Florida Medicaid Gold Card Providers

Date:

Florida Medicaid Eligibility Guidelines

COVID-19: Florida Makes Medicaid Changes (CMS Approves)

To qualify for Medicaid in Florida, an individual must meet the eligibility requirements of the program.

There are several Medicaid programs that people in Florida can be eligible for. Each program has its own income and asset requirements.

However, all applicants must meet the general requirements below in order to qualify for Florida Medicaid.

Florida Department Of Children And Families

The Florida Department of Children and Families also maintains regional facilities for your convenience.

Central Region Brevard, Citrus, Hardee, Hernando, Highlands, Lake, Marion, Orange, Osceola, Polk, Seminole, Sumter

Northeast Region Alachua, Baker, Bradford, Clay, Columbia, Dixie, Duval, Flagler, Gilchrist, Hamilton, Lafayette, Levy, Madison, Nassau, Putnam, St. Johns, Suwannee, Taylor, Union, Volusia

Northwest Region Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Okaloosa, Santa Rosa, Wakulla, Walton, Washington

Southeast Region Broward, Indian River, Martin, Okeechobee, Palm Beach, St. Lucie

Southern Region Dade, Monroe

SunCoast Region Charlotte, Collier, DeSoto, Glades, Hendry, Hillsborough, Lee, Manatee, Pasco, Pinellas, Sarasota

The Agency for Health Care Administration also provides information several state health care related topics. This includes things such as Civil Rights Compliance, Complaint Investigations of Facilities, Financial Statements for the ACHA, Hospital Financial Data, Recipient and Provider Assistance, and many more. To access a complete list of information topics, go here.

Thank you, Matt. You’re very knowledgeable, patient and easy to talk to. You gave me some great ideas I had no idea I would be qualified for.

Wendy G. – TN

Satisfied Client

I want to applaud how helped me save a bunch of money on my Medicare, by making a few simple changes. Thank you!

Randy Y. – AZ

How Many People Are On Medicaid

According to the Centers for Medicare & Medicaid Services, as of July 2020, here are the number of people enrolled in Medicaid and Chip in the entire United States:

  • 75,521,263 individuals were enrolled in Medicaid and CHIP
  • 68,826,573 individuals were enrolled in Medicaid
  • 6,694,690 individuals were enrolled in CHIP

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Unitedhealthcare Connected For Mycare Ohio

UnitedHealthcare Connected® for MyCare Ohio is a health plan that contracts with both Medicare and Ohio Medicaid to provide benefits of both programs to enrollees. If you have any problem reading or understanding this or any other UnitedHealthcare Connected® for MyCare Ohio information, please contact our Member Services at from 7 a.m. to 8 p.m. Monday through Friday for help at no cost to you.

Si tiene problemas para leer o comprender esta o cualquier otra documentación de UnitedHealthcare Connected® de MyCare Ohio , comuníquese con nuestro Departamento de Servicio al Cliente para obtener información adicional sin costo para usted al de lunes a viernes de 7 a.m. a 8 p.m. .

How Do I Apply For Medicaid In Florida

Activate Florida Medicaid Gold Card

You can apply for Florida Medicaid online by completing an application you will find here.

You can also complete a hard copy paper application that can be mailed, faxed or returned in person to any ACCESS Service Center location.

To get a hard copy of the Florida Medicaid application, go here.

There are also several community partner agencies that help the Department of Children and Families provide access to all forms of public assistance, including Medicaid. To find a local community partner agency near you, go here.

You will need to provide your full name, Social Security number and birthdate as well as any citizenship or immigration documentation. Income and employer information will also be required, and you will also need to provide details on any existing healthcare coverage or potential healthcare coverage through your employer.

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Medicaid Expansion In Florida

Florida is one of 12 states that, as of August 2020, has not expanded Medicaid eligibility as allowed under the Affordable Care Act .

This means that adults without dependents who have low income cannot qualify for Medicaid, like residents in the 38 states that have expanded Medicaid.

In Florida, if Medicaid had been expanded under the ACA, some 391,000 people who do not currently have coverage would gain coverage.

