How do I apply for Medicaid in Florida over the phone?
Florida Medicaid applications can be submitted through the Department of Children and Families (DCF). Call the toll-free number (866) 762-2237 or click here to get started. A person who moves here from another state, who had Medicaid in the prior state, has to apply for Medicaid in Florida. Click here to watch the full video at the end of this article "How to apply for Florida Medicaid".
Medicaid Florida Requirements
To be eligible for Florida Medicaid, you must be a resident of the state of Florida, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.
What documents are needed to apply for Medicaid in Florida?
Florida Medicaid Application – Online Filing
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Your Social Security number
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You date of birth
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Proof of identity
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Proof of citizenship
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Income verification, which can include (but is not limited to) income from a job or self-employment, child support or alimony payments, pensions, etc
Who is eligible for Medicaid in Florida for seniors?
To be eligible, you must be 65 or older (if under 65, disabled or blind), a U.S. citizen or qualified non-citizen, and be medically needy (need the assistance of another in order to perform activities of daily living (ADLs). Click here to watch the full video at the end of this article "How to apply for Florida Medicaid".
How to contact Fl Medicaid Member Services
Call 1-877-711-3662
How to update my Coordination of Benefits (COB)
Call the Department of Children and Families (DCF) at 1-866-762-2237
How do I speak to a live person at DCF Florida?
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Abuse Hotline. 1-800-962-2873
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Suicide Prevention. 1-800-273-8255
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Domestic Violence Hotline. 1-800-500-1119
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Background Screening. 1-888-352-2849
Income & Asset Limits for Florida Eligibility
Institutional / Nursing Home Medicaid
Income Limit $2,829 /month Asset Limit $2,000
Does Florida Medicaid check your bank account?
yes. You will need to provide a variety of documents to verify the information you provide on your Medicaid application, and that is sure to include checking and savings accounts.
Who handles Medicaid in Florida?
Medicaid services in Florida are administered by the Agency for Health Care Administration. Medicaid eligibility in Florida is determined either by the Department of Children and Families (DCF) or the Social Security Administration (for SSI recipients).
Who do I talk to about Florida Medicaid?
If you have questions, please call 1-877-711-3662, TDD 1-866-467-4970, Monday through Thursday from 8 a.m. to 8 p.m.; Friday from 8 a.m. to 7 p.m. The call is free. Text your enrollment or frequently asked questions to 357662. Click here to create a FL Medicaid Member Portal account and send a secure message.
Can you have Medicaid and private insurance in Florida?
Yes, you can have Medicaid and private insurance at the same time. Private insurance is your primary coverage. It pays first for services. Medicaid is your secondary coverage, meaning it pays last.
Can I use my Florida Medicaid in another state?
If you leave Florida to live in another state, your Florida Medicaid eligibility stops. A provider is someone who gives you a medical or related service. Be sure to ask the doctor, pharmacy or other provider if they will accept Florida Medicaid as payment before services are given, or you may have to pay.
How do I apply for emergency Medicaid in Florida?
Applications for Medicaid are made through the Department of Children and Families (DCF). Call the toll-free number (866) 762-2237 or visit https://www.myflfamilies.com/services/public-assistance
What is Limited to Family Planning?
Medicaid reimburses for family planning waiver services to eligible women for a maximum of 24 months including: Family planning initial or annual examinations. Family planning counseling visits. Family planning supply visits. Human immunodeficiency virus (HIV) counseling visits.
Can undocumented immigrants get Medicaid in the US?
Undocumented immigrants are not eligible to enroll in federally funded health coverage including full Medicaid, CHIP, or Medicare, or to purchase coverage through the Health Care Marketplace (ACA). Undocumented immigrants are only potentially eligible for emergency Medicaid or labor and delivery services.
Can non-U.S. citizens get Medicaid in Florida?
The state provides Medicaid to citizens and nationals of the United States and certain non-citizens consistent with requirements of 42 CFR 435.406, including during a reasonable opportunity period pending verification of their citizenship, national status or satisfactory immigration status.
What documents are required for Medicaid in the US?
