Medicaid in Florida falls under the Agency for Health Care Administration (AHCA). Most recipients are enrolled through the Statewide Medicaid Managed Care (SMMC) Program, which has three parts: LTC (Long-Term Care), MMA (Managed Medical Assistance) program, and the Dental Program. Kids can get Medicaid coverage through Florida KidCare. At first glance, these acronyms and phrases can seem daunting, but we’re going to break it all down for you here. Medicaid is supposed to help you, so let’s make it simple.
To meet Florida Medicaid eligibility, you must be a Florida state resident, a U.S. citizen (or legal alien) and be at least one of the following:
If you do not meet the income limits, but you find yourself below the income limits due to high health care spending, you can qualify for the Florida “Share of Cost” program. This means that even though you don’t technically meet Florida Medicaid eligibility, Medicaid will pay your costs once you spend a certain dollar amount on your monthly health care costs.
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Within Medicaid is the “Medicaid for Aged and Disabled” (MEDS-AD) program. Those who are either disabled or above the age of 65 can apply. To qualify, you must either receive institutional care (like from a nursing home), receive hospice care, receive home care, or not be eligible for Medicare. Additionally, you must meet the following income requirements (2018):
If you think you may be eligible for Medicaid (but you aren’t sure), you can go ahead and complete the Florida Medicaid application – applying is free!
Medicaid coverage can differ slightly by state. Be careful, because even if Medicaid Florida covers the care you need, you may need to get prior approval to get the coverage you need. The program typically covers:
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Medicaid Florida works as a cost-sharing program. That means that at first, you will share your health care costs with Medicaid. Once you hit an out-of-pocket limit, Medicaid will cover the rest. This limit can differ based on the managed care plan you choose.
If you are in the Medicaid “Share of Cost” program, you’ll want to keep track of every penny you spend on health care each month. The second your health care expenses for the month reach your share of cost limit, your Medicaid coverage will kick in. For example, if your share of cost limit is $1, 000 per month, but you only spend $10 on your health care services this month, Medicaid won’t cover that $10. However, if you spend $1, 000, this month, Medicaid will reimburse you for that $1, 000 service (as long as it is a Medicaid-covered service).
If you are age 21 or over and need more dental services through Medicaid, you may qualify if you are pregnant or lack other options.
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As of 2018, FL Medicaid dental plans are managed through a separate dental plan. Click here to find a dental plan that accepts Medicaid Florida.
Medicaid Florida provides reimbursements for most prescription outpatient drugs and some over-the-counter medications if a valid prescription is given. Reimbursements will only be provided for medically necessary prescriptions. In some cases, you may need to get prior approval from the Medicaid program before getting your prescription to receive coverage.
To find a hospital, doctor, pharmacy, dentist, or specialist near you who accepts Medicaid in Florida, use the MMA provider locator. Once you are enrolled in your managed care plan under Florida Medicaid, your specific plan will provide a provider network. Ask your plan for more information about what doctors you can see.
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Florida KidCare provides free or low-cost health coverage for Florida kids through the age of 18. Most families won’t pay a premium; some will pay up to $20 per month per household. The program is split into four programs: Medicaid, MediKids (for ages one through four only), Florida Healthy Kids (for ages five through 18), and the Children’s Medical Services Managed Care Plan (for kids with special needs). Coverage includes doctor visits, hospital stays, immunizations, surgeries, prescriptions, dental, vision, hearing, and mental health. To be eligible for MediKids, Florida Healthy Kids, or the Children’s Medical Services Managed Care Plan, your child must not be eligible for the regular Florida Medicaid program.
Medicaid in Florida also has a Medicaid Child Health Check Up available to eligible kids at birth, 3-5 days, one month, two months, four months, six months, nine months, one year, 15 months, 18 months, 24 months, 30 months, and then yearly. Included are physical exams, growth measurements, immunizations, vision, hearing, and dental screenings, and treatment referrals. There is no copayment for these services until age 20.
