Who is eligible for Medicaid and How to get it?

Eligibility Requirements

To qualify for Medicaid, an individual must meet specific eligibility requirements, such as income, assets, age, citizenship or resident alien status, and Florida residency. The individual must have a social security number or proof of having applied for one.

Who Determines Eligibility

Eligibility for Medicaid is determined by the Florida Department of Children and Families (DCF), Office of
Economic Self-Sufficiency and by the federal Social Security Administration (SSA).

Eligibility Determined by the Department of Children and Families

The Department of Children and Families determines eligibility for the following groups who have income and resources within established limits:low-income families with children and their caretakers, pregnant women, children in foster care, special-needs adoptees, low-income individuals who are age 65 and older, low-income individuals who are blind or permanently and totally disabled, and low-income individuals in need of hospice or institutional care. Information about public assistance and other Medicaid eligibility requirements is available from any Department of Children and  Families service center.

Presumptive eligibility for pregnant women (PEPW) is determined by qualified provider agencies designated by the Department of Children and Families, including County Health Departments, Regional Perinatal Intensive Care Centers, and other agencies that have been approved upon request.

Eligibility Periods

Periods of Medicaid coverage are not the same among Medicaid eligibility programs. Depending on the Medicaid program, the recipient’s eligibility may begin either on the first day of the month of application or on a specific day within the month and end before the last day of the month. Medicaid eligibility may be approved retroactively for up to three months prior to the date of application.

Medicaid coverage will continue as long as a recipient meets all of the requirements for eligibility. A provider must verify a recipient’s eligibility for the date of service prior to rendering the service.

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