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Florida Medicaid Rules

Medicaid is one of the most commonly utilized government programs in the state of Florida. Due to the high number of applicants for the program, federal- and state-level officials in the Sunshine State impose a number of rules to help ensure that all applicants who wish to participate in the program are eligible to do so. These rules also help to cut down on abuse and fraudulent activity with Medicaid funds.

  1. Families With Children

    • People who reside in the state of Florida, including children up to the age of 18 and their parents or legal caretakers, can receive Medicaid if they meet certain qualifications. In order to qualify to participate in the program, the household income must not exceed allowable limits as determined by family size. The family must also not have assets in excess of $2,000. Assets include cash or items of value that can be liquidated into cash such as stocks, bonds and life insurance policies. Items such as the family car or home are typically excluded and not counted as assets.

    Aged or Disabled

    • Elderly Florida residents and residents of the state who are disabled may qualify for Medicaid. In order to qualify for Medicaid, an applicant must be at least 65 years old or determined to be disabled by a qualified physician. Any Florida resident who qualifies to receive Supplemental Security Insurance (SSI) through the federal government will automatically qualify to receive Medicaid through the program. No separate application is required unless nursing home services are needed. If nursing home services are necessary, the applicant will need to sign a Home and Community-Based Services (HCBS) waiver, which is available on the Access Florida website. The HCBS program provides in-home and assisted living services designed to help patients stay in their own homes and to avoid institutionalization.

    Medically Needy

    • Applicants who do not qualify for Medicaid because their income or assets are too high may still qualify for the Medicaid Medically Needy program if they can demonstrate need. In order to qualify, applicants must be able to show that they exceed a certain number of medical bills per month and that denial of access to the program will create a health and financial hardship. Once an approved applicant demonstrates that he has paid a set amount of medical bills each month, Medicaid will cover all or part of the remainder. The amount that the applicant is required to pay before Medicare takes effect each month is determined by income.

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