Qualifications for Medical Assistance Enrollment in Florida

Medical coverage is provided to low-income families and individuals in the state of Florida through Medicaid--a state and federally funded program administered by the Agency for Health Care Administration. Medicaid eligibility is determined by the Department of Children and Families (DCF) or the Social Security Administration, and medical coverage is available to low-income families with children, children only, pregnant women, non-citizens with medical emergencies and aged or disabled individuals.

Medical Assistance for Low-Income Families with Children

• Children who are 18 years of age or younger, as well as their custodial parents or caretakers, are eligible for Medicaid if their "countable" family income does not exceed the prescribed limits and their countable assets are $2,000 or lower. Recipients of Temporary Cash Assistance (TCA) from the state of Florida are eligible for Medicaid. Persons who are eligible for TCA, but choose not to receive it, may still be eligible for Medicaid.

Medical Assistance for Children Only

• A child age 18 or under who is living with at least one custodial parent or a caretaker is eligible for Medicaid if family income requirements are met. Medicaid-eligible children may also enroll in the Child Health Check-Up Program and receive regularly scheduled health checkups, dental screenings, immunizations and other medical services. A child who does not qualify for Medicaid because his family income is too high may still be eligible for Florida Healthy Kids--a program that provides medical assistance to children with family income levels less than 200 percent of the Federal Poverty Level.

Medical Assistance for Pregnant Women

• Low-income pregnant women may be eligible for medical assistance in Florida through Presumptively Eligible Pregnant Women (PEPW), Simplified Eligibility for Pregnant Women (SEPW) or ACCESS. PEPW is temporary coverage for outpatient prenatal services that does not include labor and delivery costs. SEPW provides full medical coverage for pregnant women up to two months after the pregnancy ends. ACCESS is regular Medicaid, which includes medical coverage for other family members, cash assistance and food assistance.

Emergency Medical Assistance for Non-Citizens

• Non-citizens of the United States in Florida who meet other Medicaid eligibility requirements are eligible for Medicaid to cover medical emergencies, including emergency childbirth. Applicants for assistance for medical emergencies must provide proof from a medical professional that the treatment was for an emergency condition.

Medical Assistance for the Aged or Disabled

• Low-income persons who are 65 or older, or disabled, are eligible for Supplemental Security Income-Related Medicaid. Residents of Florida who receive, or are eligible for, Supplemental Security Income are automatically eligible for Medicaid coverage from the United States Social Security Administration.

Assistance for the Medically Needy

• The Medically Needy program helps families or pregnant women in Florida who are eligible for Medicaid, but their income or assets are too high. Persons enrolled in the Medically Needy program have a share of cost or deductible that varies depending on family size and income. There is no income limit to qualify for the Medically Needy program, but there is an asset limit based upon family size.