Proof of date of birth (e.g., birth certificate) Proof U.S. citizenship or lawful residence (e.g., passport, drivers license, birth certificate, green card, employment authorization card) Proof of all types of income, earned and unearned (e.g., paycheck stubs, retirement benefits, Supplemental Security Income).
Can college students get Medicaid in Florida?
Medicaid provides health coverage for eligible low-income individuals. In Florida, Medicaid is an option for students who meet the income and other eligibility criteria.
Is Florida Medicaid accepted out of state?
If you leave Florida to live in another state, your Florida Medicaid eligibility stops. A provider is someone who gives you a medical or related service. Be sure to ask the doctor, pharmacy or other provider if they will accept Florida Medicaid as payment before services are given, or you may have to pay.
What are the rules for Medicaid in Florida?
To be eligible for Florida Medicaid, you must be a resident of the state of Florida, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income.
Do you have to reapply for Medicaid every year in Florida?
In Florida, the program is administered by the Agency for Health Care Administration (AHCA). If you're enrolled in Medicaid in Florida, you'll need to complete a Medicaid redetermination every year to keep your benefits.
How long does Medicaid take to approve Florida?
Once all the information needed to make a determination is available, the Department will make a decision on eligibility within 45 days. The Department will review your application to determine if you are eligible for Medicaid and the level of Medicaid coverage you are eligible to receive.
Why was i denied Medicaid Florida?
Excessive Income and Assets: Long-term care applicants might exceed Medicaid's financial thresholds, leading to denials. Careful asset management is key. Incomplete Disclosure of Assets: All assets, including those easily overlooked, must be fully disclosed. Incomplete disclosure can trigger a denial.
What verification is needed for Medicaid Florida?
Medicaid is intended for individuals with limited income and assets. Therefore, you must provide comprehensive information about your financial situation, including: Income Verification: Pay stubs, employer letters, or benefit statements (Social Security, pensions, etc.) serve as evidence of income.
Do you have to pay back Florida Medicaid?
According to federal and state law, the money that the Florida Medicaid program pays on behalf of a Medicaid recipient is a debt owed back to the state. Upon the death of the Medicaid recipient, the Medicaid program files a claim against the decedent's estate in order to seek reimbursement for the amount owed.
How to claim Medicaid Florida for adults?
Online at ACCESS Florida, or submit a paper application by mail, fax or in person to a local service center. For help with the application process, call 1-866-762-2237.
How do you prove residency for Medicaid in Florida?
Applicants for Florida Medicaid must be residents of the state. To prove your residency, you can provide documents such as a Florida driver's license, utility bills, lease agreement, voter registration card, or school records for children. The documents should establish that you currently reside in Florida.
How do I find my Florida Medicaid ID number?
The front of your Florida Medicaid gold card shows your name and a card identification number called the Card Control Number.
How many documentation is required for Medicaid in Florida?
For a successful Medicaid application, comprehensive financial documentation is key. In Florida, this includes five years of bank statements, proof of income, and records of any closed accounts. The state requires a thorough review of each applicant's financial history to ensure eligibility.
How do I get a replacement Medicaid card in Florida?
For a replacement card, call the toll-free number (866) 762-2237. If you were just approved for Medicaid it can take two to three weeks to receive the card. To request a replacement card, call 1-866-762-2237. Those on Medicaid can print a temporary Medicaid card from their MyACCESS Account.
How do I file a complaint against Medicaid in Florida?
If you need help submitting a complaint, you can call our Medicaid Helpline at 1-877-254-1055 (TDD 1-866-467-4970). Staff are available to help you Monday through Friday, 8:00am to 5:00pm EST. Medicaid Helpline staff can also help you check on the status of a complaint submission.
What is the 183 day rule in Florida?
Florida residency refers to the legal status of individuals who maintain their primary home in the state of Florida. To establish residency, a person must demonstrate intent to make Florida their permanent home. Key factors include: Physical presence in Florida for at least 183 days per year.
How to appeal a Medicaid denial in Florida?
