Parents and other caretaker relatives of children

  • Children up to age 18 who live with them may be eligible for Medicaid if the family’s countable income does not exceed certain income limits.
  • Individuals who receive Temporary Cash Assistance (TCA) are eligible for Medicaid. Individuals who are eligible for TCA, but choose not to receive it, may still be eligible for Medicaid.
  • Families who lose Medicaid eligibility due to earned income may be eligible for up to twelve (12) additional months of Medicaid, if they meet certain requirements.
  • Families that lose Medicaid eligibility due to the receipt of alimony may be eligible for four (4) additional months of Medicaid.

Children

  • Parents and caretakers may apply for Medicaid on behalf of children under age 21 living in their home, if the family income is under the limit for the age of the child.  There is no requirement for a child to reside with an adult caretaker to qualify for Medicaid.
  • Children under age 19 who become ineligible for Medicaid may remain on Medicaid for up to twelve months after their last eligibility review.
  • Children eligible for Medicaid may enroll in the Child Health Check-up Program.  This program provides regularly scheduled health checkups, dental screenings, immunizations and other medical services for children.  For information on the Child Health Check-up Program, visit the Agency for Health Care Administration’s information page at https://ahca.myflorida.com/
  • Families may also apply for medical assistance for children through Florida KidCare.

Pregnant Woman

  • A pregnant woman may qualify for Medicaid if her family’s countable income does not exceed income limits.  Once eligible, a pregnant woman remains eligible throughout her pregnancy and for a twelve-month post-partum period, regardless of a change in income. For pregnant women who do not meet the citizenship requirements for Medicaid, see the information below about Emergency Medical Assistance for Non-Citizens.
  • Presumptively Eligible Pregnant Women (PEPW) is temporary coverage for prenatal care only and eligibility is determined by Qualified Designated Providers (QDP) based on limited information from the pregnant woman.  During the temporary coverage period, the pregnant woman will need to submit an application to have her ongoing Medicaid eligibility determined.
  • Women with family income over the limit for Medicaid may qualify for the Medically Needy Program.  For more information, see the Family-Related Medicaid Factsheet.

Foster Care Individual

Individuals who are under age 26 may receive Medicaid if they were in foster care under the responsibility of the State and receiving Florida Medicaid when they aged out of foster care.  There is no income limit for this program.

Non-Citizen with a medical emergency

Non-citizens, who are Medicaid eligible except for their citizenship status, may be eligible for Medicaid to cover a serious medical emergency.  This includes the emergency labor and delivery of a child.  Before Medicaid may be authorized, applicants must provide proof from a medical professional stating the treatment was due to an emergency condition.  The proof also must include the date(s) of the emergency.

Note: Applicants approved for emergency Medicaid are not eligible for post-partum coverage

Aged or Disabled individual not currently eligible

Medicaid for low-income individuals who are either aged (65 or older) or disabled is called SSI-Related Medicaid.

Florida residents who are eligible for Supplemental Security Income (SSI) are automatically eligible for Medicaid coverage from the Social Security Administration.  There is no need to file a separate ACCESS Florida Application unless nursing home services are needed.

Individuals may apply for regular Medicaid coverage and other services using the online ACCESS Florida Application and submitting it electronically.  If long-term care services in a nursing home or community setting are needed, the individual must check the box for HCBS/Waivers or Nursing Home on the Benefit Information screen.  HCBS/Waiver programs provide in-home or assisted living services that help prevent institutionalization.

Medicare Savings Programs (Medicare Buy-In) help Medicare beneficiaries with limited finances pay their Medicare premiums; and in some instances, deductibles and co-payments.  Medicare Buy-In provides different levels of assistance depending on the amount of an individual or couple’s income.  Individuals may apply for Medicare Buy-In coverage only by completing a Medicaid/Medicare Buy-In Application.

Print the form, complete it and mail or fax it to a local Customer Service Center.

Individuals eligible for Medicaid or a Medicare Savings Program are automatically enrolled in Social Security’s Extra Help with Part D (Low Income Subsidy) benefit for the remainder of the year.  An individual may also apply directly with Social Security for the Medicare Extra Help Program.  Individuals who do apply directly for the Medicare Extra Help Program have the option of having the same application consideration for the Medicare Savings Program.  If the individual takes the option of having the Medicare Extra Help Program application considered for the Medicare Savings Program, the Social Security Administration will send information electronically to Florida and the individual will be contacted.

More information about Medicaid programs for aged or disabled individuals is available in the SSI-Related Fact Sheets. Information for Medicaid providers who need to communicate with DCF about SSI-Related Medicaid eligibility status is contained in the SSI-Related Provider Communication Guide.

Income and asset limits may be found on the SSI-Related Programs Financial Eligibility Standards.  Important information for individuals seeking Medicaid for long-term care services in a nursing home or community setting is available in the Qualified Income Trust Fact Sheet.