Florida

Florida Medicaid: who qualifies

Florida Medicaid is run by Agency for Health Care Administration (AHCA), with eligibility determined by the Department of Children and Families (DCF) through ACCESS Florida. Children are covered through Medicaid for Children (part of Florida KidCare), with Florida KidCare just above that. Florida never expanded Medicaid, so who qualifies here is far narrower than most people expect.

Medicaid never expanded 3,903,326 people enrolled Back-dated coverage changes Jan 1

Start here

The income limit is far lower than almost anyone expects

$486

a month — the most a parent in a family of three can earn and still get Florida Medicaid

And that figure has barely moved since 1996.

Florida sets this as a fixed dollar amount inherited from the old pre-ACA rules, not a percentage of the federal poverty line, last revised in July 16, 1996.

It does not rise with inflation, and it does not rise when the poverty line does. So every year the cost of living goes up while this number stands still, the bar quietly gets harder to stay under, and fewer working parents qualify than the year before.

Source: Florida DCF Economic Self-Sufficiency Program Policy Manual, Appendix A-7 (Family-Related Medicaid Income Limit Chart) and Appendix A-9 (SSI-Related Medicaid), both current as of 2026; Fla. Admin. Code R. 65A-1.707(6) and Fla. Stat. §409.903(1)(c).

Who you are

Income limit

What to know

An adult with no children at home

No pathway

Not covered at any income, unless you are 65 or older, blind, or have a disability. There is no lower bound to fall under — $0 income still does not qualify you.

A parent or caretaker relative

$486/mo

Must have a minor dependent child living in the home and meet caretaker-relative relationship rules; income test uses MAGI household rules with the standard disregard applied to reach the effective gross figure above. Figure shown is for a family of three. Frozen since July 16, 1996.

A child, infants under age 1

$4,554/mo

200% of the poverty line, household of three — more than 9 times the limit for that child's own parent.

A child, children ages 1 through 18

$3,028/mo

133% of the poverty line, household of three — more than 6 times the limit for that child's own parent.

Pregnant

$4,212/mo

185% of the poverty line. Coverage continues for 12 months of continuous coverage after delivery after the birth.

65 or older, blind, or disabled

$994/mo

Per person, and savings count too — the resource limit is $2,000 for one person. A higher limit of $2,982 a month applies for nursing-home care.

Children can qualify even when their parents can't. The limit for a child here is several times the limit for that child's parent, so it is entirely normal for a family to end up with the kids covered and the adults not. If that is your household, apply for the children anyway — it costs nothing to try, and they may be eligible today.

The coverage gap

304,000 people here earn too much for Medicaid and too little for help buying a plan

They sit above Florida's very low Medicaid limit but below the poverty line, which is where federal help with premiums begins. There is nothing in between. This is the second-largest coverage gap in the nation after Texas.

57.3%

are in working familiesAt least one person in the household has a job. This is not a gap about not working.

81.3%

have no children at homeWhich is exactly the group with no pathway at all in this state, at any income.

56.8%

are people of colorThe gap does not fall evenly across the state's population.

The gap runs from about $5,832 a year (the parent limit for a family of three) down to $0 for adults without children, up to roughly 100% of the federal poverty level where ACA marketplace tax credits begin. Figures from CBPP, March 19, 2026, using 2024 ACS data. Credible estimates for Florida range from 267,000 to 315,000 depending on the survey year used; we quote the most recent.

January 1, 2027

What changes in Florida on January 1, 2027

Back-dated coverage drops from 3 months to 2 If you already have unpaid medical bills, applying sooner covers more of them. This is the January change that reaches you. Two months. There is no expansion group in this state, so every enrollee gets two.

Reasonable opportunity period eliminatedapplicants whose citizenship or immigration status can't be verified quickly lose coverage during the verification window, which can affect eligible children and citizens who simply lack documents on hand.

State-directed payments to hospitals capped at 110% of Medicare ratesa cut from Florida's prior commercially-benchmarked rates that pressures safety-net hospital finances, particularly in rural counties.

Medicare Savings Program enrollment simplification blockedslows automatic enrollment for Florida's large population of low-income dual-eligible seniors.

$50 billion Rural Health Transformation ProgramFlorida's rural hospitals, already squeezed by the payment-rate cap above, are candidates for this federal grant pool.

P.L. 119-21 §71112, amending 42 U.S.C. §1396a(a)(34). Applies to applications submitted on or after January 1, 2027.

If you don't qualify

What the marketplace can and cannot do for you

The standard advice is “try the marketplace.” For some people here that is good advice. For others it is simply untrue, and it matters a great deal which one you are.

✗ If you are below the poverty line

The marketplace is not an expensive option. It is not an option.

Help with premiums starts at the poverty line. Below it there is no subsidy at all, at any price. That is what makes this a gap rather than a cost problem.

It works this way because the law assumed every state would extend Medicaid up to that line, and Florida did not. What is left for you:

Federally Qualified Health Centers (FQHCs) statewide offer sliding-scale care regardless of insurance status — findahealthcenter.hrsa.gov
Children may qualify for Medicaid or Florida KidCare even when their parents don't
The Family Planning Waiver covers family planning services only, not comprehensive care

✓ If you are above the poverty line

You can buy a plan, but it costs more than it did last year.

The enhanced premium tax credits expired at the end of 2025. Smaller credits still exist for household incomes between 100% and 400% of the poverty line, but the share you pay yourself went up.

Marketplace enrollment in this state went from 4,300,000 to 3,850,000 this year — About 10% — roughly 450,000 fewer enrollees, the largest raw-number drop of any state, driven by the expiration of enhanced premium tax credits at the end of 2025.