Write us, or call us and follow up in writing, within 60 days of our decision about your services. 1-866-796-0530 (phone) or TTY at 1-800-955-8770. Ask for your services to continue within 10 days of receiving our letter, if needed. Some rules may apply.
Who oversees Medicaid in Florida?
Medicaid services in Florida are administered by the Agency for Health Care Administration. Medicaid eligibility in Florida is determined either by the Department of Children and Families (DCF) or the Social Security Administration (for SSI recipients).
How to find a Doctor that takes Medicaid insurance
To find doctors, dentists, and specialists in your community that serve Medicaid patients, go to www.flmedicaidmanagedcare.com or call 1-877-711-3662 to talk to a Choice Counselor.
What happens if I can't find my ID Card?
For a replacement card, call the toll-free number (866) 762-2237. If you were just approved for Medicaid it can take two to three weeks to receive the card. To request a replacement card, call 1-866-762-2237. Those on Medicaid can print a temporary Medicaid card from their MyACCESS Account.
What is the phone number for disability benefits in Florida?
You can apply for Disability benefits online, or if you are unable to complete the application online, you can apply by calling our toll-free number, 1-800-772-1213, between 8:00 a.m. and 7:00 p.m.
How much is disability payment in Florida?
If you meet the work requirements, your monthly benefit payment is determined through a calculation that uses your lifetime earnings with the maximum benefit being $3,627 a month. The average monthly benefit in 2023 according to the Social Security Administration is $1,483 at of 2/24/23.
What services are available for disabled adults in Florida?
Services include but are not limited to: adult day care; case management; chore service; transportation service; homemaker service; and personal care.
How to get Financial assistance in Florida?
The Florida Temporary Assistance for Needy Families (TANF) program is designed to help needy families achieve self-sufficiency. States receive grants to design and operate programs that accomplish one of the purposes of the TANF program.
The four purposes of the TANF program are to:
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Provide assistance to needy families so that children can be cared for in their own homes.
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Reduce the dependency of needy parents by promoting job preparation, work and marriage.
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Prevent and reduce the incidence of out-of-wedlock pregnancies.
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Encourage the formation and maintenance of two-parent families.
About Veteran Debt Assistance
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Financial Assistance | HCA Florida
HCA Florida Healthcare offers many forms of financial assistance for patients without healthcare insurance needing emergent or non-elective services.
Can you have both Medicare and Medicaid in Florida?
People who have both Medicare and full Medicaid coverage are “dually eligible.” Medicare pays first when you're a dual eligible and you get Medicare-covered services. Medicaid pays last, after Medicare and any other health insurance you have.
What if I can't speak English?
If you have difficulty understanding English, you can request free language assistance or other aids and services by calling (850) 300-4323.
Who can help me get Medicaid in Florida?
Call the Medicaid Choice Counseling Hotline at 1-877-711-3662 or visit www.flmedicaidmanagedcare.com. Call Social Security at 1-800-772-1213 or visit www.ssa.gov. Florida KidCare is a health insurance program for children in Florida. It includes Medicaid for children and the Children's Health Insurance Program (CHIP).
What is the poverty level in Florida for Medicaid?
As of 4/3/24, to qualify for Medicaid in Florida, parents must earn less than 28 percent of the federal poverty level (or less than $7,230 for a family of three annually). * Adults without dependent children are not eligible for Medicaid at all.
Does Florida Medicaid require referrals for specialists?
Florida Statutes allow access to certain specialties without a referral. Members may continue to access Obstetrics and Gynecology, Dermatology, Podiatry, Chiropractic specialties directly, without the need for a referral.
Top 10 Telehealth services in Florida
Florida houses some of the country’s top-quality telehealth care providers. If you are residing or temporarily staying in Florida, you can expect to receive the best service. Click here for a list of state-licensed providers who can diagnose, treat, and prescribe medications along with other telemedicine services
Economic Self Sufficiency Program
A program from the Florida Department of Children and Families that offers assistance with food, cash, Medicaid, and more
Head Start
Head Start is a program of the United States Department of Health and Human Services that provides comprehensive early childhood education, health, nutrition, and parent involvement services to low-income children and families.
