About the Program
In Florida, Medicaid is a medical assistance program funded by the state and federal government for low-income residents who cannot afford health insurance. Though it is optional in every state, all 50 participate in a medical assistance program. Also, because of joint funding from the federal government, each state has the ability to vary their medical assistance program to a certain extent but must follow a loose structure of federal guidelines.
Florida Medicaid services are organized and overseen by the Florida Agency for Health Care Administration. Different types of Floridians qualify for the program, based on eligibility criteria set by the Department of Children and Families (DCF) and the Social Security Administration.
The Florida DCF determines qualifying residents by income, age, employment and health status for individuals and families, while the Social Security Administration regards Supplemental Security Income (SSI) beneficiaries, such as disabled, aged or medically needy individuals. The Department of Children and Families is responsible for deciding who is eligible for Florida Medicaid for low income families with children, pregnant women, children only, non-residents of the U.S. in need of emergency care, and elderly or disabled individuals without SSI benefits.
CHIP is the Children’s Health Insurance Program belonging to Medicaid that guarantees children the right to health insurance if they do not have any coverage. If a child does not qualify for one program, they will qualify for the other. The CHIP program in Florida is called Florida KidCare, and children are eligible separately from their families regardless of income. If a family’s income is too high to qualify a child for Medicaid, the child alone can still be get insured through KidCare’s Florida Healthy Kids program.
Medicaid & the Affordable Care Act
The Patient Protection and Affordable Care Act (ACA), commonly referred to as health reform or the endearing term ObamaCare, altered the future of Medicaid and made a large impact on the program. Several laws within the ACA upgraded Medicaid and CHIP to include more individuals, intended to cover the nation with more health insurance. By raising the income bracket of accepted individuals to 133% of the Federal Poverty Level (FPL), many more Americans would thus be able to utilize the health care system starting January 1, 2014.
After the ACA released its information in March 2010, Medicaid programs in most states began to restructure their income limits before the law was technically supposed to begin. This would lead to the inclusion of more people in Medicaid and jump start the new health care law. Many states adopted the 133% above FPL rule and others went higher or lower, varying based on demographic.
Most states decided to allow pregnant women with an income up to 133% of FPL into the program, while others pushed it all the way to 200%. The ACA broadens eligibility criteria by law for the whole country, meaning each state would have to provide more Medicaid to its residents, even the ones who haven’t followed suit by making changes since 2010 and continue to see a low enrollment rate.
Initially, Medicaid expansion would have increased the number of insured individuals so greatly that a projection of 15.9 million more people throughout the country would be enrolled in the program by 2019. The federal government planned to pick up most of the tab for fiscal years 2017 through 2019 for the expansion, and still covering 90% of costs starting in 2020, though states would have to pay 10% at which point.
As of June 28, 2012, the Supreme Court ruling on the ACA had a drastic effect on the health care law’s vision for the Medicaid program. Instead of keeping one of the most important provisions, Medicaid expansion, their ruling succeeded in narrowing eligibility and closing the criteria window more than it currently was restricted. The Supreme Court made it possible for any state to opt out of Medicaid expansion if they wish, and also made it possible for current enrollees to have their benefits terminated if the state sees fit.
Governors of several states, including Florida, immediately responded with eagerness to not participate, which could prove extremely detrimental to Medicaid beneficiaries and the future of Florida’s uninsured population. Medicaid is an incredibly important program, and we hope before any official action takes place that other parties can intervene and save the program’s future around the country – especially in Florida.
Florida Medicaid Eligibility
Various groups are accepted for Medicaid, as mentioned above, and includes even more qualifying individuals and types of arrangements. All SSI recipients are eligible for Medicaid, as their income is generated solely through the government and therefore it is understood that they need assistance paying for health care. Children ages 0 – 18 are also accepted for CHIP throughout the state of Florida regardless of income or health status. Except for emergency care, all Medicaid recipients in Florida must be US citizens or Qualified Aliens, and residents of Florida. Below is a list of criteria for Medicaid programs in Florida.
Low-income Families: 1931 Medicaid
- Parents or caretaker relatives of children up to age 18, if the household income falls within the income limits of 58% of FPL and no more than $2,000 in assets.
- Families whose income exceeds Medicaid limits, or have experienced an increase in child support, and therefore lose their Medicaid eligibility may be able to keep their coverage for 4 or 12 months with Extended Medicaid.
- Temporary Cash Assistance (TCA) beneficiaries.
- Individuals who qualify for TCA but do not receive benefits.
- Unemployed or underemployed parents and their children up to age 18.
- Pregnant women with or without other children.
- 18 – 21 years old with a family income below the payment standard.
- Under 19 living with a foster parent from an orphanage, private adoption agency, or group home that is not state funded, or a relative who is not within a certain degree of relationship to the child.
- Children under age 1 with household income at or below 200% of FPL, with no asset limit. (KidCare Medicaid)
- Children age 1 – 5 with household income at or below 133% of FPL, with no asset limit. (KidCare Medicaid)
- Children age 6 – 19 with household income at or below 100% FPL, with no asset limit. (KidCare Medicaid)
- Children 0 – 18 with special behavioral or physical health needs or have a chronic illness. (Children’s Medical Services Network)
- Children age 1 – 5 with a household income between 133% and 200% of FPL. (MediKids – household pays a monthly premium)
- Children age 5 – 18 with a family income between 133% and 200% of FPL. (Florida Healthy Kids – family pays a monthly premium)
- Presumptive Eligibility is temporary Medicaid coverage for instant prenatal care access. This is available to pregnant women with a household income that does not exceed 185% of FPL. Citizenship status does not disqualify anyone from PE.
- Simplified Eligibility is full Medicaid for pregnant women whose family income is less than or equal to 185% of FPL. Coverage lasts throughout delivery and two months after giving birth.
- Presumptive Eligibility for Newborns is offered to children born to mothers who are eligible for Medicaid on the day of birth. Children are eligible to receive Medicaid for up to 13 months after birth.
Elderly or Disabled
- Persons age 65 or older, who are either not on Medicare Part A or Part B, or who are receiving institutional care, hospice, home health care services with a waiver despite their Medicare status.
- Blind or disabled persons under age 65, with a disability that prevents them from working, lasts at least 12 months, or is potentially life-threatening.
- SSI beneficiaries (low-income individuals who are over age 65 or disabled) automatically receive Medicaid from the State of Florida.
- SSI recipients living in a skilled nursing facility whose income does not exceed 300% of SSI benefits and whose home equity is less than $500,000.
- Aged, blind or disabled persons living alone, with a household income up to 75% of FPL ($820) and no more than $5000 in assets.
- Married elderly, blind or disabled persons with a family income up to 83% of FPL ($1110) and assets that do not exceed $6000.
- Emergency Medical Assistance is available through Medicaid to individuals living in Florida without citizenship status who meet eligibility criteria. A health care professional must verify the individual’s condition as an emergency, which can include emergency labor and delivery, before Medicaid can be granted.
- Pregnant non-citizens are eligible for Presumptive Eligibility and Simplified Eligibility Medicaid.
Families or pregnant women who have income or resources that exceed the limits of Medicaid qualification may be able to obtain Medically Needy coverage. Individuals with who have high medical bills each month, set at a certain level by Medicaid, can use the Medically Needy program. Under this program, full Medicaid benefits are not received, but a portion of your health care expenses will be covered.
This works by having a designated share of cost, determined by income and family size, that a person must meet each month before Medicaid will cover the rest of the month’s costs. When reaching this amount, the eligible individual reports their bills to DCF in order to approve Medicaid coverage thereafter.