Republicans control Floridas House and Senate as well as the governors office.

Democrats in the Florida legislature have been pushing for Medicaid expansion for years, but have consistently been blocked by Republicans.

Insurance & Contracted Managed Care Plans

The list of insurance & contracted managed care plans provided on this page is for reference purposes only and is subject to change. Check with your health plan to confirm that Cleveland Clinic is included.

Cleveland Clinic may participate in some, but not all, products offered by a health plan. Coverage limitations are dependent on individual group contracts.

For questions about insurance coverage and specific plan products including Medicare and our Las Vegas location, please contact your insurance carrier directly.

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Florida Medicaid Income Limit Charts

The FL Medicaid eligibility income limit charts are divided by groups.

For example, the first chart is focused on income limits for children who qualify for Medicaid.

Similarly, the second chart below focuses on the Medicaid income limits for adults in Florida who qualify for Medicaid.

Florida Medicaid Income Limit for Children

Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.

Florida Medicaid Income Limit Children
Children Medicaid Ages 0-1
N/A

How to Read the Florida Medicaid Income Limits Charts Above

You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.

Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.

For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 191% of the Federal Poverty Level which for a family of two is $33,272 as shown in the chart above.

The Difference Between Medicaid And Medicare

Medicaid fraud investigation

The federal government administers two healthcare related programs to assist individuals. One is Medicaid and the other is Medicare. Although they sound alike and are sometimes confused with each other, they are distinctly different.

The main difference is that Medicaid is an assistance program and Medicare is an insurance program.

Medicare helps people who are 65 and over or who have qualifying conditions under age 65 by providing coverage for their medical bills. Medicare is divided into four parts known as Part A, Part B, Part C and Part D. Each provides certain types of coverage. For some services and coverages, beneficiaries may need to pay a monthly premium. If a person has paid into Medicare throughout their working life, then some parts of Medicare will be free. Medicare is strictly a federal program and is administered uniformly throughout the United States.

Medicaid is an assistance program and has no age restrictions. It is based purely on need and will provide benefits if a person falls below certain income and asset levels. Most all services are provided at no cost, except in a few limited cases. Although Medicaid adheres to federal guidelines, it is administered by state and local governments.

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Ahcamyfloridacom Medicaid Pdffilesagency For Health Care Administration Using Floridamedicaid

If visiting outside of Florida, FloridaMedicaid will pay only for emergency care, or care that has been arranged and approved by FloridaMedicaid ahead of time. If an out-of-state provider is willing to accept FloridaMedicaid, let that provider use your gold card or health plan membership card to verify your eligibility. APPEAL RIGHTS

Already Enrolled In Florida Medicaid

If you want to switch from your current Medicaid plan and enroll in Humana Healthy Horizons in Florida, you can:

  • Text ENROLL to FLSMMC
  • You will need the Medicaid ID number for each member and the account PIN number.
  • Create a Member Portal Account or chat with a virtual enrollment assistant.
  • Call the Helpline to speak with a Choice Counselor at 1-877-711-3662
  • To pick a new plan, you will need each members birth year and Medicaid ID or Gold Card number.

    Read Also: Family Of Three Income For Medicaid

    Florida Medicaid Expansion Update

    Florida is one of 12 states that, as of August 2020, has not expanded Medicaid eligibility as allowed under the Affordable Care Act .

    This means that adults without dependents who have low income cannot qualify for Medicaid, like residents in the 38 states that have expanded Medicaid.

    In Florida, if Medicaid had been expanded under the ACA, some 391,000 people who do not currently have coverage would gain coverage.

    Republicans control Floridas House and Senate as well as the governors office.

    Democrats in the Florida legislature have been pushing for Medicaid expansion for years, but have consistently been blocked by Republicans.

    What Is The Medically Needy Program

    MEPS State Specific Showcards

    This program can help pay for Medicaid-covered services. Beneficiaries enrolled in this program have income or assets that exceed the limits for regular Medicaid.

    Before Medicaid benefits can be approved, an enrollee must meet their share of cost meaning that they must pay a portion of the medical bills they incur before Medicaid benefits kick in. This is similar to what a deductible would be in a health insurance policy. The amount of share of cost is based on a familys monthly income.

