Medicaid is a government health insurance program that helps certain people get health care services at a lower cost. There are several different Medicaid programs in Florida. Medicaid for people who are older (age 65+) or live with a disability, and who have limited income and resources, is called SSI-Related Medicaid. SSI stands for Supplemental Security Income.

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What does Florida Medicaid cover?

SSI-Related Medicaid pays for routine and acute health care services. This includes:

• Visits to health care providers (including physicians and nurse practitioners)
• Inpatient and outpatient hospital services
• Early and periodic screening, diagnostic, and treatment services
• Preventive care (e.g., vaccinations)
• Lab tests and X-rays
• Dialysis services
• Mental health services
• Substance use treatment
• Rural health clinic services
• Medical transportation
• Long-term care (e.g., nursing facility care, home health services)

Most states also cover optional services such as:

• Physical, respiratory, and occupational therapy
• Home- and community-based care
• Case management
• Prescription drugs
• Dental and vision care
• Hearing services
• Podiatry services
• Hospice care

Since the program serves those with limited income and resources, people with Medicaid pay few to no out-of-pocket costs for their benefits. To get coverage once you are enrolled, you must go to health care providers that take part in the Florida Medicaid program.

In Florida, Medicaid is administered by the Agency for Health Care Administration (AHCA). Eligibility is determined by the Department of Children and Families (DCF). Check with your local DCF Family Resource Center to learn more about the coverages provided

How do I know if I qualify for SSI-Related Medicaid?

SSI, or Supplemental Security Income, provides monthly payments to older adults and people with disabilities who have very limited income and resources. You may be able to get a monthly payment of up to $943 for 1 person or up to $1,415 for a couple. Your income, things you own, and other factors affect if you qualify for SSI and how much money you can get.

If you are a Florida resident and you get SSI benefits, you are automatically enrolled in the Medicaid program. There is no need to file a separate ACCESS Florida Application (unless nursing home services are needed).

If you need help with your health care coverage and costs, you should apply for Medicaid even if you think you are over the income limit or your assets are too high. This is because:

• Not all types of income are counted toward the income limit.
• You may qualify for a different form of health care assistance. For example, if you have Medicare, you may qualify for a Medicare Savings Program(MSP).
• If you are over the income limit, but you have very high medical costs, you may be able to qualify for the Medically Needy Program.

What is Medically Needy Medicaid?

If your income puts you over the limit to qualify for SSI-Related Medicaid, but you have very high medical expenses, you may still be able to get coverage through the Medically Needy Program. This may also be called the “Share of Cost” or “Medicaid Spend-Down” program.

How does the Medically Needy Program work?

You pay a monthly “share of cost,” which is like an insurance deductible. The amount you pay depends on your income and household size. To get Medicaid benefits, you must submit current paid or unpaid medical bills equal to or greater than your monthly share-of-cost amount. Once your bills reach this amount, you will get Medicaid coverage for the rest of the calendar month.

Some examples of medical expenses you can use to meet your share of cost include:

• Unpaid medical bills that have not been used to meet the share of cost before
• Health insurance premiums
• Medical bills you paid within the last three months
• Medical bills that will not be paid by health insurance (or any other source)
• Co-pays for medical bills
• Medical services prescribed by your doctor
• Transportation by ambulance, bus, or taxi to get health care services

Some examples of medical expenses you cannot use to meet your share of cost include:

• Premiums for insurance policies that pay you for hospitalization
• Over-the-counter medical supplies (e.g., cold medicine, bandages)

Note: Certain health care providers do not accept Florida Medicaid or the Medically Needy Program. Be sure to tell your provider that you take part in the Medically Needy Program before making an appointment.

How do Medicare and Medicaid work together?

Medicaid pays for some services not covered by Medicare. If you get Medicare, you may also be able to get help from Florida SSI-Related Medicaid. Millions of Americans have both Medicare and Medicaid coverage. This is called being "dual eligible."

If you have Medicare and qualify for full Medicaid coverage, the state will pay your Medicare Part B (Medical Insurance) monthly premiums.

Depending on the level of Medicaid you qualify for, the state might also pay for:

• Your share of Medicare costs, like deductibles, coinsurance, and copayments
• Part A (Hospital Insurance) premiums, if you have to pay a premium for that coverage

In addition, if you are dual-eligible for Medicare and Medicaid:

• You will automatically be signed up for the Low-Income Subsidy (LIS)/Extra Help program through Medicare Part D (prescription drug coverage). This program helps people with low income pay for their medicines.
• You may be able to get your coverage through a Medicare Advantage Special Needs Plan (SNP) instead of having original Medicare with separate Medicaid coverage. This plan can help you manage the health care services you need. SNPs may also offer more benefits than what you already get from original Medicare. In some cases, you may have no monthly premiums and/or you may pay lower co-payments. All SNP plans are different, so check with the plans to see what they cover and if you can enroll.

Note: SNPs are not available in every community. To find out if there is an SNP in your area, visit the Medicare website or call 1-800-633-4227 or 1-877-486-2048 (TTY).

How do I prepare to apply for Florida Medicaid?

When you apply for Medicaid in Florida, you’ll be asked for important information to help determine if you qualify for benefits.

Before you start, gather some basic information to make your application process easier: 

• A document that shows your age, such as your birth certificate or driver’s license
• Your Social Security card
• Pay stubs for anyone in your household who has earned income
• Documentation that shows any other form of income, such as letters from Veterans Affairs (VA) or the Social Security Administration (SSA)
• Information about your financial assets, such as bank account or investment account statements

How do I apply for SSI-Related Medicaid in Florida?

There are a few different ways you can apply for Medicaid in Florida. Read below to learn more about which option might be right for you.

The quickest and easiest way to apply for SSI-Related Medicaid in Florida is online through the My ACCESS portal. All your personal information is kept 100% confidential and protected by special security technology.

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You can download and print a benefits application, complete it, and mail it to your nearest DCF Family Resource Center or community partner office. You can also drop your application off in person. Find a location near you.

How can I get help with my application?

There are a few ways to get help filling out your Medicaid application:

• Call the DCF Customer Call Center at 1-850-300-4323 (TTY: 1-800-955-8771).
• Visit a Benefits Enrollment Center (BEC), if there’s one near you. See if there’s one in your area.
• NCOA also has a HelpLine you can call to get free support. To get started today, call 1-800-794-6559.