Florida has not expanded Medicaid under the Affordable Care Act and remains one of ten states that have declined to do so. Without expansion, the state’s program covers only narrow groups: children, pregnant women, seniors, people with disabilities, and parents with very low incomes. An estimated 260,000 Floridians fall into a coverage gap where they earn too much for Medicaid but too little for marketplace subsidies. Childless adults without a qualifying disability are shut out of Medicaid entirely, no matter how little they earn.
Why Florida Has Not Expanded
The Affordable Care Act originally required every state to extend Medicaid to adults earning up to 138% of the federal poverty level. In 2012, the Supreme Court struck down that mandate in National Federation of Independent Business v. Sebelius, ruling that the federal government could not pull existing Medicaid funding from states that refused to expand. Expansion became a state-by-state choice, and Florida’s legislature has consistently declined.
The legislature’s recurring objection centers on long-term costs if the federal government ever reduces its share. For states that do expand, the federal government currently covers 90% of costs for the newly eligible population, leaving the state to pay the remaining 10%. Florida’s traditional Medicaid program receives a lower federal match that varies year to year. Because the state has not expanded, it receives none of the enhanced funding and continues to operate under the narrower eligibility rules that existed before 2010.
Who Qualifies for Florida Medicaid Right Now
Eligibility is split by category. You have to fit one of the categories first; the income test comes second. The federal poverty level for a single person in 2026 is $15,960 per year.1HHS ASPE. 2026 Poverty Guidelines: 48 Contiguous States
Children
Children in families earning up to 133% of the federal poverty level qualify for Medicaid with no monthly premium. For a family of four, that comes to about $43,890 a year. Children in families earning between 133% and 200% of the poverty level can enroll in Florida KidCare, the state’s Children’s Health Insurance Program, for a monthly premium of $15 or $20 depending on the child’s age.2Florida KidCare. 2025 General Annual Income Guidelines
Pregnant Women
Pregnant women qualify if their household income is at or below about 191% of the federal poverty level, which includes a standard 5% income disregard. Coverage runs through the pregnancy and continues for a full twelve months after delivery.3Florida Department of Children and Families. FINAL April 2024 MFAM Fact Sheet Before Florida adopted the longer timeline, coverage ended just 60 days after birth.
Seniors and People With Disabilities
Residents aged 65 or older and people with qualifying disabilities face both income and asset tests. For someone who needs nursing-home-level care through the Institutional Care Program, the monthly income cap is approximately $2,982 in 2026. Total countable assets must stay below $2,000 for an individual or $3,000 for a married couple.4Florida Department of Children and Families. Chapter 1600 Assets Program MFAM – 1640.0000 SSI-Related Medicaid, State Funded Programs Eligibility for seniors and people with disabilities uses income-counting methods from the Supplemental Security Income program rather than the modified adjusted gross income rules that apply to children and pregnant women.5Medicaid.gov. Eligibility Policy
Parents and Caretaker Relatives
Here is where Florida’s rules are harshest. Parents and caretaker relatives of dependent children qualify only if their income falls below roughly 27% of the federal poverty level. For a family of three, that translates to a monthly income limit of just a few hundred dollars.6Florida Department of Children and Families. Appendix A-7 – Family-Related Medicaid Income Limit Chart A parent working part-time at minimum wage can easily exceed that threshold.
Childless Adults
Adults without a dependent child and without a qualifying disability are not eligible for Florida Medicaid at any income level. This is the group most directly affected by Florida’s decision not to expand.
The Coverage Gap
Florida’s narrow eligibility rules collide with federal subsidy rules to create a gap where no affordable coverage exists. Under the Affordable Care Act, premium tax credits for marketplace plans are available starting at 100% of the federal poverty level, $15,960 for a single person in 2026.1HHS ASPE. 2026 Poverty Guidelines: 48 Contiguous States Congress designed the law assuming every state would expand Medicaid to cover everyone below 138% of poverty, so it never created subsidies for people earning under 100%.