Florida Medicaid Preferred Drug List Effective 7/1/24
The Florida Medicaid Preferred Drug List (PDL) is subject to revision following consideration and recommendations by the Pharmaceutical & Therapeutics (P&T) Committee and the Agency for Health Care Administration.
The PDL is in order by The Therapeutic classification. To locate a specific drug or Therapeutic class, use The search feature available in Adobe Acrobat Reader. Phosphate Binders and Prescription Strength Vitamins are covered for dialysis patients. While a product name may be listed on the PDL, a specific NDC may or may not be reimbursable.
Auto PA In-Progress: Armodafinil, Fanapt, Leuprolide Depot 3-Month, Qelbree, Rexulti, Trelstar Prior Authorization (PA) Column Definitions:
Auto PA - System automated criteria check for specific requirements (e.g., diagnosis, age, previous therapies, etc.). If all requirements are found, the claims will pay at the pharmacy counter without need of manual prior authorization submission.
Clinical PA - These drugs require prior authorization submission that must include clinical documentation. The drugs that require clinical prior authorization review and the prior authorization forms can be found in this link:
Florida Medicaid’s Covered Services and Waivers
The purpose of the Medicaid Long-term Care Waiver is to provide services to eligible individuals age 18 or older who need long-term services and supports, including individuals over the age of 18 with a diagnosis of cystic fibrosis, AIDS, or a traumatic brain or spinal cord injury. The Long-term Care Waiver is designed to delay or prevent institutionalization and allow waiver recipients to maintain stable health while receiving services at home and in the community. Individuals in the program may also be served in a nursing facility setting.
Medicaid reimburses for over two dozen home and community-based services and nursing facility services through this program.
The Long-Term Care Waiver is a capitated, managed care program. It is offered by Statewide Medicaid Managed Care Long-term Care plans and Managed Medical Assistance Comprehensive plans.
Eligibility
Individuals enrolled in the Long-term Care program must be:
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65 years of age or older AND need nursing facility level of care; or
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18 years of age or older AND eligible for Medicaid by reason of disability AND need nursing facility level of care
Or:
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18 years of age or older with a diagnosis of cystic fibrosis AND have a hospital level of care.
Resource Information
More information on the Long-Term Care Waiver is available on the Federal Authorities webpage.
Learn more about Accessing Long-Term Care Services.
Refugee Cash Assistance
The Refugee Cash Assistance (RCA) program helps eligible refugees and other humanitarian immigrants by providing cash assistance for up to twelve months from their arrival date in the United States (or from the date of their immigration status for asylees or victims of trafficking). RCA is for eligible people who do not have minor children.
You can apply for Refugee Cash Assistance services online at WashingtonConnection.org, at your local Community Services Office, or over the phone by calling 1-877-501-2233. Interpretation and translation services are available.
What is Medicaid SOC?
In Florida, the "share of cost" for Medicaid is essentially a monthly amount an individual must pay in medical expenses before being eligible for Medicaid coverage for the rest of that month. This program, also known as the "Medically Needy" program, is for those whose income or assets slightly exceed standard Medicaid limits. The share of cost is calculated based on household size and income, and it's similar to a deductible.
You can find more information and resources on the Florida DCF website.
How it works:
1. Calculate your share of cost:
The Florida Department of Children and Families (DCF) determines your individual share of cost, based on your household size and income.
2. Incur medical expenses:
You then incur medical expenses, which can include doctor visits, hospital stays, prescription costs, etc.
3. Meet the share of cost:
Once your allowable medical expenses for the month equal or exceed your calculated share of cost, you become eligible for Medicaid for the rest of that month.
4. Submit proof:
You'll need to submit proof of your medical expenses (like bills or receipts) to DCF to demonstrate that you've met your share of cost.
5. Medicaid coverage:
Once DCF confirms you've met your share of cost, Medicaid will pay for your eligible medical expenses for the rest of that month.
