Florida Medicaid: Eligibility, Income Limits, and How to Apply

Florida Medicaid eligibility is decided category by category: children, pregnant women, parents or caretaker relatives, seniors, and people with disabilities each face their own income rules, and the senior and disability categories add an asset test on top. Because Florida has not expanded Medicaid under the Affordable Care Act, most non-disabled adults without dependent children cannot qualify no matter how little they earn. The Agency for Health Care Administration runs the program, but applications go through the Department of Children and Families (DCF).

Who Can Qualify

Florida Medicaid is open to people who fit one of the covered groups and meet that group’s financial rules. The covered groups are low-income children, pregnant women, parents and caretaker relatives of minor children, seniors, and people with disabilities (including those who need long-term care).

Adults who do not have minor children at home and are not pregnant, elderly, or disabled generally cannot qualify in Florida, even with no income at all. This is the coverage gap left by the state’s decision not to expand Medicaid. If you fall into that gap, Medicaid is not the right program to pursue; marketplace coverage or county-level programs may be the next place to look.

Income Limits for Children, Pregnant Women, and Parents

These groups face an income test only. There is no limit on savings, a car, or other assets. Florida uses Modified Adjusted Gross Income (MAGI), and the thresholds are set as a percentage of the Federal Poverty Level (FPL):¹

Infants under age 1: household income up to 206% FPL.
Children ages 1 through 5: up to 140% FPL.
Children ages 6 through 18: up to 133% FPL.
Pregnant women: up to 191% FPL.
Parents and caretaker relatives: approximately 24% FPL, set as a fixed dollar figure rather than a standard percentage.

That parent and caretaker threshold is strikingly low. It works out to a few hundred dollars a month for a family, so a single parent earning even modest wages will usually exceed it. The child, however, can still qualify on their own income rules.

Children whose family income is above the Medicaid limits but below 210% FPL may qualify for Florida KidCare, the state’s separate Children’s Health Insurance Program.¹ KidCare is a separate application, not an automatic rollover, but Medicaid screening often refers families to it.

Income and Asset Limits for Seniors and People With Disabilities

The Aged, Blind, and Disabled (ABD) and Long-Term Care (LTC) categories use a different rulebook. Applicants must pass both an income test and an asset test.

For 2026, the gross monthly income cap for an individual applying for institutional or long-term care Medicaid is $2,982, which is 300% of the federal Supplemental Security Income benefit. Income above that cap is not an automatic disqualification: you can still qualify by setting up a Qualified Income Trust (sometimes called a Miller Trust), which holds the excess income and spends it under Medicaid rules.

The countable asset limit for a single applicant is $2,000. Not everything you own is counted. Key exempt resources include your primary home (as long as the equity falls below the state’s home equity limit, which CMS adjusts annually), one vehicle regardless of value, irrevocable burial contracts and a small burial fund, and personal belongings like household goods and clothing.

When one spouse needs nursing home care and the other stays in the community, Florida lets the community spouse keep a portion of the couple’s combined assets called the Community Spouse Resource Allowance (CSRA). The CSRA figure is adjusted each year. The community spouse can also keep a minimum monthly income allowance drawn from the institutionalized spouse’s income if their own income falls below a set floor. These protections exist so the healthy spouse is not left impoverished.

If Your Income Is Too High: The Medically Needy Program

Florida’s Medically Needy program is a path to coverage for people whose income exceeds the standard limits but who have substantial medical expenses. It works like a monthly deductible. DCF calculates your share of cost based on household size and income, and once your medical bills for the month hit that amount, Medicaid covers the rest of that month.²

You meet the share of cost by sending DCF proof of qualifying medical expenses. What counts: unpaid medical bills that have not been used before, bills you paid within the last three months, health insurance premiums, copays, prescriptions, and even ambulance or transit costs to reach medical care. Over-the-counter items like bandages and cold remedies do not count.²

The share of cost resets each month, so you have to meet it again. One useful detail: expenses from any household member whose income was counted in the eligibility determination can be used, even if that person is not themselves Medicaid-eligible.² You can submit documentation through the MyACCESS portal, by fax, by mail, or in person.

How to Apply

You apply through the Department of Children and Families, not through AHCA. The most common route is the online ACCESS Florida portal at myaccess.myflfamilies.com. You can also mail or fax a paper application, or apply in person at a local DCF office or community partner.

Have these documents ready:

Identity verification such as a birth certificate or driver’s license.
Social Security numbers for everyone in the household.
Proof of Florida residency, like a utility bill or lease.
Current income verification such as pay stubs or an employer letter.
For ABD and LTC applicants, documentation of assets including bank statements and property records.

Federal rules give the state up to 45 days to process a standard application and up to 90 days when a disability determination is required. DCF may contact you during that window asking for more information. Respond quickly. Slow responses to document requests are one of the most common reasons applications stall or get denied.

When Coverage Begins

For most adults age 21 and older who are not pregnant, Florida Medicaid coverage starts on the first day of the month in which you file your application. Florida eliminated the three-month retroactive coverage window for this group in February 2019, so medical bills from before the application month generally will not be covered.

Retroactive coverage of up to three months before the application date is still available for children under 21 and for pregnant women. If you fall into one of those groups and had qualifying medical expenses in the three months before you applied, those bills may be covered as long as you were otherwise eligible during that time. If you have outstanding hospital bills, the timing of your application can directly affect what you owe.

Keeping Your Coverage

Medicaid eligibility is not permanent. DCF reviews each case periodically, and you must complete a renewal (also called redetermination) to keep coverage. The agency mails a renewal notice to the address on file, and missing the deadline results in automatic termination.

The most common reason people lose coverage they still qualify for is a missed renewal, usually because the notice went to an old address. Log into MyACCESS regularly and keep your mailing address, phone number, and email current. If a renewal packet comes back undeliverable, DCF will close the case without further contact.

If your coverage is terminated and you think the decision was wrong, you can request a fair hearing to appeal. Timing matters: a hearing request filed before the termination takes effect can keep benefits active while the appeal is pending. If you miss that window, you may still be able to reapply, and in some situations receive retroactive reinstatement.

1
Medicaid.gov. Medicaid, Children’s Health Insurance Program, and Basic Health Program Eligibility Levels
2
Department of Children and Families (Florida). Medically Needy Program: An Explanation of Share of Cost