The Medicaid program and the related Children’s Medical Insurance Program (CHIP) provide healthcare coverage to over 60 million people across the country. Both programs are run as partnerships between individual states and the federal government.
In the state of Florida the Agency for Health Care Administration (AHCA) is responsible for overseeing Medicaid. The Agency successfully completed the implementation of Statewide Medicaid Managed Care (SMMC) program in 2014. The program has two components, the Long-term Care (LTC) program and the Managed Medical Assistance (MMA) program.
In addition, Florida Medicaid is in the process of developing the Invitation to Negotiate (ITN) to re-procure health plans for the SMMC program.
As of December 2016, 4,337,514 Florida residents enrolled in Medicaid and CHIP program.
In order to be eligible for Florida Medicaid, applicants must be US citizens or Qualified Aliens, must be Florida residents and must provide Social Security Numbers and proof of identity. Applicants must disclose all forms of income and assets and a determination on eligibility will be made within 45 days of receipt of the application.
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 the following populations:
- Low income families with children
- Children only
- Pregnant women
- Non-citizens with medical emergencies
- Aged and/or disabled individuals not currently receiving Supplemental Security Income (SSI)
The Children’s Medical Insurance Programs (CHIP) is part of a program called Florida KidCare that offers a variety of healthcare services for Florida children. CHIP enrollees are usually children whose families do not meet the income requirements for Medicaid but cannot afford to pay for private healthcare. Florida children up to age 18 and their families may be eligible for Medicaid if the family’s annual income is under a certain threshold and their countable assets are not above $2,000.
Medically Needy Program
The Medically Needy Program is available to Florida residents who are not eligible for "full" Medicaid because their income or assets are over the Medicaid program limits. This is a “share of cost” program, meaning that individuals that incur medical bills over a certain threshold in a month could be eligible for financial assistance from the Florida Medicaid program.