Florida Medicaid Alien Plan coverage
In Florida, Medicaid generally provides emergency medical coverage for undocumented aliens who meet all other eligibility requirements, including income and residency. This coverage includes emergency services like labor and delivery and dialysis, but does not extend to continuous or episodic care after the emergency has been alleviated.
Here's a more detailed breakdown:
1. Eligibility for Emergency Medicaid:
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Individuals who are not U.S. citizens or nationals, but who meet all other Medicaid eligibility requirements except for citizenship, are eligible for Emergency Medicaid.
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This includes individuals who are not lawfully present in the United States.
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Some non-citizens, like lawful permanent residents ("green card" holders), refugees, and asylees, may also be eligible for full Medicaid benefits after meeting a waiting period, but non-qualified aliens, including those who are unauthorized or illegally present, can only receive emergency Medicaid.
2. Scope of Emergency Coverage:
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Emergency Medical Services:
Medicaid covers services provided in an emergency situation, such as those in a hospital's emergency department.
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Examples:
This includes services for labor and delivery, dialysis, and other medical emergencies.
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No Continuous Coverage:
Medicaid will not pay for ongoing or non-emergency medical care once the immediate threat to health has been addressed.
3. How to Apply for Emergency Medicaid Florida
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Apply online: Individuals must apply for Medicaid online to receive services, according to the Florida Department of Health.
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Provide Verification: Applicants may need to provide documentation to verify their eligibility.
4. Important Considerations:
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Lawful permanent residents (green card holders) generally must wait five years before they can receive full Medicaid benefits, but this waiting period may not apply to children and pregnant women, according to HealthCare.gov.
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Some states may offer additional Medicaid benefits to immigrants, including those covered by a five-year bar.
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Emergency Medical Treatment and Active Labor Act:
Hospitals are legally obligated to provide emergency services to all individuals, regardless of their immigration status or ability to pay, according to the Florida Agency for Health Care Administration.
Will Medicaid Fl pay for Dental services?
Medicaid reimburses for dental services that provide for the study, screening, assessment, diagnosis, prevention, and treatment of diseases, disorders, and conditions of the oral cavity.
Medicaid reimburses for dental services for recipients under the age of 21 years including:
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Crowns
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Diagnostic evaluations
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Endodontics
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Full and partial dentures
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Oral surgery
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Orthodontic treatment
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Periodontal services
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Preventive services
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Radiographs necessary to make a diagnosis
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Restorations
Find a Medicaid Florida Dentist
Click here to find a Medicaid Florida Dentist in your county. Please note that it's always a good idea to contact the provider directly to confirm current participation and to schedule appointments.
Florida Medicaid Member Portal
Login or create an account to do the following;
Status Check
Check your Medicaid eligibility and enrollment status
Update Address
View and update your address
Secure Messaging
Request help using secure messaging
Enroll or Change Plans
Enroll in a plan or change plans
Manage Complaints
File complaint and see what is happening with your complaint
Go Paperless
Choose to only get letters from Medicaid electronically
Receive Alerts
Receive email or text message alerts
Supplemental Nutrition Assistance Program (SNAP)
SNAP, formerly known as the Food Stamp Program, is the nation’s most important anti-hunger program. SNAP provides nutritional support for low-income seniors, people with disabilities living on fixed incomes, and other individuals and families with low incomes. SNAP is a federal program administered by the Florida Department of Children and Families Office of Economic Self-Sufficiency (ESS). ESS is responsible for determining eligibility for SNAP using federal guidelines.
Eligibility
SNAP eligibility rules and benefit levels are, for the most part, set at the federal level and uniform across the nation, though states have flexibility to tailor aspects of the program. Individuals must pass all eligibility rules to receive food assistance benefits. Find out more about eligibility rules.
Temporary Cash Assistance (TCA) Program
The TCA program provides cash assistance to families with children under the age of 18 or under age 19 if full time secondary (high school) school students, that meet the technical, income, and asset requirements. The program helps families become self-supporting while allowing children to remain in their own homes. Pregnant women may also receive TCA, either in the third trimester of pregnancy if unable to work, or in the 9th month of pregnancy. Parents, children and minor siblings who live together must apply together.