Medicaid in Florida: Renewal and Eligibility Guide (2026)

Medicaid remains one of the most essential health coverage programs in the United States, offering free or low-cost medical services to eligible low-income individuals and families. In Florida, Medicaid provides care for children, pregnant women, adults with qualifying incomes, seniors, and people with disabilities. In 2026, understanding Medicaid eligibility and the ongoing renewal process is critical as state policies adjust to federal requirements and post-pandemic changes.

This article breaks down Florida Medicaid eligibility, how renewal works, key deadlines, income limits, documentation requirements, common issues, and how to avoid losing coverage.

What Is Medicaid? A Quick Overview

Medicaid is a joint federal-state health insurance program that covers medically necessary care for people who meet income and categorical criteria. Federally funded and run by states, Medicaid covers services such as:

• Doctor visits

• Hospital stays

• Prescription drugs

• Preventive care

• Behavioral health services

• Long-term care for seniors and those with disabilities

Coverage varies slightly by state, and Florida implements its own rules within federal guidelines.

Why Renewals Matter Now (2026 Context)

During the COVID-19 public health emergency (PHE), Medicaid renewals were paused nationwide under a federal requirement known as the continuous coverage provision. That meant people kept coverage even if they might not have remained eligible under usual rules.

As the public health emergency ended, states began renewing Medicaid eligibility for all enrollees. Florida’s renewal process has been ongoing, and 2026 remains a year of active renewals and eligibility updates. Renewals are no longer automatic — enrollees must respond to requests for information or risk losing coverage.

Who Is Eligible for Medicaid in Florida?

Eligibility is based primarily on income and certain categorical criteria. Federal rules require states to cover certain groups; Florida also offers options beyond the federal minimum.

Here’s a breakdown of principal eligibility groups:

1. Children

• Children under age 19 in low-income families

• Income limits vary by age and household size

• Coverage is generally more generous for children than adults

2. Pregnant Women

• Pregnant individuals with incomes up to a specified percentage of the Federal Poverty Level (FPL) qualify

• Prenatal, delivery, and postpartum care included

3. Adults 19–64

• In Florida, adults without dependent children historically had limited eligibility

• After federal Medicaid expansion passing in 2023 by the Florida Legislature and approval of a Section 1115 waiver, more adults may qualify based on income

• Income limits are tied to FPL guidelines

4. Seniors and People with Disabilities

• People 65+ and individuals with qualifying disabilities can receive Medicaid if they meet financial and medical criteria

• Long-term care is a major benefit for this group

5. “Low-Income Pool” and Other Waiver Populations

• Florida has approved waiver programs that expand services to additional populations, including some working adults and those needing supportive care services

Income Eligibility: How It’s Calculated

Eligibility is primarily determined by Modified Adjusted Gross Income (MAGI) for most populations, except for seniors and people applying under medically needy rules.

As of 2026, the key income thresholds (based on federal guidelines that update annually) are generally:

Group	Income Limit (% of FPL)	Notes
Adults (19–64)	~138% FPL (approx $20,000 for single adult)	After expansion
Children	Higher than adult limits	Depends on age, up to ~300% FPL
Pregnant Women	~185% FPL	Includes prenatal/postpartum benefits
Seniors/Disabled (non-MAGI)	Asset and income tests apply	More complex rules

Important: These figures adjust annually with the federal poverty levels. Always check current FPL tables when applying.

Eligibility Categories Simplified

Categorically Eligible

These are people who fit explicit federal categories:

• Children

• Pregnant women

• Seniors

• Individuals with disabilities

• Families receiving Temporary Assistance for Needy Families (TANF)

Medically Needy

Some adults may qualify under a “spend-down” program if income is above the MAGI limit but high medical costs reduce countable income.

Waiver Programs

Section 1115 waivers allow Florida to expand eligibility or provide non-traditional services, such as enhanced home-based care for seniors to avoid institutionalization.

What Happens During a Medicaid Renewal?

Medicaid renewals determine whether a current enrollee should continue receiving benefits.

Key Steps in the Renewal Process

1. State Sends Renewal Notice

   • Florida Agency for Health Care Administration (AHCA) sends a renewal packet or notice.

   • Notices are usually mailed; electronic notices may occur if opted in.

2. Enrollee Responds

   • Must provide updated information on income, household composition, and other eligibility factors.

   • Response may require supporting documentation.

3. State Reviews Information

   • AHCA verifies income, residency, and other criteria through databases and submitted documents.

   • If information is missing or unclear, a follow-up request is sent.

4. Decision Notice

   • If eligible: coverage continues.

   • If not eligible: termination notice with appeal rights.

5. Appeals

   • Individuals can appeal renewals they believe are incorrect.

   • Appeals must be filed by the deadline in the notice.

What You Must Do to Avoid Losing Coverage

Renewals fail primarily for administrative reasons, not because someone truly lost eligibility. To protect coverage:

1. Open and Respond to Mail and Notices

Renewal notices are legal communications. Missing them can lead to coverage termination.

2. Update Contact Information

Ensure AHCA has the correct address, phone, and email.

