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Learn About Requirements for Medicaid in Florida

Understanding how to qualify for Medicaid in Florida is the first step to completing a successful application. Before you apply, it is important to ask, “What are the requirements for Medicaid in Florida?” and more specifically, “What are the income requirements for Medicaid in Florida?” since Medicaid has many stringent eligibility requirements in order to guarantee only qualified applicants truly in need of medical assistance are accepted into the program. Understanding who is eligible for Medicaid and what the FL Medicaid eligibility requirements are enable future applicants to maximize preparation for their application, thus increasing their possibility of receiving medical assistance. Therefore, continue reading the sections below to learn more about who qualifies for Medicaid in Florida.

Who qualifies for Medicaid in Florida?

First and foremost, when addressing who is eligible for Medicaid in Florida, it is important Florida Medicaid applicants understand that Florida opted not to expand their Medicaid program when the Affordable Care Act passed. Because the state did not accept the ACA Medicaid expansion, Medicaid eligibility guidelines do not extend to adults younger than 65 years of age who do not fall within exceptional circumstances. However, to qualify for Medicaid, every applicant, regardless of his or her situation, must meet general income and residency requirements. To be eligible for Medicaid in FL, the essential requirements all Medicaid applicants must meet include:

  • Applicants must be United States citizens.
  • Applicants must be residents of Florida.
  • Applicants must meet the annual salary limits.

Medicaid benefits eligibility in Florida makes an exception for non-citizens who have experienced a medical emergency, including the labor and delivery of an infant. In order to qualify for emergency assistance, non-citizens must meet the income requirements. Although adults between the ages of 19 and 65 who do not suffer from a disability or are not pregnant do not qualify for FL Medicaid benefits, parents and caretakers of children who are younger than 21 years of age can qualify for coverage if the child meet the income limits. Furthermore, a family can still qualify for medical assistance even if they are receiving Temporary Cash Assistance.

Children younger than 21 years of age may meet the Florida Medicaid eligibility requirements regardless of whether or not they live in the care of an adult. Additionally, all individuals who were in the foster care program as children and met Medicaid benefits eligibility when they aged out of the system may receive Medicaid benefits until they are 26 years old. These applicants are excluded from the income requirements as long as they have had their foster care and previous Medicaid status validated by the Office of Child Welfare.

Florida Medicaid eligibility requirements also cover pregnant women who are classified as low-income by the federal government. However, if an expectant mother is overqualified for Medicaid, she may be qualified for the Medically Needy Program, which would not require a separate application.

Finally, elderly and disabled individuals who meet the income requirements are eligible for Medicaid in FL, and are automatically qualified for Supplemental Security Income.

What are the income requirements for Medicaid in Florida?

The income requirements for Medicaid in Florida were established to prevent individuals who are not in financial need of medical assistance from applying. This eligibility requirement for Medicaid is because the program is designed to provide low-income families and individuals in need of health care services with affordable coverage. To be eligible for Medicaid benefits and categorized as low-income, individuals and families seeking health care assistance must generally fall below 133 percent of the federal poverty level. However, this percentage increases for pregnant women and infants. Additionally, household salary requirements for Medicaid in FL fluctuate depending on the size of the household. If there are more household members, the salary needed to qualify for Medicaid increases, and if there are fewer household members, the salary limit decreases. To learn more about income requirements, download our free guide today.

What are the Medicaid application guidelines in Florida?

Applicants must be able to prove they satisfy the basic Florida Medicaid requirements in order to meet Medicaid application guidelines in Florida. Proof of Medicaid eligibility typically consists of supplemental documentation that verifies an applicant’s identity, citizenship status and gross household income. Additionally, any applicant who does not meet Medicaid eligibility requirements and may be eligible for another assistance program need only submit one application to Florida’s Department of Children and Families. While an FL Medicaid application partially consists of verifying an applicant’s eligibility, there is much more information an applicant should be prepared with before submission. Download our free guide today to get more details on the Medicaid application process.

What are disqualifications for Medicaid in Florida?

Although an applicant can always appeal their Medicaid eligibility determination, it is important to prevent disqualification from the program by reviewing Medicaid eligibility requirements before completing an application. A common reason applicants fail to meet FL Medicaid benefits eligibility is because they do not meet income requirements. Additionally, in Florida, many applicants do not meet the special circumstances the Florida Medicaid program requires to be eligible to receive benefits. For example, an applicant may be 133 percent below the federal poverty line, but he or she may be 25 years of age with no kids. This applicant will not qualify for Medicaid under Florida statue because Florida requires applicants be children, pregnant, disabled or elderly.