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Florida Medicaid Eligibility Requirements

Medicaid is a state and federal program that enables individuals and families to obtain healthcare coverage who could not otherwise afford it. In Florida, the Department of Children and Families (DCF) determines Medicaid eligibility. There are four general groups of Florida residents for whom Medicaid eligibility requirements have been established: low-income families with children, children only, pregnant women, and aged or disabled individuals. There is also a program to provide assistance for those with high medical costs who do not qualify for Medicaid.

  1. Medicaid for Families with Children

    • Families in Florida who meet state income and asset requirements and who have children under the age of 18 may qualify for Medicaid assistance. Either parents or relatives who are caretakers for the children may apply. In order to qualify, the adults must be citizens of Florida, U.S. citizens or qualified non-citizens, must have filed for a social security number, and must meet the income and asset requirements of the state. Income requirements vary by family size, and for most Medicaid programs, assets cannot exceed $2,000. Anyone participating in the Temporary Cash Assistance program, which provides financial help to low-income residents, is qualified automatically for Medicaid.

    Medicaid for Children Only

    • Medical assistance eligibility for children in Florida varies depending on the age of the children and is tied to the federal poverty level (FPL). If there is a child under the age of one in the family, household income must be below 200% of the FPL, while families with children age six to 18 must have income below 100% of FPL. In order to qualify, the child must be a U.S. citizen or qualified non-citizen, but the parent or guardian need not be a citizen. In addition to Medicaid for children, there are three other programs in Florida geared towards health coverage for children from low-income families: MediKids, Florida Healthy Kids, and the Children's Medical Services Network. Each of these programs covers children of different ages and anyone not eligible for Medicaid may qualify for one of these programs.

    Medicaid for Pregnant Women

    • Presumptive Eligibility in Florida provides up to 60 days worth of prenatal care for pregnant women. Eligibility is based on the woman's income and family size, which includes the woman, the father of the child if living in the same house, the unborn child and any other children. Once a women has been approved for Presumptive Eligibility, her application is sent to Medicaid to be processed. Once Medicaid coverage is approved, Presumptive Eligibility coverage ends. The Simplified Eligibility program provides ongoing Medicaid coverage for pregnant women based on family income. It does not cover other family members, however, but pregnant women may also apply for standard Medicaid along with other members of the family.

    Medicaid for the Aged or Disabled

    • Elderly or disabled residents of Florida with low incomes may qualify for the Medicare Savings Program (MSP). MSP helps senior citizens and the disabled pay Medicare premiums and will possibly cover deductibles, co-pays and co-insurance. Those who qualify for MSP will also receive assistance paying for prescription drug plan premiums and drug co-pays. There are different levels of assistance available that depend on household income and assets.

    Medicaid for the Medically Needy

    • For families and pregnant women who are over-income or whose assets are too high to qualify for Medicaid, the Medically Needy program may provide assistance with medical bills. Medical costs are evaluated to determine eligibility for this program. In addition, applicants must have a dependent child under age 18, be pregnant, be a dependent child under age 21, have applied for a social security number and be a U.S. citizen or qualified non-citizen.

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