Frequently Asked Questions Surrounding Medicaid in Florida

Oct 1, 2021 | Medicaid Planning Legal Blogs | Elder Law P.A

What is Medicaid?

Medicaid is a federal and state health insurance program that covers the cost of healthcare for eligible low-income families, disabled and blind people, children, and those whose income is insufficient to cover the cost of basic medical services. Medicaid is available in all 50 states in the USA. Am I eligible for Medicaid in Florida?


Who Qualifies For Medicaid in Florida?

Am I qualified for Medicaid in Florida? You first need to be a U.S. citizen or a legally residing resident. Some non-citizens, like the DACA recipients, may be eligible for Medicaid if there are funds. However, non-citizens can qualify for labor and delivery services, including emergency treatment, if they can meet the income requirements.

What is the Income Level to Qualify For Medicaid in Florida?

Am I qualified for Medicaid in Florida? The entire household income has to be under the limits set by the Federal Poverty level and is dependent on the size of the family. The same applies to seniors who are applying for long-term care programs. Medicaid also has some programs that may meet eligibility requirements due to pregnancy, medical, or disability exams.

What Does Medicaid Consider as Income?

Any money that you receive from working or money that is given to you is considered income. For example, all unemployment benefits, social security checks, retirement benefits, and child support are considered income. To obtain Medicaid assistance, your family size matters, and the type of Medicaid program you are applying to also matters. The income caps are set every year by the federal government.

Does Having Private Health Insurance Make Me Ineligible for Medicaid in Florida?

It all depends on your income and family size. You may still be eligible for Medicaid but some Medicaid programs mandate that you are not allowed to have any other type of healthcare insurance at the same time.

How Does One Apply for Medicaid in Florida?

  1. To apply for Medicaid, contact the local county social service office who will help guide you through the process.
  2. OR go online to the state’s Medicaid website and use ASSIST to check if you are eligible. This will mean completing a screening questionnaire. If you are eligible, ASSIST will permit you to apply online.
  3. You may complete the Medicaid forms and mail them in. You can call the Medicaid hotline and ask to be directed to the Division of Social Services for help completing the forms.
  4. If you are a senior, you will need to complete the long-term care application as well.

What Documents are Needed for the Medicaid Application?

  1. First, you will need to show proof you are a U.S. citizen. Non-residents (illegal and legal) will need to provide proof of their status in the USA.
  2. Second, you will need proof of your income.
  3. If you are pregnant, you will need a doctor’s report stating that.
  4. You will need some documentation to show that you are a resident of Florida. You can only apply for Medicaid in the state where you reside.

What Healthcare Services are Covered by Medicaid in Florida?

After determining who qualifies for Medicaid in Florida, you can then determine the services that are covered.

Major basic services covered by Medicaid include the following:

  • Doctor visits
  • Prescriptions
  • Lab testing
  • All outpatient and inpatient hospital care
  • X-rays
  • Hospice care
  • Home healthcare
  • Dental care up to age 21
  • Medical transportation services
  • Medical supplies and equipment

The Medicaid benefit packages do vary significantly in each state. Every state has the flexibility to include services like vision and dental care for adults and also determine the duration, amount, and type of services you can receive.

For example, if you are on Medicaid in Florida, chances are unlikely that you will be able to get a liver transplant if you continue to drink alcohol. Plus, you may not have all the preventive services included in the package.

How Long Can I Receive Medicaid Benefits?

Medicaid benefits are not forever but are determined every month. In addition, each year your application will be reviewed to make sure that you meet the eligibility criteria. In some cases, you are supposed to report to Medicaid any changes in your employment or financial status. For example, if you get a job, this must be reported to Medicaid within 10 days.

When Determined Eligible, When Will Medicaid Benefits Start?

If you are approved for Medicaid, the healthcare benefits may take up to three months to start due to the amount of time the paperwork might make getting through the system.

What Can I Do If My Medicaid Application is Rejected?

You always have the option of asking for a fair hearing by the administrative office if you feel that your application was unfairly rejected.

Is It Possible to Develop Medical Debt Under Medicaid?

Unlike private healthcare, it is very rare for participants of Medicaid to incur any debt. The reason is that if you have a low income, all the services will be covered for you. If you are not able to pay your deductible or copayment, then it will be waived depending on your financial status.

Does Medicaid Maintain the Confidentiality of my Information?

Yes, Medicaid prides itself on maintaining full confidentiality of all the information you provide. In fact, there are state and federal laws to ensure that your information remains private. Unauthorized disclosure is extremely rare.

Do Medicaid Benefits Come With Copayments and Deductibles?

Yes, some Medicaid programs do require participants to pay copayments or deductibles for the medical service they receive. However, the following participants do not have to pay copayments:

  • Pregnant females
  • Those needing emergency services
  • Age less than 21
  • Native Americans or tribal members who have enrolled in Medicaid
  • Individuals needing family planning
  • Those who require hospice care
  • Those living in a nursing facility, are disabled, or intellectually impaired

How Much is the Medicaid Copayment?

Unlike private healthcare, Medicaid copayments usually vary from $1.00-$3.00 for the majority of services. There is a one-time $75 copayment if you are admitted to the hospital for medical care.

Can I Select my Medical Provider?

In general, most participants do not have to select a medical care provider from a predetermined list and are free to go to whomever they choose. Some healthcare providers, however, do not accept Medicaid patients. Pregnant women and families with children have to choose a primary care provider who will be responsible for their healthcare and refer them to a specialist if needed.

Does Medicaid Place a Lien on Property?

In general, Medicaid does not place a lien against a property. However, in some cases where the individual is over age 55 and/or permanently institutionalized before age 55, Medicaid may utilize the estate recovery process on the estate. When these individuals die, Medicaid will try to recover the cost of benefits that were paid – but this is only done if there are no siblings, if a spouse is not alive, or if a living child and/or spouse is disabled or blind.

Who qualifies for Medicaid in Florida? There are many questions that arise with the complex issues of qualifying for Medicaid. It is advisable to seek the counsel of an attorney who is experienced with the rules and regulations of Medicaid. Call Elder Law today to speak to a lawyer who can answer your questions.

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