Medicaid eligibility and enrollment in Florida | healthinsurance.org (2024)

Florida is one of just 10 states that have refused to expand Medicaid, leaving hundreds of thousands without access to coverage

Apply for Medicaid in Florida

Online at ACCESS Florida, or submit a paper application by mail, fax or in person to a local service center. For help with the application process, call 866-762-2237.

Eligibility: Children up to 1 year old with family income up to 206% of FPL; children 1-5 with family income up to 140% of FPL; children 6-18 with family income up to 133% of FPL; pregnant women with family income up to 191% of FPL; young adults 19-20 with family income up to 30% of FPL; adults with dependents with family income up to 30% of FPL.People who qualify for Supplemental Security Income automatically qualify for Medicaid. For information: SSI-Related Programs Financial Eligibility Standards

Review Florida’s eligibility criteria, and if you believe you are eligible to enroll in Medicaid you have several options:

• Apply online at ACCESS Florida, or fill out a paper form. Use thisapplicationfor low-income children, pregnant women, families, and aged or disabled individuals who are not currently receiving Supplemental Security Income (SSI).
• Use thisapplicationto apply for food or cash assistance in addition to Medicaid. You should also use this form if you currently receive SSI or if you are applying for home-based and community services, hospice care, or nursing home care.
• Submit a paper application submitted by mail, fax or in person to alocal service center.

For help with the application process, call 1-866-762-2237.

Many Medicare beneficiaries receive Medicaid financial assistance that can help them with Medicare premiums, lower prescription drug costs, and pay for expenses not covered by Medicare – including long-term care.

Our guide tofinancial assistance for Medicare enrollees in Floridaincludes overviews of these programs, including Medicaid nursing home benefits, Extra Help, and eligibility guidelines for assistance.

Medicaid disenrollments were paused nationwide throughout the COVID pandemic. But that ended in April 2023, and states resumed regular eligibility redeterminations, disenrolling people who were no longer eligible for Medicaid (as well as those who fail to respond to renewal information requests).

During the pandemic, Medicaid enrollment in Florida grew from 3.8 million in March 2020 (when the pause on Medicaid disenrollments began) to nearly 5.8 million by April 2023. Eligibility redeterminations must be conducted for all of these enrollees during a 12-month window referred to as the “unwinding” period.

Florida resumed disenrollments in April 2023. By December 2023, more than 1.2 million people had been disenrolled from Florida Medicaid,⁷ mostly for “procedural” reasons — meaning the state didn’t have enough information to determine whether they were still eligible.

But coverage had been renewed for another 2.4 million enrollees⁷ who still met the eligibility criteria and completed their renewal paperwork, if necessary (in many cases, eligibility can be automatically redetermined using data the state has on file and integrated systems that work with SNAP and TANF eligibility).

Florida continued to process renewals and eligibility redeterminations throughout the pandemic. But if a person was found to be ineligible or didn’t reply to a request for information, their coverage did not end. As of late 2022, Florida Medicaid estimated that they had 900,000 cases in which at least one person in the household was no longer eligible for Medicaid, and 850,000 cases in which the enrollee didn’t respond to eligibility redetermination information requests during the pandemic. But these individuals were still enrolled at that point, due to the pandemic-related rules.

Starting in April 2023, Florida began prioritizing eligibility redeterminations for enrollees who were already flagged in the system as likely ineligible, and who had not used Medicaid services in the past 12 months (indicating that they may already have other coverage in place). After that, the state began processing eligibility redeterminations for the rest of the people who had been flagged as likely ineligible. Vulnerable populations, including those under 21 with complex medical conditions and low-income people who are institutionalized or in hospice care will have their eligibility redetermined towards the end of the 12-month “unwinding” period.

If a person is no longer eligible for Medicaid, they should understand what their coverage options are once their Medicaid coverage terminates. Other coverage options might include an employer-sponsored plan, Medicare, or a plan purchased through the exchange/marketplace. Florida’s integrated eligibility system will also be able to determine whether a person might now be eligible for Florida KidCare (CHIP) or a subsidy in the exchange/marketplace (HealthCare.gov), and will transfer the enrollee’s application to those resources when applicable.

For people who end up needing to purchase their own replacement coverage (ie, they aren’t eligible for Medicare or an employer’s plan), HealthCare.gov is offering an extended enrollment opportunity, through July 31, 2024, for anyone who loses Medicaid at any time during the “unwinding” process. Since Florida does still have a coverage gap due to the state’s refusal to expand Medicaid under the ACA, low-income residents need to be aware of how to avoid this coverage gap.

People who are eligible for Medicare will have a special enrollment window during which they can sign up for Medicare without a late enrollment penalty it continues for six months after the person’s Medicaid ends. People who are eligible for an employer’s plan will generally only have 60 days to sign up for that plan after their Medicaid ends (enrollments can also be submitted before the termination of Medicaid, and that’s generally necessary to avoid a gap in coverage).

Florida was one of the later states to implement Medicaid, not adopting the program until January of 1970 (the first states to implement Medicaid did so in early 1966).

Florida Medicaid spending grew13.5%on average every year between 1980 and 2004. In an effort to slow that trend, Florida applied for and received approval for an1115 waiverfor itsMedicaid Reformpilot. The pilot implemented managed care in two counties in 2006 and added three more counties in 2007; the waiver was extended several times.

In 2013, the federal government approved anamendmentfor statewide expansion of managed care; the amendment also renamed Medicaid Reform asManaged Medical Assistance(MMA).Almost nine out of tenFlorida Medicaid beneficiaries are now enrolled in managed care plans, like health maintenance organizations (HMOs). The state hopes to improve quality through better coordination of care and save money through smaller networks of providers.

As originally written, the Affordable Care Act included Medicaid expansion as a key strategy to reduce the number of uninsured people in the U.S. The ACA allowed the federal government to reduce funding for states’ existing Medicaid programs if they did not expand Medicaid to cover adults with household income up to 138% of the federal poverty level.

However, the U.S. Supreme Court ruled in 2012 that the withholding of funds for existing Medicaid programs was unconstitutional. Medicaid expansion was left as an option for states, and Florida has not implemented it. As of mid-2023, Florida is one of 11 states that have not expanded Medicaid.

Florida’s decision not to expand Medicaid leaves nearly 400,000 people in the state in thecoverage gap— ineligible for Medicaid and also ineligible for tax subsidies to help them afford private health insurance (people with income over 100% of the poverty level are currently eligible for premium subsidies in the exchange, but those with income between 100% and 138% of the poverty level would switch to Medicaid eligibility if Florida were to expand coverage).

Florida’s economy is negatively impacted by not expanding Medicaid. According to an analysis by the Florida Policy Institute, Florida couldsave $200 million per yearby expanding Medicaid. And that was before the American Rescue Plan created a provision to give states additional Medicaid funding for two years if they newly expand Medicaid. Florida could choose to start receiving that funding at any time, by opting to expand Medicaid.