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Medicaid Guidelines in Florida

Medicaid is a federally-subsidized, state-administered program to provide health insurance and basic health insurance to pregnant and nursing women, the poor, the indigent and children of low income families. While the federal government sets broad guidelines, the states have broad authority to set eligibility limits, based on their budgets and their assessment of the public need.

  1. Eligibility Overview

    • Medicaid is a need-based program, intended to serve the poorest and the disabled first. In Florida, the state agency responsible for administering the Medicaid program is the Florida Department of Children and Families, except in the case of SSI recipients, in which case it is the federal Social Security Administration that determines eligibility for Medicaid benefits.

    Children of Low Income Families

    • Florida imposes an asset limit of $2,000 on families applying for assistance under the Medicaid for Low Income Families program. In addition, the income level of the household must be at or below the published maximum, $303 for a family of three, and $364 for a family of four, as of 2011. However, pregnant women with higher assets or higher income may be eligible as well.

    Medicaid for Children Only

    • Requirements are less stringent under the Florida Medicaid for Children program. If the child is under age 1, a U.S. citizen or qualified non-citizen, and has a Social Security Number or proof of application for one, they can qualify if their family income is under 200 percent of the federal poverty level, or FPL. If the child is age one through five, they can qualify if their family income is under 133 percent of FPL. If the child is age 6 through 18, family income must be less than the FPL for families of that size. Pregnant women can be counted if household income is under 185 percent of the poverty line, regardless of assets.

    Nursing Home Medicaid Guidelines

    • For Floridians seeking assistance with nursing home costs, Florida Medicaid kicks in when your countable assets -- that is, those assets not specifically excluded from the calculation -- fall below $2,000. Additionally, your gross income from all sources before any deductions cannot exceed $2,022. If both spouses in a married couple are in a nursing home, the maximum allowable countable asset level for Medicaid eligibility is $3,000. However, if only one spouse is in the nursing home, the spouse not in the nursing home is allowed to retain $109,560 in assets, and keep an income of up to $2,739 per month. Personal residences, a wedding ring, an irrevocable burial contract, cemetery plots and certain other assets are not counted against the applicant for the purposes of determining eligibility for Medicaid assistance.

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