If you have to make Florida KidCare payments, you can do so online fromHealthyKids.org. You can also sign up for auto pay or scheduled payments, or pay by phone by calling1-800-821-5437. You can also make a cash payment at a Fidelity Express location, but there will be a $2 service fee.Click hereto find a location near you.
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ACCESS, the Automated Community Connection to Economic Self Sufficiency, acts as a Florida Medicaid login and allows you to access your benefit programs online. Aside from Medicaid, your MyACCESS account can help you determine your eligibility for food, cash, and other medical assistance. You can also use FL Medicaid ACCESS to view your application status, information about your benefits, or report any changes, such as a change in address or income. If you lose or misplace your Medicaid card, you can also use FL Medicaid ACCESS to print a temporary card.
To apply for Medicaid in Florida, call 866-762-2237 or click here to apply through ACCESS. You can also mail or fax in an application or visit a local Florida Department of Children and Families service center.
If you meet the Florida Medicaid eligibility requirements but are also either over the age of 65 or diagnosed with ALS or ESRD, you can get both Medicare and Medicaid benefits in the form of a special needs plan. Dual special needs Medicare Advantage plans are exclusively for those eligible for both Medicare and Medicaid. Take advantage of the benefits available to you and enroll today!THIS WEEK: Free Online Workshops on Estate Planning and Medicaid Planning. REGISTER NOW THIS WEEK: Free Online Workshops on Estate Planning and Medicaid Planning. REGISTER NOW
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Navigating the Medicaid waiver waitlist in Florida can be a complex process, and understanding priority scores is essential to receiving the care you need. Priority scores determine the order in which individuals receive Medicaid services, and being on the waitlist doesn't guarantee access to services.
A Florida Medicaid planning lawyer can help you explore how the Medicaid waiver waitlist works in Florida, how priority scores are calculated, and how you can increase your chances of receiving services.
The Florida Administrative Code Rules and state statutes explain how people who apply to the Florida Statewide Medicaid Managed Care Long-Term-Care Waiver Program are prioritized and enrolled.
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Applicants are given a priority rank based on their priority score, which signifies the assessed need for long-term care services and determines placement on the HCBS wait list (maintained by the Department of Elder Affairs).
The priority score is provided by the Department of Elder Affairs’ (DOEA’s) screening, conducted per FAC Rule: 58A-1.010. Priority is determined by Florida Statutes, 409.979, per the priority score calculation methodology by DOEA.
The higher the score, the more frail the Florida Medicaid Waiver applicant is deemed to be, which results in a higher priority placement on the Medicaid Waiver waitlist.
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Each series of Medicaid waitlist screening questions has a point scale associated with the answer. The points are added up to assign a priority rank:
Once a Medicaid applicant has been released from the waiver waitlist, the Agency for Health Care Administration (AHCA) will enroll them into a long-term care managed care program in their area.
Florida Statues, Chapter 409, Part IV (409.961 – 409.985) governs the Medicaid Managed Care and Medicaid Long Term Care Managed Care Program:
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The Medicaid waiver waitlist and priority scores can be challenging to navigate, but with the help of an experienced elder law attorney, you can increase your chances of receiving the care you need. An attorney can guide you through the application process, help you understand priority score calculations, and advocate for you to ensure you receive the services you need.
Don't hesitate to contact our team at Elder Needs Law for assistance if you have any questions or concerns about Medicaid in Florida.
All information on this website is provided for general informational purposes only, and may not reflect the current law in your jurisdiction. No information contained in this post should be construed as legal advice, nor is it intended to be a substitute for legal counsel on any subject matter. No reader of this post should act, or refrain from acting, on the basis of any information included in, or accessible through, this website without first hiring a lawyer licensed in your state to discuss the particular facts and circumstances at issue.Florida’s Medicaid enrollment increased by 1% in June with 48, 468 low-income residents qualifying for subsidized health care, according to the state’s Agency for Health Care Administration (AHCA).
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As of June 30, there were 4, 846, 412 low-income, elderly and disabled Floridians enrolled in Medicaid, an increase of more
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