|  | Healthcare Industry | Health Insurance

Florida Medicaid Eligibility Standards

Florida's Agency for Health Care Administration, AHCA, mainly through the Department of Children and Families, determines eligibility of applicants for Medicaid benefits. Medicaid is a joint state-federal program that provides medical assistance to low-income, elderly and disabled people. States like Florida are free to develop their own eligibility requirements within the framework of broad federal guidelines. In Florida, Medicaid is part of the ACCESS Florida Program, which offers Medicaid, TCA, temporary cash assistance, and food assistance. Medicaid assistance eligibility is based on criteria for income levels, number of children, parental and guardian issues, age and residency/citizenship status.

  1. Low-income Families

    • Income is the most important factor in Medicaid eligibility in Florida. Monthly income limits are determined by household size. Following is a breakdown of monthly income levels: one person $180, two people $241, three people $303, four people $364, five people $426, six people $487, seven people $549 and eight people $610. For each household member with more than eight, add $62 to the income limit. There is a $2,000 cap on total assets, despite the size of the family. To be eligible, you also must be a Florida resident, have a dependent child under the age of 18 in the home, or qualify as a dependent child yourself, have, or apply for, a social security number and be a U.S. citizen or qualified non-citizen. Applicants must file for any other benefits for which they're eligible, such as TCA and the Food Assistance Program, and parents and guardians must cooperate with Child Support Enforcement. Pregnant women and children under 21 with incomes higher than the identified limits may be eligible for Medicaid benefits under different programs. Families losing eligibility because of increased income may be eligible for up to 12 months of additional Medicaid coverage, and families losing eligibility due to child support or alimony payments may receive up to four months coverage.

    Medicaid for Children Only

    • Parents, guardians and caretakers can apply for Medicaid for children under 19 if household income levels meet maximum thresholds. For example, households with a child under the age of one must have gross incomes below 200 percent of the federal poverty level, FPL. The household income limit rises as children get older. Qualifying children must be Florida residents under 19, live with a caretaker, have or apply for a social security number, be U.S. citizens or qualified non-citizens and disclose all other insurance. There is no asset cap amount, non-guardian incomes are not counted as household income and the parents' citizenship is not taken into account. Children also can receive medical coverage through Florida's KidCare program, which was established as part of the federal Balanced Budget Act of 1997 through the Child's Health Insurance Program, CHIP, now SCHIPS, or States' Child's Health Insurance Program. Your child can qualify under any of four parts of the program: Medicare, MediKids, Florida Healthy Kids or the Children's Medical Services Network. Income levels relative to the FPL and your kids' ages are deciding factors.

    Maternity Medicaid

    • Pregnant women with or without children are eligible for Medicaid benefits if they have gross incomes below 185 percent of the FPL, can verify citizenship and residency and provide proof of pregnancy, including a due date from a doctor or health care provider. No asset limit is imposed when applying. Pregnant women also can qualify through a QDP, qualified designated providers, which in Florida, includes county health departments, regional perinatal intensive care centers and other state-approved health providers. Pregnant women also will be automatically assigned Medicaid application status if they apply for other Florida assistance --- such as TAC or food assistance --- by completing an ACCESS application.

    Other Eligible Applicants

    • Florida offers the Medicaid Institutionalized Care Program, ICP, for elderly qualifiers seeking nursing home payment assistance. There are strict asset and income ceilings. Non-citizens who would be Medicaid-eligible if not for their citizenship status may qualify serious emergency medical coverage. Written proof from the provider, including dates and procedures performed, are necessary when applying for emergency Medicaid coverage.

Health Insurance - Related Articles