid eligibility if Florida were to expand coverage).
Florida’s economy is negatively impacted by not expanding Medicaid. According to an analysis by the Florida Policy Institute, Florida could save $200 million per year by expanding Medicaid. And that was before the American Rescue Plan created a provision to give states additional Medicaid funding for two years if they newly expand Medicaid. Florida could choose to start receiving that funding at any time, by opting to expand Medicaid.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
- “July 2023 Medicaid & CHIP Enrollment Data Highlights” , Medicaid.gov, Accessed November 2023
- “3.7 Million People Would Gain Health Coverage in 2023 If the Remaining 12 States Were to Expand Medicaid Eligibility” , urban.org, Accessed July 2022
- “Medicaid and CHIP National Summary of Renewal Outcomes” , medicaid.gov, Accessed October 2023
- “Last 11 States Should Expand Medicaid to Maximize Coverage and Protect Against Funding Drop as Continuous Coverage Ends” , cbpp.org, Accessed January 2023