3. Submit All Required Documents Promptly

Common documents include:

• Proof of income (pay stubs, tax returns)

• Proof of citizenship or lawful presence

• Proof of residency

• Social Security numbers for all household members

4. Use Online Tools If Available

Florida often provides online platforms where enrollees can track renewal status and upload documents.

5. File an Appeal if Denied

If coverage ends in error or eligibility information was misunderstood, appeals can reinstate benefits during review.

Common Reasons Medicaid Coverage Is Lost

Understanding why people lose coverage helps avoid preventable terminations:

Failure to Respond to Renewal Request

This is the most common reason.

Missing or Incomplete Documentation

Not providing proof of income or identity leads to “incomplete eligibility.”

Income Changes Not Reported

If income rises above eligibility thresholds and isn’t reported, coverage can end.

Not Reporting Household Changes

Marital status changes, dependency changes, or address changes can affect eligibility.

Redetermination Information.pdf

Download PDF • 144KB

Frequently Asked Questions (FAQ)

Q: Do I need to renew Medicaid every year?

Yes. Renewals are typically annual. Renewal notices will detail deadlines and required actions.

Q: What if I miss the renewal deadline?

You may lose coverage, but you can file an appeal. Some states allow a grace period if you respond shortly after the deadline.

Q: Can I update my information before the renewal period?

Yes. Updating income, address, or household information proactively helps keep coverage current and can make renewals go smoother.

Q: What about Medicare vs. Medicaid?

Medicaid is income-based. Medicare is age/disability based. Some individuals are eligible for both (“dual eligible”).

Q: Can I get coverage while an appeal is pending?

Often, yes — coverage may continue through the appeal review period if requested timely. Check the notice for exact rules.

Q: Are undocumented immigrants eligible?

Federal Medicaid requires lawful presence for most benefits. Some limited state programs may offer restricted services, but full Medicaid coverage typically requires eligibility documentation.

Understanding Florida’s Policy Environment (2026)

The Medicaid landscape in Florida continues to evolve:

• Medicaid Expansion: Florida passed legislation in 2023 to expand Medicaid eligibility to adults under ~138% of the FPL; implementation rolled out over subsequent years. Expansion increased coverage for low-income adults without dependent children.

• 1115 Waivers: Florida uses federal waivers to tailor services, especially for long-term care, behavioral health, and supportive living arrangements.

• Work Requirements and Reporting: Some states have proposed work or community engagement requirements for able-bodied adults. Florida has considered similar policies but must ensure compliance with federal Medicaid rules before implementation.

Practical Tips When Renewing Medicaid

Start Early

Don’t wait for the last minute — begin collecting documents as soon as you receive a notice.

Organize Critical Documents

Use a folder for:

• Tax returns

• Pay stubs

• IDs and Social Security cards

• Lease or utility bills

• Medical documentation for disabilities

Use Online Portals

Electronic submissions are faster and reduce risk of lost paperwork.

Check for Third-Party Help

Community organizations, health clinics, and legal aid groups often assist with Medicaid renewals.

Keep Copies of Everything

Especially documents sent to the state or uploaded online.

Medicaid and Other Assistance Programs

Medicaid eligibility often intersects with other programs:

• Children’s Health Insurance Program (CHIP): For children who may not qualify for full Medicaid but have low income.

• Supplemental Nutrition Assistance Program (SNAP): While separate, SNAP eligibility can trigger simplified verification for Medicaid.

• Temporary Assistance for Needy Families (TANF): May help families meet categorial eligibility for Medicaid.

Coordinating benefits can ensure broad support for housing, food security, and medical care.

Key Takeaways

• Florida Medicaid renewals are back in full effect after the federal continuous coverage pause ended.

• Responding to renewal requests promptly and providing required documentation is essential.

• Eligibility includes children, pregnant women, adults, seniors, and people with disabilities.

• Income limits are tied to federal poverty levels and categories can differ.

• Renewal issues often arise from failure to respond, missing documents, or outdated contact information.

• Appeals are available if coverage is improperly terminated.

• Florida’s Medicaid policy continues to evolve with expansion and waiver programs.

Where to Get Official Help

Contact the Florida Agency for Health Care Administration or your local Medicaid office to:

• Verify eligibility status

• Request renewal forms

• Upload documents

• Ask about deadlines

Official contact information is available on the AHCA website and state health department portals.

This article summarizes eligibility criteria, renewal processes, risks, and practical steps for Floridians navigating Medicaid in 2026. Staying informed, organized, and proactive will help ensure continued access to vital healthcare coverage.

Related Article you need to read

Important Changes to Florida Medicaid in 2026: What You Need to Know

If you or a loved one may need Medicaid assistance for long-term care in Florida, 2026 brings several changes that directly affect eligibility and planning strategies. These updates impact asset limits, income thresholds, home equity rules, and gift penalties for applicants seeking coverage for home care, assisted living, nursing homes, or PACE programs.

Understanding these numbers matters. Planning around them can mean the difference between qualifying smoothly and paying out of pocket far longer than necessary.

Disclaimer

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