**Navigating Medicaid Insurance Transition In Florida: A Step-By-Step Guide**

If you are looking to change your insurance with Medicaid in Florida, there are a few things you should know. Firstly, you must be eligible for Florida Medicaid, which means you must be a resident of the state, a U.S. national, citizen, permanent resident, or legal alien with low income or very low income. Secondly, you can change your health or dental plan by logging into the FL Medicaid Member Portal, which will walk you through the process of changing your plan. You can also change your plan by texting ENROLL to FLSMMC (357662) or calling the Helpline at 1-877-711-3662 to speak with a Choice Counselor. It's important to note that once you enroll in a plan, you generally keep it for the year unless you qualify for coverage through another source, like your job. Additionally, after the initial 90-day trial period, you cannot change health plans until the next open enrollment period unless you have a valid reason.

Enrolling in a new plan

If you are enrolling in a Florida Medicaid plan for the first time, you must first meet the eligibility criteria. 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 with a low income or very low income. You must also be responsible for a child aged 18 or younger, have a disability or a family member in your household with a disability, or be 65 or older.

Once approved for Medicaid, you can choose a Medicaid Managed Care Plan. You will have 90 days to try the plan. During this 90-day period, you can switch for any reason to a new plan. After this period ends, you cannot change health plans until the next open enrollment period, unless you have an event that allows a change.

You can enroll in a new plan in several ways:

• Online: Log in to the FL Medicaid Member Portal to change your Health or Dental Plan.
• By phone: Call the Helpline at 1-877-711-3662 to speak with a Choice Counselor.
• By text: Text "ENROLL" to FLSMMC (357662). You will need the Medicaid ID number for each member and the account PIN number.
• In-person: Visit your local Department of Children and Families office.

If you are unable to change plans online, there are several other options available to you. These include calling the Helpline or texting "ENROLL" to FLSMMC.

Switching from your current plan

If you are already enrolled in a Florida Medicaid plan but would like to switch to another, you can do so by texting ENROLL to FLSMMC (357662). You will need the Medicaid ID number for each member and the account PIN number. You can also create a Member Portal Account or chat with a virtual enrollment assistant. Alternatively, you can call the Helpline to speak with a Choice Counselor at 1-877-711-3662. To pick a new plan, you will need each member's birth year and Medicaid ID or Gold Card number.

If you are switching from a non-Medicaid plan, you can apply for Medicaid coverage in Florida by calling the Helpline at 1-877-711-3662 to speak with a Choice Counselor.

Once approved for Medicaid, you can choose a Medicaid Managed Care Plan. When you first enroll in a Medicaid Managed Care Plan, you have 90 days to try the plan. During this 90-day period, you can switch for any reason to a new plan. After this 90-day period ends, you cannot change health plans until the next open enrollment period, unless you have an event that allows a change.

The yearly Open Enrollment Period gives mandatory enrollees another chance to change plans for any reason. If you are happy with your current plan, you do not need to do anything.

If you are a mandatory enrollee and you want to change plans after you are locked in, you must have a state-approved reason. For a list of state-approved reasons, refer to your Member Handbook or call Medicaid Managed Care/Choice Counseling at 1-877-711-3662 (TTY: 1-866-467-4970), Monday to Thursday, 8 a.m. to 8 p.m., and Friday, 8 a.m. to 7 p.m.

Some Medicaid members can change their plans at any time, for any reason. To find out if you may change plans, call an enrollment broker at 1-877-711-3662 (TTY: 711).

Maintaining your relationship with your physicians

One of the most common obstacles to switching Medicaid plans is maintaining your relationship with the physicians that know you best. If you are switching plans, staff from your new plan will work with you and your doctors to continue any services you are receiving, even if the doctor is not in their network. It is important to let them know right away if you are getting services that you will need to continue so that they can provide you with the information you need to continue receiving the health care you need.

Eligibility requirements

To be eligible for Medicaid in Florida, 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, and be characterized as low-income or very low-income.

Additionally, you must be responsible for a child aged 18 or younger, have a disability or a family member in your household with a disability, or be 65 or older.