    Once an individual meets the share of cost for the month, the individual must contact DCF to complete bill tracking and approve Medicaid for the remainder of the month.

    Information about this program can be found in the Medically Needy Brochure.

    Read Also: Pediatricians In Amarillo Tx That Accept Medicaid

    How Do I Change My Florida Medicaid Plan

    After you have enrolled in a Medicaid plan, you can change your choice in several ways.

    The easiest way is to go online to the Statewide Medicaid Managed Care page and log on to your account. From there you will be taken through the steps to make your desired changes.

    If you cant make a change online, you can access the MMA automated phone system at 1-877-711-3662. You will need your pin number to access your account

    Florida Medicaid also offers counselors that are available to assist with changes by calling 1-877-711-3662, Monday through Thursday, 8 am to 8 pm, and Friday from 8 am to 7 pm. TDD users only should call 1-866-467-4970.

    You will need to make sure you have your Florida Medicaid number or Social Security number and birth year for each person you want to make changes.

    Be Careful About Medicare Scams

    Protect yourself and your loved ones by learning about the most common Medicare scams and how to determine whether communication from your doctor, your insurer or the Centers for Medicare & Medicaid Services is legitimate. Scams claiming to be with Medicare are targeting patients and fraudulent activity tends to increase around the Medicare Open Enrollment period. Remember, if you get a phone call and you’re even slightly suspicious, do not share your ID number, home address or other personal information. Hang up and call your doctor or Medicare at the number on your card. Report anything suspicious to Medicare. If you suspect fraud, call 1-800-MEDICARE.

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    When Is Florida Medicaid Open Enrollment

    People can apply for Medicaid at any time in Florida. Those who are accepted can also make changes in their plan online, by phone or in person at statewide customer service centers.

    Medicaid applications in Florida can also be filed through the Health Insurance Marketplace for those seeking coverage. Open enrollment for Marketplace insurance is typically offered for those who may not qualify for Medicaid or who may want different benefits than what Medicaid offers. Open enrollment runs for about six weeks in October, November or December each year and gives applicants the ability to sign up for healthcare coverage during that time.

    There are also supplemental enrollment periods that accommodate people who may qualify due to life events such as losing other coverage, getting married or having a baby.

    How Do I Find My Florida Medicaid Number

    Florida Medicaid

    Your Florida Medicaid identification number is not listed on your gold card. Your Florida Medicaid number is kept in your Florida Medicaid file.

    Any Medicaid provider can use your gold card or health plans membership card to check the Florida Medicaid file to find out if you are eligible for Florida Medicaid services.

    Read Also: Georgia Application For Medicaid And Medicare Savings

    Who Qualifies For Florida Medicaid

    In Florida, the Department of Children and Families determines eligibility for public assistance programs, including Medicaid. Federal regulations and Florida Statute and Administrative Rules contain the specific polices that must be adhered to for eligibility. For those people who receive Supplemental Security Income, the Social Security Administration will determine eligibility.

    He or she who qualifies for Florida Medicaid must be a U.S. citizen or a qualified non-citizen, must be a Florida resident, and must provide Social Security numbers to facilitate data matching. Eligibility may be verified electronically through the Federal Data Services Hub.

    Applicants must also apply for all benefits to which they are entitled including pensions, Social Security and Medicare benefits. Income from wages and self-employment is also used to determine eligibility as well.

    Family-Related Medicaid is based on need and there are strict income limits for those who want to receive benefits. Income limits are based on the expected tax filing status for each applicant. A households countable income, after allowable deductions, must be less than the applicable income limits. To view the 2018 limits for each target group, go here.

    Households with income that exceeds limits for Family-Related Medicaid will be enrolled in the Medically Needy Program. Those applicants may be referred to the Federally Facilitated Marketplace or the Childrens Health Insurance Program.

    Florida Medicaid Income Limits Summary

    We hope this post on Florida Medicaid Income Limits was helpful to you.

    If you have any questions about Medicaid in the state of Florida, you can ask us in the comments section below.

