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Florida Medicaid Eligibility Requirements

There are many people in Florida who may qualify for medical care or nursing home treatment under Medicaid. Usually, those people are in a lower income bracket, and may have issues like disabilities or age that prevent them from working. If you would like to know more about eligibility for Medicaid in Florida, the following article provides the basics.

Medicaid Basics

Medicaid is a federal and state program designed to supplement the income of persons who need medical and/or nursing home treatment. If the person qualifies for Medicaid benefits under the Institutional Care Program (ICP), the state will pay the difference between the person's monthly income and the monthly charge for the nursing home. The Medicaid program in Florida is administered by the Florida Agency for Health Care Administration.

Basic Medicaid Eligibility

Medicaid eligibility in Florida is determined by Florida's Department of Children and Families or the Social Security Administration for recipients of supplemental security income (SSI). In order to be eligible, the individual must be a child, the parent or caretaker of a child, pregnant, elderly, blind, or disabled, and meet income requirements. The Affordable Care Act made changes to Medicaid Eligibility that are effective as of January 1, 2014. Now, Medicaid eligibility is based on IRS rules for determining household and income.

Income Requirements for Florida Residents

For many of the groups eligible for Medicaid, income eligibility is determined in relation to the Federal Poverty Level, which changes every year. In Florida, if the household income of a person eligible for Medicaid is less than a certain percent of the Federal Poverty Level, that person meets the income requirements. These percentages change based on family size and eligibility group (e.g. pregnancy, age, or disability). For example, Florida may set the income eligibility limit as 153% of the Federal Poverty Level for a family of two in one eligibility group, and 205% for a family of three in another eligibility group.

Calculating Income for Medicaid Eligibility

Medicaid income eligibility is based on Modified Adjusted Gross Income (MAGI). This calculation is based on federal income tax rules, but is not a number that is found on a tax return. Unlike the calculations before the Affordable Care Act, there are no "asset tests" or "disregards." The basic calculation for MAGI is Adjusted Gross Income (based on tax rules) plus foreign income not included in taxes, interest that was not included in taxes, and tax-exempt social security income. Some examples of income that is NOT included in MAGI are:

  • Child support income
  • Scholarships, fellowships, and grants used for educational purposes
  • American Indian and Alaska Native income received from distributions, payments, ownership interests, and real property usage rights.

Calculating Household for Medicaid Eligibility

Generally, the number of people in a household for Medicaid eligibility is the same as the number of people in the household for tax purposes. Parents, children, and siblings are all part of the same household. Step parents and parents are treated the same. Children and siblings, whether or not they have income, are included in the same household as the rest of the family. Older children count in the household, as long as a parent claims them as a dependent on taxes. A child's income does not count towards the household income if the child is not required to file a tax return.

If you would like to know more about whether you or someone you know qualifies for Medicaid, or have questions that are specific to your case or income, there are many attorneys in Florida who may be able to help.

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