Florida Medicaid Application Information

Low-income individuals and families living in state of Florida can get medical coverage through Medicaid. Federal government and state of Florida jointly provide revenue for the program. Agency for Health Care Administration administers the program.

Low-income families taking care of children, pregnant women, U.S. citizens, Non-citizens if they have medical emergency, aged and disabled individuals not receiving benefits under Supplemental Security Income (SSI) program can receive benefits under Medicaid.

Medicaid coverage covers wide range of low-income families with children. Medicaid is divided into different categories i.e. low-income families with children, pregnant women, child-only coverage, aged and disabled individuals, and aliens with medical emergency. To get medical coverage through Medicaid program, individuals and families will have to meet eligibility criteria for any of these categories.

Application and eligibility criteria for each of the categories vary. For instant, only pregnant women can fall into Medicaid category for Pregnant Women. Similarly, age limit varies for category Child Only and Medicaid for Aged and Disabled. Similarly, other eligibility requirements also vary.

Medicaid for low-income families with children

Medicaid is available for parents and even caretaker relatives if their income is within income limit. Similarly, individuals will have to have resources below $2,000 in order to qualify for Medicaid.

Even if an individual is receiving aid through Temporary Cash Assistance (TCA) program, they can still qualify for Medicaid. In case such individual chooses not to receive TCA benefits, his or her eligibility for Medicaid will not be affected.

In case a family qualifies for Medicaid but then loses eligibility because of increase in earned income, it will continue to receive benefits for another 12 months if they meet most other requirements of the program.

Similarly, families loosing eligibility for Medicaid due to child support will continue receiving such benefits for another 4 months.

You can get more information about Medicaid for families with low income and children by clicking here.

Medicaid for Children Only

If families have income below the income limit for their children under the age of 19, they can apply for Medicaid benefits for their children. However, parents can only apply for Medicaid for their children when they are living with them. Caretakers can also apply for Medicaid benefits for children.

Children meeting the eligibility for Medicaid program can also apply for Child Health Check-up Program. Once a child enrolls in this program, he or she will receive regular health checkup along with dental screening and immunizations. Children enrolling in this program will also be able to receive other medical services necessary for proper child health.

Families receiving Medicaid benefits will stop receiving such benefits when their last child turns 18 years of age. For children between 18 and 21, Medicaid benefits are only limited to the child and not to the family.

A child born to a woman with Medicaid eligibility will automatically start receiving benefits under Medicaid for next thirteen months. The Presumptive Eligibility for Newborns begins from the date of birth.

Medicaid for pregnant women

Pregnant women will be able to enjoy benefits through presumptive eligibility. Presumptive Eligibility for Pregnant Women (PEPW) provides Medicaid to pregnant women in emergency who may need instant parental care. Women with income less than 185% of federal poverty level can qualify to receive Medicaid through PEPW. Simplified Eligibility for Pregnant Women (SEPW) is another way to get qualified for full Medicaid cover. Pregnant women qualifying for PEPW can then apply for SEPW and get full coverage which would not be available with PEPW.

Emergency Medical Assistance (EMA) for non-citizens

If a non-citizen meets entire eligibility criteria apart from citizenship status, such non-citizen can still receive aid through the program for medical emergencies. Emergency child delivery is covered in this program.

Medicaid for Aged or Disabled

Aged or disabled individuals can receive benefits through Medicaid program. SSI related Medicaid has a simple application process and it covers most medical requirements of such individuals.

Medically Needy

An individual can enjoy Medicaid benefits even if he or she does not meet the income or assets eligibility. In such cases, individuals can apply for medically needy program and enjoy the benefits through sharing the cost of medical bills.

Before an individual applies for Medically Needy Program, he or she must provide some kind of proof of being medically needy. In most cases, medical bills from previous few months do the task.

Once enrolled in the Medically Needy Program, individuals will have to share certain portion of the cost. The share of cost will directly depend on the income and resources of the individual.

In order to receive benefits, allowable medical expenses have to unpaid at the time of making application. Moreover, such bills should not be payable by a third party to receive benefits from Medicaid for medically needy.

Eligibility Requirements

Eligibility for Medicaid for low-income families with children

  • Applicant must be a U.S citizen or a qualified alien
  • Applicants must be residents of Florida
  • Applicant must be able to provide Social Security Number
  • Applicants must be able to provide proof of their identity
  • Applicants must cooperate with Child Support Enforcement
  • Applicants must provide a proof of their earned income and assets should be
  • Parents applying for Medicaid should have at least one child meeting all the eligibility criteria of Medicaid
  • Resource limit for Medicaid is set at $2,000
  • Family income should be below the TCA limit. You can see the complete TCA eligibility chart HERE.
  • Relatives within specified degree of relationship can also receive benefits from Medicaid if they are caretakers of the eligible children.
  • Applicants' assets should be below the limit, which is $2,000

Individuals receiving Temporary Cash Assistance (TCA) benefits will be eligible to receive Medicaid benefits if they qualify.

Although most factors in the eligibility criteria can be verified electronically but authorities can request a documents for manual verification.

