Finding out who can get Medicaid in Florida is honestly a bit of a headache. If you’ve spent any time on the official state websites, you probably noticed they don’t make it easy to find a straight answer. Florida is one of the few states that hasn't expanded Medicaid under the Affordable Care Act, which basically means there’s a massive "coverage gap" where many low-income adults don't qualify for anything.
It’s frustrating. You’d think being low-income would be enough, but in the Sunshine State, you usually have to fit into a specific "category" on top of having a small paycheck.
We’re talking about being a parent, a child, a senior, or having a documented disability. If you’re a single, healthy adult with no kids? Under current 2026 rules, you’re almost certainly out of luck unless something major changes with the 2028 ballot initiative.
The Reality of the Florida Coverage Gap
Most people think Medicaid is for anyone who can’t afford health insurance. In Florida, that’s just not true.
Because the state legislature has repeatedly opted out of expansion, thousands of Floridians earn too much to qualify for Medicaid but too little to get subsidies on the federal marketplace (Obamacare). It’s a weird, stressful middle ground.
For 2026, the push to change this via a ballot initiative was actually pushed back to 2028 because of new state laws regarding signature gathering. So, for now, we have to play by the old, strict rules.
Who Actually Qualifies?
To figure out if you're eligible, you have to look at two things: your category and your finances. You can’t just have one; you need both.
Parents and Caretakers
This is where it gets really tough. Florida has some of the lowest income limits in the country for parents. To qualify as a "Caretaker Relative," a single parent with one child can only make around $355 a month.
Yes, you read that right. Not a week. A month.
If you make $400 a month, the state often considers you "too rich" for parent Medicaid. It’s a strikingly low bar that leaves many families scrambling.
Children (Florida KidCare)
Thankfully, the rules for kids are much more generous. Florida wants children covered.
- Infants under age 1: The income limit is much higher, roughly $2,754 monthly for a household of one (though usually calculated for the mother/child pair).
- Children ages 1 to 18: The limits vary slightly by age, but generally, if a family of four makes under $3,698 to $5,654 a month (depending on the specific program), the kids can usually get some form of coverage.
Even if you make more than that, you might qualify for Florida KidCare, which includes MediKids and Florida Healthy Kids. These aren't always free—you might pay a $15 or $20 monthly premium—but it’s a lifesaver compared to private insurance.
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Pregnant Women
If you’re pregnant, the state is much more flexible. For a household of two (you and the baby count as two), the income limit is around $3,456 per month. This coverage is vital because it covers prenatal visits, delivery, and postpartum care.
Seniors and People with Disabilities
This is often called "SSI-Related Medicaid." If you’re 65 or older, or if you’ve been declared legally disabled by the Social Security Administration, the rules change again.
For "Regular Medicaid" (Aged and Disabled), the income limit for a single person in 2026 is roughly $1,149 per month, with an asset limit of $5,000.
The "Asset Test" Nobody Likes
Most Medicaid categories for adults come with an asset test. This isn't just about the money in your pocket; it’s about what you own.
Basically, Florida looks at your bank accounts, stocks, and second properties.
- What they don't count: Your primary home (usually up to a certain value, around $730,000+), one car, and your personal belongings.
- What they DO count: Savings accounts, CDs, 401ks (sometimes), and that extra plot of land you inherited.
If you’re a senior applying for Long-Term Care Medicaid (for nursing homes or in-home help), the asset limit is even tighter: just $2,000.
It’s a brutal system that often forces people to "spend down" their life savings just to get the help they need. However, there are legal ways to handle this, like Qualified Income Trusts (QITs), which are basically legal "workarounds" if your income is just slightly over the limit but your medical bills are huge.
How to Check if You're Eligible
The easiest way to start is through the ACCESS Florida portal. It’s the digital gateway for the Department of Children and Families (DCF).
You’ll need to have your documents ready. Don't try to wing it.
- Proof of Income: Pay stubs or a tax return.
- Identification: Social Security numbers for everyone in the house.
- Proof of Residency: A utility bill or lease works fine.
- Asset Info: Bank statements from the last few months.
A Note on "Medically Needy" (The Share of Cost)
If you're over the income limit but have massive medical bills, you might get put into the Medically Needy program.
Think of it like a monthly deductible. Let's say your "share of cost" is $800. You have to pay (or owe) $800 in medical bills in a single month before Medicaid kicks in to pay for anything else. For people with chronic conditions, this is better than nothing, but it’s still a huge financial burden.
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What to Do Right Now
If you think you might qualify, or even if you’re unsure, apply anyway. The system is complex, and sometimes there are nuances—like the "Working Disabled" category—that might fit your specific situation.
Immediate Next Steps:
- Visit the ACCESS Florida website or call 1-866-762-2237 to start an application.
- Gather your bank statements for the last 3 months to see where you stand on the asset test.
- If you have kids, check out FloridaKidCare.org separately; their rules are different and often easier to meet.
- Consult an Elder Law attorney if you are seeking long-term care; the "spend-down" rules are far too complicated to navigate alone without risking your house or savings.
Florida's Medicaid landscape is tough, but knowing exactly where the lines are drawn is the first step to getting covered.