Source: KFF marketplace enrollment data, reported by The Conversation and NBC6 Miami, August 2026.

Do this now

Applying is free and you can do it any time of year — Medicaid has no open-enrollment window. If you are not sure whether you qualify, apply anyway and let the state work it out. Deciding for yourself that you don't qualify is the most common way people miss coverage they were entitled to.

Apply or renew ACCESS Florida / MyACCESS (Dept. of Children and Families) Free, and open all year Talk to a person 1-866-762-2237 DCF ACCESS Customer Call Center — apply, renew, report changes, general eligibility questions Statewide Medicaid Managed Care (SMMC) Choice Counselor / enrollment broker 1-877-711-3662 pick or change a health plan once already enrolled (TDD 1-866-467-4970) Florida Medicaid Helpline (AHCA) 1-877-254-1055 problems getting care, plan complaints Nothing else has worked 1-888-419-3456 Ombudsman — independent help with a stuck case

Deaf, hard of hearing or speech-impaired: 7-1-1 (Florida Relay Service).

EnglishSpanishHaitian Creole

The MyACCESS application portal has been available in English, Spanish, and Haitian Creole since its December 2023 relaunch. DCF also provides free interpreter services in any language by request for anyone applying for or using Medicaid — ask for an interpreter when you call the ACCESS Customer Call Center.

If a letter arrives

Most people who lose coverage lose it over paperwork, not eligibility

32% of the coverage losses recorded in Florida were procedural — a form, a deadline, or an address, rather than a real change in whether someone qualified. Which means the letter is usually the thing that decides it.

Agency for Health Care Administration (AHCA), with eligibility determined by the Department of Children and Families (DCF) through ACCESS Florida · Notice of action

NOTICE OF ELIGIBILITY DETERMINATION

Case number: ███████
Date of this notice: 1January 12, 2027

Based on the information available to us, your household is no longer eligible for Florida Medicaid.

2If you believe this determination is incorrect, you may request a fair hearing on or before February 11, 2027.

3Coverage for other members of your household may continue. A separate notice is enclosed for each person.

The clock starts on this date. Not the day the letter reached you, and not the day you opened it. Assume you have less time than it feels like.

You can ask for a fair hearing. It's free, you don't need a lawyer, and asking for one can keep your coverage running while it's reviewed. Call 1-866-762-2237 and say you want to appeal.

Read it person by person. Everyone in the household has a different limit. Your children may still be covered even when you are not — one envelope can mean different things for different people in the same home.

Keep your address current. These notices come by post. An out-of-date address is the single most common reason people lose coverage they still qualify for.

Know your state

What the federal data says about coverage here

Public federal data describes how each state runs its program. Almost all of it is written for policy analysts. Here is what three of those numbers mean if you are the person enrolled.

Procedural disenrollment · CMS

32%

Of people who lost coverage here, this share lost it over paperwork rather than eligibility.

Open every letter. Keep your address current with the agency, not just the post office.

How care is delivered

Managed care

Coverage here runs through private health plans rather than the state paying providers directly. You pick a plan, and your plan decides your network.

Check your doctor is in the plan before you choose it.

15,504 people in Florida are on a waiting list for home and community-based services. If you need long-term care at home rather than in a facility, get your name on the list as early as you can — the wait is measured in years, and it starts when you apply, not when you need it.

Common questions

Questions people ask about this

Does the new Medicaid work requirement apply in Florida?

No. The 80-hour-a-month requirement in H.R. 1 applies only to adults covered through Medicaid expansion, and Florida never expanded Medicaid.

Can an adult with no children get Medicaid in Florida?

Not through income alone. Unless you are 65 or older, blind, or have a disability, there is no pathway at any income — including no income at all.

What is the income limit for parents on Florida Medicaid?

About $486 a month for a family of three, a fixed dollar amount unchanged since July 16, 1996.

Can my children qualify if I don't?

Yes, and it is common. The limit for a child is several times the limit for that child's parent, so families frequently end up with the children covered and the adults not. Apply for the children regardless of your own result.

What changes on January 1, 2027 in Florida?

Back-dated coverage shrinks from 3 months to 2. If you already have unpaid medical bills, applying sooner covers more of them.

How do I apply for Florida Medicaid?

Online at ACCESS Florida / MyACCESS (Dept. of Children and Families), or by phone on 1-866-762-2237. It is free, there is no open-enrollment window, and you can apply at any time of year.

How do I renew Florida Medicaid?

The state reviews eligibility at least once a year and mails or posts a renewal notice. Answer it before the date on the letter, even if nothing has changed. Keep your address and phone number current so the notice reaches you — most people who lose coverage lose it over paperwork, not because they stopped qualifying.

Other states

Guides for neighboring states

The rules change completely at the state line. If you moved recently, or you're helping family somewhere else, start with their state rather than this one.

AlabamaWho actually qualifies GeorgiaPathways and December 31

See all 50 states and Washington, D.C. on the map →

Florida's income limit for parents has been frozen by state law since July 16, 1996 — about $486 a month for a family of three, and it has never been adjusted for inflation in 30 years.

If you're a working parent earning more than that, you will not qualify for Medicaid no matter how low your income feels, and if you have no children at home you cannot qualify at any income unless you are 65+, blind, or disabled.

Applying costs nothing and takes about twenty minutes. If you are anywhere near the line, let the state decide rather than deciding for them.

Apply at ACCESS Florida / MyACCESS (Dept. of Children and Families) →