Your annual household income (before taxes) must be below the following amounts:

• For a household of 1: $16,090
• For a household of 2: $21,775
• For a household of 3: $27,460
• For a household of 4: $33,145
• For a household of 5: $38,830
• For a household of 6: $44,515
• For a household of 7: $50,199
• For a household of 8: $55,884
• For households with more than eight people, add $7,155 per additional person.

Medicaid eligibility in Florida is determined either by the Department of Children and Families (DCF) or the Social Security Administration (for SSI recipients).

DCF determines Medicaid eligibility for:

• Parents and caretaker relatives of children
• Individuals who receive Temporary Cash Assistance (TCA)
• Families who lose Medicaid eligibility due to earned income or the receipt of alimony
• Parents and caretakers who may apply for Medicaid on behalf of children under 21 living in their home
• Children under 19 who become ineligible for Medicaid but may remain on Medicaid for up to 12 months after their last eligibility review
• Pregnant women
• Former foster care individuals under 26
• Non-citizens with medical emergencies
• Aged or disabled individuals not currently eligible

The Social Security Administration determines eligibility for the Supplemental Security Income (SSI) program.

Applying for a Special Enrollment Period

The Special Enrollment Period (SEP) is a time outside the yearly Open Enrollment Period when you can sign up for health insurance. You may qualify for the Special Enrollment Period if you have experienced certain life events, such as:

• Losing health coverage
• Moving
• Getting married
• Having a baby
• Adopting a child
• Gaining employment
• Turning 26 and aging off your parents' health plan
• Losing a student health plan
• Getting divorced
• Having a change in immigration status
• Being released from incarceration

The Special Enrollment Period for 2024 of the Health Insurance Marketplace runs from January 16, 2024, to October 31, 2024. If you missed the enrollment window, you may still be eligible to enroll for coverage.

If you are unsure if you qualify for coverage under the Special Enrollment Period, you can contact a Marketplace Navigator to see if there is anything they can do to help. Certified Navigators are available to help your family find the exact coverage you need.

If you want to change from your current Medicaid plan, you can enroll in Humana Healthy Horizons in Florida. To do so, you can text ENROLL to FLSMMC (357662) or call the Helpline at 1-877-711-3662 to speak with a Choice Counselor. You will need the Medicaid ID number for each member and the account PIN number.

If you have been approved for Medicaid, you may change your plan during the first 120 days of your enrollment. After the 120 days, you will only be able to change your plan during your open enrollment period or with a State-approved For Cause reason.

Cancelling your plan

If you want to cancel your Medicaid coverage in Florida, you will need to go through the Florida Department of Children and Families (DCF). You can do this by phone, by visiting a local office, or online through the DCF website.

If you are cancelling because you no longer qualify for Medicaid, you are responsible for reporting any changes to the information you initially provided. This could include an increase in household income, or a change in household composition, such as no longer caring for a minor.

If you are cancelling for another reason, you will typically still need to report changed circumstances as a reason to end your coverage.

Cancelling MAGI Medicaid Coverage

If you qualified for Medicaid because your modified adjusted gross income (MAGI) was below the government threshold, you can cancel your coverage by contacting the DCF. You can do this by phone, by visiting a local office, or online through the DCF website.

Cancelling Classic Medicaid Coverage

If you qualified for Medicaid for a reason other than your income, you can cancel your coverage by calling or visiting your local DCF office. You can also cancel online through your account on the DCF website.

Cancelling Medicaid Managed Care

If you were automatically assigned to a Health Maintenance Organization (HMO) and want to cancel, you will only have a brief period of time (around 90 days) to do so. After this, you will be locked into that plan for 12 months, unless you have a state-approved reason for cancelling. To cancel, call the DCF helpline and ask for a disenrollment form.

If your Medicaid coverage is cancelled, you will receive a notification by mail, email, or through the MyACCESS portal. If you are no longer eligible for Medicaid but qualify for another healthcare coverage program, you will be referred to agencies that might be able to offer financial assistance, such as Florida KidCare, the Medically Needy Program, or other subsidized federal programs.

Frequently asked questions