Eligibility for Medicaid for Children Only

  • Child should be under the 19 years of age/li>
  • Child should be uninsured
  • Child must meet the income eligibility for Medicaid
  • Child should be a U.S. citizen or qualified alien
  • Child should meet Medicaid general eligibility
  • Income eligibility: In case of a child under the age of 1 year, family income should be less than 200% of federal poverty level. For child aged between 1 and 5 years, family income should be less than 133% of the federal poverty level. For children between 6 and 18, family income should be less than 100% of federal poverty level.

Medicaid for Pregnant Women Eligibility

Pregnant women will be able to enjoy benefits through presumptive eligibility. Presumptive Eligibility for Pregnant Women (PEPW) provides Medicaid to pregnant women in emergency who may need instant parental care. Women with income less than 185% of federal poverty level can qualify to receive Medicaid through PEPW.

Simplified Eligibility for Pregnant Women (SEPW) is another way to get qualified for full Medicaid cover. Pregnant women qualifying for PEPW can then apply for SEPW and get full coverage which would not be available with PEPW.

Emergency Medical Assistance (EMA) for non-citizens Eligibility

  • Individual must have Medical Assistance basis of eligibility
  • Individual must have a genuine medical emergency
  • Individual must be a resident of Florida

Medical emergency purposes for EMA can include:

  • Chronic medical condition which can place individual's health in dangerous condition if left unattended
  • Chronic medical condition which can cause impairment to the body if left unattended
  • Chronic medical condition which can cause some body organs to dysfunction if left unattended
  • Individual has a sudden onset of conditions (physical or mental) that can result in acute symptoms

Eligibility for Medicaid for Aged or Disabled

Aged or disabled individuals can receive benefits through Medicaid program. SSI related Medicaid has a simple application process and it covers most medical requirements of such individuals.

Medicaid Application Instructions

Apply for Medicaid for low-income families with children

When applying for Medicaid, you will get the answer within 45 days, which will be either approval or denial. Authorities will have to verify all eligibility factors within this time.

Family Related Medicaid can be applied retroactively, meaning individuals can receive benefits for up to three months before the month of making the application.

Apply online: Applicants can apply online by opening an account with ACCESS. Use THIS link to create your account.

Apply by fax or mail: Individuals looking to get application mailed to them can contact Atomated Response Unit by dialing 1-866-762-2237

Apply for Medicaid for children only

Apply Online: You can apply online for this program at www.myflorida.com/accessflorida/.

Apply by mail or fax. You can apply for Medicaid for children through fax or email.

  • Print application HERE
  • You can mail completed application to Florida Kidcare, P.O. Box 980, Tallahassee, FL 32302-0980
  • You can email your application and documents to the address listed on this page

Children eligible for Medicaid can also receive benefits under Florida KidCare Program. In fact, Medicaid is a part of Florida KidCare program. Advantage of applying for Florida KidCare is that applications rejected due to higher income will be automatically transferred to Florida Healthy Kids.

You can find more information about this program HERE.

Apply for Medicaid for Pregnant Women

You can apply for Medicaid for pregnant women in three different ways

  • Presumptively Eligible Pregnant Women (PEPW): This coverage is only available at local clinics and it is only temporary. However, when a pregnant woman qualifies for PEPW, her application is automatically sent to DCF, who will determine eligibility for ongoing Medicaid determination.
  • Simplified Eligibility for Pregnant Women (SEPW): Pregnant women can get full coverage by applying through one page application. You will be required to print application so that you can mail it to ACCESS. You can also fax or return the application in person at an ACCESS office. You can download the application by clicking HERE.
  • ACCESS application: You can apply for Medicaid benefits through regular process. Regular Medicaid provides benefits for pregnant women. You can apply through THIS link.
  • You can apply for Medicaid for Pregnant Women electronically or by using this link to request application by mail or fax.

Apply for Emergency Medical Assistance (EMA) for non-citizens

Apply locally: You can apply through Local Service Center. Use THIS link to find a local center near you.

Apply online: You can apply online by clicking here.

In order to receive benefits through EMA, one has to provide a proof such as a medical professional's statement showing that the procedure was carried out in emergency. Such proof should also exhibit the date of such emergency.

Non-citizens will have to apply for benefits by filling an application and providing verification proof when asked. Non-citizens are exempt from Social Security Number and cooperation with Child Support Enforcement.

Non-citizens with a temporary stay in the U.S for tourism or business visit will not be able to receive benefits under Medicaid for aliens.

Apply for Medicaid for Aged or Disabled

Applying online: Individuals can apply for Medicaid electronically. All they have to do is to go to ACCESS Florida website and fill out the application forms there. The entire process can be completed online. You will automatically qualify for Medicaid if you are eligible for SSI. You can apply for SSI using this LINK. However, if you need nursing services, you will have to make sure that you are checking the box that asks for HCBS or Nursing Home on benefit information page. This program will provide services for assisted living so that individuals do not have to be institutionalized.

Applying through fax or mail: You can print application from ACCESS Florida website and mail or fax it to your local customer service center. You can find your nearest local customer service center by clicking here.

Apply for the Medically Needy

If you meet all the eligibility criteria for medically needy, you will have to provide a proof of your medical expenses to a DCF ACCESS office by mail, fax or in person. Such proof should include your name, case number, total amount of expense, date of expense, due date of payments and details of any payments you have made.

To get information about Medicaid in your area, you can find information about Area Medicaid Office using THIS link.