Are you eligible for Florida Medicaid

Are You Eligible For Florida Medicaid

In this article “Are You Eligible For Florida Medicaid“, you will learn exactly that. Everyone’s situation is different and you might have circumstances which might qualify you beyond the basic requirements. Please visit FL Medicaid Managed Care to apply for benefits. 

What is Medicaid?

Medicaid is a State & Federal program that provides health coverage for select people with low incomes.

Who is eligible for Florida Medicaid?

To be eligible for Florida Medicaid, you must be a resident of the state of Florida, a U.S. national, citizen, permanent resident, or legal alien, in need of health care/insurance assistance, whose financial situation would be characterized as low income or very low income. You must also be one of the following:

  • Pregnant, or
  • Be responsible for a child 18 years of age or younger, or
  • Blind, or
  • Have a disability or a family member in your household with a disability, or
  • Be 65 years of age or older.

To be eligible, you must have an annual household income (before taxes) that is below the following amounts (2021 Chart):

Medicaid Income Chart

*For households with more than eight people, add $5,958 per additional person. Always check with the appropriate managing agency to ensure the most accurate up to date guidelines.

PLEASE NOTE: You might qualify for partial benefits if you income is outside of the the above chart. The best way to find out if you qualify is to APPLY ONLINE

What does the program cover?

There are three different programs that makeup the Statewide Medicaid Managed Care.

Managed Medical Assistance (MMA) Program, Long-term Care (LTC) Program, and Dental Program. Here is a quick breakdown of all to make sure you understand them. 

Managed Medical Assistance (MMA)

Provides medical services like doctor visits, hospital care, prescribed drugs, mental health care, and transportation to these services. Most people on Medicaid will receive their care from a plan that covers MMA services. Services may be different in different regions of the state, the following list of provided services is for region 5 which is Pasco & Pinellas County:

  • Ambulatory Surgical Center Services
  • Assistive Care Services
  • Birth Center and Licensed Midwife
  • Chiropractic
  • Clinic
  • Emergency Care
  • Family Planning Services and Supplies
  • Healthy Start
  • Hearing
  • Home Health and Nursing Care
  • Hospice
  • Hospital
  • Immunizations (shots)
  • Laboratory and Imaging
  • Medical Supplies, Equipment, Prosthesis, and Orthoses
  • Mental Health and Substance Abuse Treatment
  • Nursing Facility
  • Physician, Physician Assistant, and Advance Practice Registered Nurse
  • Podiatric
  • Prescribed Drugs
  • Renal Dialysis
  • Therapy
  • Transportation
  • Visual Aids and Visual Care
  • Well Child Visits

Long-Term Care (LTC)

Provides LTC services like care in a nursing facility, assisted living, or at home. To get LTC you must be at least 18 years old and meet nursing home level of care (or meet hospital level of care if you have Cystic Fibrosis). Please check with your local Medicaid office because services provided might be different where you live, the following services are for region 5 in Florida which is Pasco & Pinellas county. 

  • Adult Companion Care
  • Adult Day Health Care
  • Assistive Care
  • Assisted Living
  • Attendant Nursing Care
  • Behavioral Management
  • Caregiver Training
  • Care Coordination/ Case Management
  • Home Accessibility Adaptation
  • Home Delivered Meals
  • Homemaker
  • Hospice
  • Intermittent and Skilled Nursing
  • Medical Equipment & Supplies
  • Medication Administration
  • Medication Management
  • Nutritional Assessment/Risk Reduction
  • Nursing Facility
  • Occupational Therapy
  • Personal Care
  • Personal Emergency Response System (PERS)
  • Respite Care
  • Physical Therapy
  • Respiratory Therapy
  • Speech Therapy

Dental Program

Provides dental services for children and adults. All people on Medicaid must enroll in a dental plan. If you are 21 years or older, you may be eligible to receive the following dental services (some services may be limited and not all are listed):

  • Dental Exams 
  • Dental X-rays
  • Dentures
  • Extractions (removal of teeth)
  • Pain Management
  • Problem Focused Exam
  • Sedation (dental services while asleep or partly asleep)

Most plan providers offer who are contracted by Florida Medicaid to provide services also offer Expanded Benefits (Services that are covered in addition to your current benefits). Contact your plan for more information but here is a list of some of the services some plans offer. Again your plans expanded benefits might be different:

  • General Expanded Benefits – Available for children and/or adults
  • Cellular Services (minutes and/or data)
  • Circumcision (newborns only)
  • CVS Discount Program (20% discount off certain items)
  • Doula Services (birth coach who helps pregnant women)
  • Home Delivered Meals
  • Housing Assistance (rent, utilities, and/or grocery assistance)
  • Meal Stipend (available for long distance medical appointment day-trips)
  • Over-the-Counter Benefit
  • Swimming Lessons (children only)
  • Transportation Services to Non-Medical Appointments/Activities
  • Adult Expanded Benefits – These services are only available for adults because they are already covered for children on Medicaid when medically necessary
  • Acupuncture Services
  • Art Therapy
  • Behavioral Health
  • Assessment/Evaluation Services
  • Behavioral Health Day Services/Day Treatment
  • Behavioral Health
  • Intensive Outpatient Treatment
  • Behavioral Health
  • Medical Services (e.g., medication management, drug screening, etc.)
  • Behavioral Health
  • Psychosocial
  • Rehabilitation
  • Behavioral Health
  • Screening Services
  • Chiropractic Services
  • Computerized Cognitive Behavioral Therapy
  • Durable Medical Equipment/Supplies
  • Equine Therapy
  • Group Therapy (Behavioral Health)
  • Hearing Services
  • Home Health
  • Nursing/Aide Services
  • Home Visit by a Social Worker
  • Homemaker Services (e.g., hypoallergenic carpet cleanings)
  • Individual/Family Therapy
  • Massage Therapy
  • Medication Assisted Treatment Services
  • Mental Health
  • Targeted Case Management
  • Nutritional Counseling
  • Occupational Therapy
  • Outpatient Hospital Services
  • Pet Therapy
  • Physical Therapy
  • Prenatal Services
  • Primary Care Services
  • Respiratory Therapy
  • Speech Therapy
  • Substance Abuse
  • Treatment or Detoxification Services (Outpatient)
  • Behavioral On-Site Services
  • Vaccine – Pneumonia
  • Vaccine – Influenza
  • Vaccine – Shingles
  • Vaccine – TDaP
  • Vision Services
  • Waived Copayments

Important Notice!

Please DO NOT make any decisions about your coverage based on this article. Requirements change all the time and if you did not qualify before, you might now. Please click on the following picture, it will take you to the Florida Medicaid Website where you can apply or find more up to date information. 

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If you live in Pasco, Hernando, Citrus, Pinellas, Hillsborough, Polk or Sumter counties, you can schedule an in-person appointment with me to discuss your Medicare options. Give me a call at 813-842-1421 or Click Here or the picture below to schedule an appointment on our website. Thank you 

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