Jane Dotson
If you've been approved for Medicaid in Florida, you may be wondering how to choose the right insurance plan for your needs. It's important to understand that Medicaid programs can vary from state to state, and Florida has its own set of eligibility criteria and coverage options. In this guide, we will walk you through the process of selecting the best insurance plan after being approved for Medicaid in the state of Florida, covering topics such as eligibility requirements, available plans, and the resources available to help you make an informed decision.
| Characteristics | Values |
|---|---|
| Florida's decision not to expand Medicaid | Leaves nearly 400,000 people without coverage |
| Who is eligible for Medicaid in Florida? | Low-income children, pregnant women, families, and aged or disabled individuals who are not currently receiving Supplemental Security Income (SSI) |
| How to apply for Medicaid in Florida | Apply online at ACCESS Florida, or fill out a paper form |
| How to appeal a decision made about your Medicaid application | Appeal by telephone at (850) 488-1429, by Fax at (850) 487-0662, in writing at Department of Children and Families, Office of Appeal Hearings, Building 5, Room 255, 1317 Winewood Boulevard, Tallahassee, FL 32399-0700 and by email at [email protected] |
| How to choose an insurance plan after being approved for Medicaid in Florida | Contact a choice counselor by calling 1-877-711-3662 or visiting www.flmedicaidmanagedcare.com |
| How long does it take to receive a Medicaid card after approval? | It can take two to three weeks to receive a Medicaid card |
| What to do if you need a replacement Medicaid card | Call 1-866-762-2237 |
| How to print a temporary Medicaid card | Log in to your MyACCESS Account |
| What to do if you need assistance from the Medicaid Beneficiary Services Unit | Call (877) 254-1055 during normal working hours |
| What happens if your household situation changes after being approved for Medicaid? | Florida allowed individuals to remain on Medicaid throughout the PHE, but the continuous coverage provision will end on March 31, 2023 |
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What You'll Learn
Understanding the difference between Medicaid and Medicare
Medicaid and Medicare are two separate U.S. government-sponsored programs designed to help cover healthcare costs for certain American residents. Despite their similar-sounding names, they have distinct purposes and eligibility criteria.
Medicaid is a joint federal and state program that provides health coverage for certain individuals and families with low incomes and limited resources. Eligibility and benefits vary from state to state, but generally, Medicaid covers children, adults, pregnant women, people with disabilities, and seniors who meet the income and asset requirements. In Florida, for example, children from families with incomes up to 211% of the federal poverty level may be eligible for Medicaid. Additionally, Florida offers the Medically Needy Program, which allows individuals who exceed the income limits for full Medicaid to still receive Medicaid coverage after meeting a monthly "share of cost."
Medicare, on the other hand, is a federal health insurance program primarily for individuals aged 65 and older. It also covers younger people with disabilities and those with End-Stage Renal Disease. Unlike Medicaid, Medicare eligibility is not based on income, and basic coverage is standardized across all states. Medicare consists of four parts: Part A covers hospitalization, Part B covers medically necessary services, Part C (Medicare Advantage Plans) offers an alternative way to receive benefits through private companies, and Part D covers prescription drugs.
While both programs aim to improve access to healthcare, they serve different populations. Medicaid focuses on providing coverage for people with limited financial resources, while Medicare targets older adults and individuals with specific health conditions, regardless of their income level. It's important to understand the differences between these programs when considering your healthcare options, especially when choosing insurance after being approved for Medicaid in Florida.
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Eligibility criteria for Medicaid in Florida
Medicaid is a program that provides free or low-cost medical benefits to eligible individuals with low incomes and assets. Eligibility for Medicaid in Florida is determined by the Department of Children and Families (DCF), the Social Security Administration (for SSI recipients), and the Office of Economic Self-Sufficiency.
The eligibility criteria for Medicaid in Florida vary based on age, income, and family situation. Here are the specific criteria:
- Children: Florida's Medicaid/CHIP (Children's Health Insurance Program) eligibility standards include a built-in 5% income disregard. Children up to one year old are eligible at 211% of the federal poverty level (FPL). Children under 19 can qualify for Florida Healthy Kids (CHIP) with modest monthly premiums if the household income is between 138% and 200% of FPL. The cap was supposed to increase to 300% in January 2024, but implementation has been delayed.
- Pregnant Women: Pregnant women can qualify for Medicaid at 196% of FPL, and this coverage extends 12 months after the baby is born.
- Adults with Minor Children: This group can qualify for Medicaid at 26% of FPL.
- Aged or Disabled Individuals: Aged or disabled individuals who are not currently receiving Supplemental Security Income (SSI) can apply for Medicaid.
If you do not qualify for Medicaid due to income limits, you may still be eligible for other programs or insurance options. These include the Medically Needy Program, Federally Qualified Health Centers, and the Children's Health Insurance Program (CHIP). Additionally, Florida KidCare offers low-cost health coverage for children based on family income.
It is important to note that Florida has not expanded its Medicaid program, which leaves a coverage gap for individuals with incomes between 100% and 138% of the poverty level. This means that these individuals are ineligible for Medicaid and may not qualify for tax subsidies to afford private health insurance.