In Florida, that assumption breaks. A childless adult earning $12,000 a year makes too much for Florida Medicaid (which doesn’t cover childless adults at all) and too little for marketplace subsidies (which start at 100% of poverty). Even parents can land in the gap: a single parent earning $10,000 exceeds Florida’s roughly 27% threshold for caretakers but falls well below the marketplace’s 100% floor. An estimated 260,000 Floridians have no realistic path to affordable health coverage as a result.
There is an additional concern for 2026. The enhanced premium tax credits from the Inflation Reduction Act, which made marketplace coverage significantly cheaper for people above 100% of poverty, were scheduled to expire at the end of 2025. If Congress did not extend them, Floridians just above the poverty line face sharply higher premiums even though they technically qualify for marketplace plans. The gap itself persists regardless.
What To Do If You Fall in the Gap
Two limited fallbacks exist, and neither is a true substitute for insurance.
The first is Florida’s Medically Needy program, often called “Share of Cost.” If your income exceeds the Medicaid limit for your category, the state calculates the difference between your income and a set threshold, and that difference becomes your share of cost for the month. Once you accumulate enough qualifying medical expenses to meet it, Medicaid covers your care for the rest of the month.7Florida Department of Children and Families. 2024 Medically Needy Brochure Qualifying expenses include unpaid medical bills, prescriptions, insurance premiums, copays, and ambulance transportation. The share of cost resets to zero every month. The program still requires you to fit one of Florida’s eligible categories, so it doesn’t help childless adults who fall outside those groups.
The second is a federally qualified health center. These clinics are required to see patients regardless of ability to pay and must offer a sliding fee scale to anyone earning below 200% of the poverty level.8CMS. Federally Qualified Health Center Emergency rooms remain another fallback for acute conditions, though they generate bills that uninsured patients often cannot pay.
Could Florida Expand in the Future?
After years of legislative inaction, advocates are trying to go around the Florida legislature through a constitutional amendment. An organizing committee originally aimed for the 2026 ballot. That shifted after the legislature passed HB 1205 in 2025, imposing stricter regulations on petition signature drives, and the campaign announced in late 2025 that it would target the 2028 ballot instead.9KFF. Status of State Medicaid Expansion Decisions
Getting a constitutional amendment on Florida’s ballot requires valid signatures from registered voters equal to 8% of the votes cast in the most recent presidential election, with that threshold met in at least half of the state’s 28 congressional districts.10Florida Department of State. Constitutional Amendments/Initiatives The exact signature count for 2028 will be calculated from 2024 presidential turnout and will likely exceed 900,000. Reaching the ballot is only the first obstacle. Florida requires a 60% supermajority to approve any constitutional amendment.
The proposed amendment would expand Medicaid to all adults with household incomes up to 138% of the federal poverty level, roughly $22,000 a year for an individual. That would bring Florida in line with the 40 states (plus Washington, D.C.) that have already adopted expansion.9KFF. Status of State Medicaid Expansion Decisions Proponents point to a financial incentive still available under the American Rescue Plan Act: states that newly expand receive a temporary five-percentage-point bump in their base federal matching rate for two years, on top of the standard 90% match for the expansion population.11KFF. New Incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending Whether that incentive survives until 2028 depends on future federal legislation. Prior expansion campaigns, including a suspended 2020 effort, never made it past the signature-gathering phase.
How To Apply and What To Do If You Are Denied
You can apply for Florida Medicaid through the Department of Children and Families. The main method is the MyACCESS online portal, which lets you submit an application, upload documents, and check your case status. You can also apply in person at a local DCF office or by phone.
Federal rules set firm deadlines on how long the state can take. For most applicants, the state must make an eligibility decision within 45 days. If your application is based on a disability, the deadline extends to 90 days to allow time for medical documentation.12CMS. CMCS Informational Bulletin: Ensuring Timely and Accurate Medicaid and CHIP Eligibility Determinations at Application
If Florida denies your application or terminates your coverage, you have a federal right to challenge the decision through a fair hearing. The state must send written notice explaining the specific reasons and your right to appeal. You have up to 90 days from the date of that notice to request a hearing.13eCFR. Subpart E Fair Hearings for Applicants and Beneficiaries These protections apply regardless of whether Florida expands. Many denials stem from missing paperwork or data-entry errors rather than genuine ineligibility, so filing the appeal is worth the effort.