The share of cost in Florida is a monthly dollar amount of medical expenses you have to rack up before Medicaid starts paying for the rest of that month. It works like a monthly deductible inside Florida’s Medically Needy program, which covers people who would qualify for Medicaid except that their income or assets are too high. The amount is set by the Department of Children and Families (DCF) based on your household size and income, and it resets to zero on the first of every month.
How the Monthly Amount Is Calculated
DCF uses a simple subtraction: your household’s countable monthly income minus the Medically Needy Income Level (MNIL) for your household size equals your share of cost.1Florida Department of Children and Families. Economic Self Sufficiency Frequently Asked Questions The MNIL is $180 per month for a single person and $241 for a household of two, with the figure rising for larger households.2Legal Information Institute. Florida Administrative Code 65A-1.716 – Income and Resource Criteria
A quick example. If you live alone and bring in $1,000 in countable monthly income, subtract the $180 MNIL and your share of cost is $820. You need $820 in qualifying medical expenses each month before Medicaid activates.3Florida Department of Children and Families. Medically Needy Program
The MNIL already includes a standard income disregard, so DCF does not apply any additional disregards when calculating your amount.4Florida Department of Children and Families. Appendix A-7 Family-Related Medicaid Income Limit Chart
Who Can Use This Pathway
Not everyone with medical bills qualifies, no matter how high the bills are. Florida limits the Medically Needy program to families with children, pregnant women, children under 21, adults 65 and older, and people who are blind or disabled. You have to fit one of those categories and be over the income or asset limits that would otherwise apply.5Florida Senate. Florida Statutes 409.904 – Optional Payments for Eligible Persons
A working-age adult with no children and no disability generally cannot use share of cost, even with catastrophic bills. That’s the gap that surprises most applicants.
Asset Limits
Resources matter too. For SSI-related coverage (aged, blind, or disabled), the asset limit is $5,000 for one person and $6,000 for a couple. For the family-related pathway, the resource limit is effectively $0.2Legal Information Institute. Florida Administrative Code 65A-1.716 – Income and Resource Criteria Your primary home and one vehicle are typically excluded. Bank accounts, investments, and additional property generally count.
Expenses That Count Toward the Total
The list of qualifying expenses is wider than most people assume. DCF accepts:3Florida Department of Children and Families. Medically Needy Program
- Unpaid medical bills you haven’t previously used to meet a share of cost
- Medical bills you paid out of pocket within the last three months
- Health insurance premiums for medical coverage
- Uninsured medical costs that no other source will cover
- Co-pays on insured medical visits
- Any treatment or service prescribed by a doctor
- Medical transportation, including ambulance rides and bus or taxi fare to appointments
The old-bills rule is the one people miss. An outstanding hospital bill from two months ago that you never applied toward a share of cost can still count this month, and that single detail sometimes decides whether you qualify.
Two things don’t count: premiums for indemnity policies that pay you cash for being hospitalized, and over-the-counter items like bandages or cold medicine.3Florida Department of Children and Families. Medically Needy Program
Meeting the Amount Each Month
Every month starts fresh. Once you’ve incurred enough qualifying expenses to hit your share of cost, contact DCF and submit the bills. DCF verifies them through a process called bill tracking, then approves Medicaid coverage for the rest of that month.1Florida Department of Children and Families. Economic Self Sufficiency Frequently Asked Questions
Timing shapes what you actually get. Hit your amount on the 25th and Medicaid only pays for the last few days of the month. A single big hospital visit early in the month usually satisfies the whole amount at once; smaller expenses like prescription co-pays and office visits take longer to accumulate. Keep every bill, receipt, and explanation of benefits organized so you can submit quickly.
On the first of the next month, everything resets. Excess expenses do not carry over.
What Medicaid Covers Once You’re Approved
After DCF approves you for the month, you get standard Medicaid benefits with one significant exception: the Medically Needy program does not cover care in skilled nursing facilities or intermediate care facilities for people with developmental disabilities.5Florida Senate. Florida Statutes 409.904 – Optional Payments for Eligible Persons If long-term nursing home care is what you need, a different Medicaid pathway with different rules applies.
Confirm before scheduling. Not every provider accepts Medically Needy coverage, so call the office and ask whether they participate.3Florida Department of Children and Families. Medically Needy Program
How to Apply
Applications go through DCF. The fastest route is the MyACCESS online portal at myaccess.myflfamilies.com, and you can also apply in person at a DCF service center or by fax.3Florida Department of Children and Families. Medically Needy Program DCF decides both whether you qualify and what your monthly amount will be.
Report income and household changes when they happen. A drop in income lowers your monthly obligation; a raise can push it up.