Who Qualifies for Florida KidCare: Age, Income, and Residency

A child qualifies for Florida KidCare if they are under 19, live in Florida, are a U.S. citizen or an eligible immigrant, and live in a household whose income falls at or below 300% of the Federal Poverty Level.¹ Families above that income line can still buy in at the full monthly rate. A handful of other situations, mostly tied to other insurance the child already has access to, can disqualify a child who otherwise meets those four tests.

Age and Residency

The child must be under 19 and must live in Florida.² Coverage runs through the last day of the month in which eligibility ends, including the month a child turns 19.³

One narrow exception extends coverage past the 19th birthday. A child who turns 19 while pregnant can keep her coverage through the pregnancy and the 12-month postpartum period, provided she doesn’t qualify for Medicaid on her own.¹

Residency is based on where the family actually lives. Moving out of state ends eligibility mid-year.

Citizenship and Immigration Status

Eligible children include U.S. citizens, eligible immigrants, and lawful permanent residents.² The eligible non-citizen categories cover refugees, individuals granted asylum, and lawful permanent residents who previously held refugee or asylee status or have held permanent resident status for at least five years.⁴

The five-year wait for some lawful permanent residents comes from a 1996 federal law that bars most qualified immigrants from federal means-tested benefits during their first five years in the country.⁵ Undocumented children are not eligible for any Florida KidCare program.

Income Limits

Income is the main gating test, and it determines not just whether a child qualifies but how much the family pays. Florida KidCare uses your household’s adjusted gross annual income, compared against the Federal Poverty Level for your family size.² Subsidized coverage reaches up to 300% of the FPL.¹

The 2025 income tiers work like this:

Up to 133% of the FPL: Medicaid for Children, no monthly premium.
133% to 158% of the FPL: $15 per month for all eligible children in the household combined.
158% to 200% of the FPL: $20 per month for all eligible children in the household combined.
Above 200% of the FPL: full-pay coverage at $248.21 per child per month (MediKids, ages 1–4) or $276 per child per month (Florida Healthy Kids, ages 5–18, dental included).

In the subsidized tiers, the $15 or $20 covers every eligible child in the household. In the full-pay tier, the premium is charged per child.⁶

For a family of four, the 2025 numbers translate to Medicaid eligibility up to roughly $42,760, the $15 tier up to about $50,797, and the $20 tier up to about $64,300. Above that, the family moves into full-pay.⁷ The thresholds update each year with the federal poverty guidelines.

Out-of-pocket costs for subsidized coverage are capped at 5% of your family’s gross annual income per plan year.³

If You’re Self-Employed

Self-employment income is counted as net profit after business expenses, the same figure you’d report on your tax return. Self-employment deductions that reduce your adjusted gross income on IRS Form 1040, like the deductible portion of self-employment tax, also reduce your income for KidCare purposes.

Situations That Disqualify an Otherwise-Eligible Child

A child can meet the age, residency, immigration, and income tests and still be shut out of the subsidized program in a few specific situations:

The child has access to a family member’s employer or group health plan, and adding the child would cost 5% or less of family income. If the cost exceeds 5%, the child can still enroll in subsidized KidCare.
The child’s private or employer-sponsored coverage was voluntarily canceled in the last 60 days. Exceptions apply for job loss, an employer dropping coverage, a child’s serious medical condition, domestic violence, exhausted COBRA, or coverage that cost more than 5% of family income.
The child was covered by the same employer’s group plan in the 60 days before applying (this blocks premium assistance through KidCare).
The child is an inmate of a public institution or a patient in an institution for mental diseases.

These exclusions apply to the subsidized, CHIP-funded portion of KidCare. A child who would have qualified for Medicaid under the rules in place on June 1, 1997, can still receive Medicaid regardless.⁸

Children With Special Health Care Needs

Children with chronic conditions or complex medical needs who meet the same age, residency, immigration, and income rules can be assigned to the Children’s Medical Services (CMS) Health Plan after a medical or behavioral screening identifies their needs.³ You don’t apply to CMS separately. The single Florida KidCare application sorts your child into whichever of the four programs fits.

Staying Qualified: The 12-Month Rule

Once a child is enrolled, coverage lasts a full 12 months without mid-year income rechecks, as long as the premium is paid.¹ A raise or a new job during the year won’t knock your child off the plan. At the end of the 12 months, you renew, and the state looks at income again. The most common reason children lose coverage is simply failing to complete the renewal, so keeping your mailing address, phone, and email current with Florida KidCare matters.³

If You’re Denied

You can request a fair hearing if your child is denied coverage or loses eligibility. Appeals go through the Florida Department of Children and Families, Office of Inspector General, Appeal Hearings Section, and can be requested at a local DCF office, through the Customer Call Center, or directly with the Appeal Hearings Section in Tallahassee.⁹

For Medicaid-related denials, you have 90 days from the date of the notice to request a hearing. If you file the request before your child’s current coverage ends, the state may be required to keep coverage in place while the appeal is pending, so acting early protects your child from a gap.

1
Florida Legislature. Florida Statutes 409.814 – Eligibility
2
Florida KidCare. Requirements
3
Florida KidCare. FAQs
4
Florida Department of Children and Families. Immigration Issues Regarding Florida KidCare
5
Office of the Assistant Secretary for Planning and Evaluation. Summary of Immigrant Eligibility Restrictions Under Current Law
6
Florida KidCare. Cost
7
Florida KidCare. 2025 General Annual Income Guidelines
8
Florida Senate. Florida Statutes 409.814 – Eligibility
9
Florida Department of Children and Families. Appeal Hearings