    Help us spread the word! If you found this post on Florida Medicaid Income Limits helpful, help us spread the word by sharing it using the Share this button below.

    Be sure to check out our other articles about Medicaid.

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    Where Can I Find A Doctor That Accepts Medicare And Medicaid

    To find a doctor that accepts Medicare payments, you may want to visit the Centers for Medicare and Medicaid Services’ Physician Compare. You can search by entering a health care professionals last name or group practice name, a medical specialty, a medical condition, a body part, or an organ system. This tool will provide you with a list of professionals or group practices in the specialty and geographic area you specify, along with detailed profiles, maps and driving directions.

    Please note that Physician Compare only lists professionals that accept Medicare. Although some may also accept Medicaid, it does not have information about which professionals do accept Medicaid.

    Medicaid programs vary by state and each state Medicaid agency maintains their own list of professionals that accept Medicaid. For further assistance, please contact your health plan or state Medicaid agency. For more information about Medicaid, visit the Medicaid & CHIP page on Healthcare.gov.

    If you have trouble accessing the Physician Compare website, please call 1-800-MEDICARE and a representative will be able to run the search for you. They can also send you a print version of the search results.

    There are other directories on MedlinePlus that will help you find health professionals, services, and facilities, some of which may serve Medicare or Medicaid payments.

    Unitedhealthcare Dual Complete Plans

    How can I get a gold Medicaid card ...

    Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies, a Medicare Advantage organization with a Medicare contract and a contract with the State Medicaid Program. Enrollment in the plan depends on the plans contract renewal with Medicare. This plan is available to anyone who has both Medical Assistance from the State and Medicare. This information is not a complete description of benefits. Call TTY 711 for more information. Limitations, co-payments, and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year.

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    Can A Single Person Get Medicaid In Florida

    Unfortunately, no. That is because Florida is one of 12 states that, as of August 2020, has not expanded Medicaid eligibility as allowed under the Affordable Care Act .

    This means that adults without dependents who have low income cannot qualify for Medicaid, like residents in the 38 states that have expanded Medicaid.

    In Florida, if Medicaid had been expanded under the ACA, some 391,000 people who do not currently have coverage would gain coverage.

    Republicans control Floridas House and Senate as well as the governors office.

    Democrats in the Florida legislature have been pushing for Medicaid expansion for years, but have consistently been blocked by Republicans.

    What Is Medicaid In Florida

    Medicaid is a federal and state health insurance program for people with a low income.

    It provides free or low-cost health coverage to millions of Americans, including families and children, pregnant women, the elderly, and people with disabilities.

    The Childrens Health Insurance Program offers health coverage to children in families with incomes too high to qualify for Medicaid, but who cant afford private coverage.

    The Medicaid program is different in every state. The federal government sets the general guidelines and each state decides how to run the program.

    Florida implemented the Medicaid program on January 1, 1970, to provide medical services to low-income people.

    The Florida State Legislature determines who qualifies for Medicaid, what services will be covered, and how much to pay for the services.

    The state agency that administers Florida Medicaid is the Agency for Health Care Administration .

    Also Check: Michigan Pregnancy Medicaid Income Limits

    Florida Medicaid Income Limit

    The Florida Medicaid Income Limit is calculated as a percentage of the Federal Poverty Line.

    To qualify, you must meet the Florida Medicaid Income limits listed below.

    Here is the Federal Poverty Level for 2021.

    2021 Federal Poverty Levels for the 48 Contiguous States & D.C.
    Household Size

    Additionally, to be eligible for Medicaid, you cannot make more than the income guidelines outlined below:

    • Children up to age 1 with family income up to 206 percent of FPL
    • Any child age 1-5 with a family income up to 140 percent of FPL
    • Children ages 6- 18 with family income up to 133 percent of FPL
    • CHIP for children with family income up to 210 percent of FPL
    • Pregnant women with family income up to 191 percent of FPL
    • Parents of minor children with family income up to 28 percent of FPL
    • Individuals who are elderly, blind, and disabled with family income up to 88% of the FPL

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