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Applying for Medicaid in Florida
Medicaid is a US federal program that provides free or low-cost medical benefits to eligible individuals with low incomes. Each state has its own requirements and programs, and Florida is one of only ten states that have refused to expand Medicaid, leaving hundreds of thousands without access to coverage.
Eligibility
Medicaid eligibility in Florida is determined by either the Department of Children and Families (DCF) or the Social Security Administration (for SSI recipients), while the Agency for Health Care Administration (AHCA) administers the Medicaid Program.
Eligibility depends on a combination of factors, including income, assets, age, family status, and disability status. In Florida, children up to 1-year-old are eligible if their household income is at 211% of the federal poverty level (FPL). Children under 19 can qualify for Florida Healthy Kids (CHIP) if the household income is between 138-200% of FPL. Pregnant women are eligible at 196% of FPL, and this coverage continues for 12 months after the baby is born. Adults with minor children are eligible at 26% of FPL.
Application Process
To apply for Medicaid in Florida, you can apply online at ACCESS Florida or fill out a paper form. You can also submit a Florida KidCare application if you only want to apply for Medicaid for your children. The application process for KidCare is the same as for Medicaid, but you can call (888) 540-5437 or visit www.floridakidcare.org for more information.
The paper application for Medicaid can be submitted by mail, fax, or in person at a local service center. If you need help with the application process, you can call 1-866-762-2237.
Appeals
If you are deemed ineligible for Medicaid and you believe this determination is wrong, you have the right to appeal within 10 days of the date on the denial letter. You can initiate an appeal by requesting a hearing by phone, fax, in writing, or by email. You can also choose to retain your Medicaid coverage while your appeal is being processed.
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Choosing a health plan after being approved for Medicaid
If you have been approved for Medicaid, you will receive a Medicaid card within two to three weeks. You can then choose a health plan that suits your needs. Florida's Medicaid program offers a range of options, including:
- Florida KidCare: This program provides low-cost health coverage for children based on family income.
- The Medically Needy Program: This program allows Medicaid coverage after a monthly "share of cost" is met, which is determined by household size and family income.
- Federally Qualified Health Centers: These centers provide medical care for clients with limited or no health insurance on a sliding scale based on income.
- Long-Term Care (LTC): The Statewide Medicaid Managed Care (SMMC) Long-Term Care program provides information on how to select an LTC plan in your region.
- Managed Medical Assistance (MMA): This program allows you to choose from a range of plans in your area and receive services from providers who are part of the plan.
You can also seek guidance from a Choice Counselor, who can help you select a plan that best meets your needs. They can be contacted via the phone number 1-877-711-3662 or through the website www.flmedicaidmanagedcare.com. Additionally, you may consider plans offered by private companies such as Aetna Better Health of Florida, which can be selected by calling the Choice Counseling Helpline at 1-877-711-3662. Remember that you have the right to change plans at certain times during the year and can disenroll from a plan if needed.
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Changing your health plan after being approved for Medicaid
If you are approved for Medicaid in Florida, you will be automatically enrolled in a health plan chosen by the state or Florida KidCare if you do not select a plan. You can change your health plan within the first 90 or 120 days of enrollment for any reason. After this period, you will need to wait until the yearly Open Enrollment Period to change your plan, unless you have a state-approved reason. The yearly Open Enrollment Period runs from November 1 to January 15.
How to change your health plan
To change your health plan, you can either do it online or by phone. To change your plan online, visit the Florida Statewide Medicaid Managed Care (SMMC) website. To change your plan by phone, call the Choice Counseling Helpline at 1-877-711-3662 (TTY: 1-866-467-4970). You can call Monday through Thursday, 8 AM to 8 PM, and Friday, 8 AM to 7 PM.
Choosing a new health plan
When choosing a new health plan, it is important to consider your specific needs and preferences. All Medicaid plans have $0 copays, the same basic benefits, and the same drug coverage. However, some plans may offer additional services and perks. You can also consider factors such as the quality of care, the providers included in the plan's network, and the customer service provided by the insurer.
Special Enrollment Period
Outside of the Open Enrollment Period, you may be able to change your health plan during a Special Enrollment Period if you have experienced certain qualifying life events, such as losing your health coverage, moving, getting married, having a baby, or adopting a child. You may also qualify for a Special Enrollment Period based on your income.
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Frequently asked questions
If you think the determination that you are ineligible for Medicaid is wrong, you have the right to appeal within 10 days of the date on the decision. You can request a hearing by telephone, fax, in writing, or by email.
Individuals who are eligible to receive long-term care services through the Statewide Medicaid Managed Care (SMMC) Long-Term Care program will receive a welcome letter and brochure with information about the SMMC program and how to select a plan. Choice counselors are available by phone to help recipients select a plan that best meets their needs.
Families who only want to apply for Medicaid for their children may submit a Florida KidCare application. Children under the age of 19 can qualify for Florida Healthy Kids (CHIP) if their household income is between 138% and 200% of the federal poverty level.
If your Medicaid coverage ends, you may be eligible for other healthcare programs such as Florida KidCare, the Medically Needy Program, or other subsidized federal healthcare programs.
