The Department of Children and Families determines Medicaid eligibility. Those who may be eligible for Medicaid include parents and caretaker relatives of minor children, children (up to age 21), pregnant women, former foster care individuals (up to age 26), non-citizens with medical emergencies, and aged or disabled individuals not currently eligible. Florida residents who are eligible for Supplemental Security Income (SSI) are automatically eligible for Medicaid coverage from the Social Security Administration. No additional applications need to be filed unless nursing home services are needed.
To be eligible for Medicaid, an applying individual must provide proof of Florida residency, citizenship, income, and expenses. Eligibility is determined by other factors including family circumstances and assets. If an individual’s circumstances, assets, or income changes, the change must be reported, as the change may affect eligibility.
Federal regulations at 42 C.F.R. §§ 435.912 and 457.340 require that eligibility for Medicaid determinations is to be made “promptly and without undue delay.” Eligibility determinations for any individual may not exceed 90 days for applicants who apply based on disability, 45 days for individuals whose eligibility is being determined based on their modified adjusted gross income, and 45 days for all other applicants.
Florida requires all Medicaid cases to redetermine eligibility once continuous coverage has ended. Eligibility may be redetermined even for individuals who were previously ineligible.
Individuals may file online at MYACCESS Florida by calling the Department of Children and Families (DCF) or by filing a paper application via fax, mail, or in person at one of the Department’s customer service centers throughout the state.