Medicaid Overview

The Department of Children & Families provides cost-saving health care programs and services to eligible individuals. If you are a Medicare beneficiary and meet the required income and asset standards, you may be eligible for Medicaid and other related programs of the State of Florida. For assistance in understanding how the programs work or where to apply, please contact the SHINE (Serving Health Insurance Needs of Elders) program through the Elder Helpline at 1-800-96-ELDER (1-800-963-5337).

FLORIDA ELDER HELPLINE AND REFERRAL

Information regarding elder services and activities is available through the Elder Helpline Information and Referral Service within each Florida county at 1-800-96-ELDER (1-800-963-5337). All elder help lines may be accessed through the Florida Telecommunication Relay System (1-800-955-8771 for TDD, or 1-800-955-8770 for Voice) which allows telephone calls to be placed between TDD users and nonusers with the help of specially trained operators translating the calls. Additional information is also available from the Department of Elder Affairs Website at http://elderaffairs.state.fl.us/.

TO APPLY FOR FLORIDA MEDICAID SERVICES (Opens the Department of Children and Families Website) The Department of Children & Families Website’s “Access your Benefits” will help you apply for Medicaid services online.

Medicaid for Aged or Disabled

The State of Florida has several programs designed to provide Medicaid to low income individuals who are either aged (65 or older) or disabled. This is referred to as SSI-Related Medicaid.

Florida residents who are eligible for Supplemental Security Income from the Social Security Administration are automatically eligible for basic Medicaid coverage. There is no need to file a separate ACCESS Florida application unless nursing home services are needed.

Individuals may apply for full Medicaid coverage and other services using the online ACCESS Florida Application and submitting it electronically. If long term care services in a nursing home or community setting are needed, the individual must check the box for HCBS/Waivers or Nursing Home on the Benefit Information screen. HCBS/Waiver programs provide in-home or assisted living services that help prevent institutionalization.

Medicare Savings Programs (Medicare Buy-In) were created to help Medicare beneficiaries with limited finances pay their Medicare premiums, and in some instances, deductibles and co-payments. Medicare Buy-In provides different levels of savings depending on the amount of an individual or couple’s income. Individuals may apply exclusively for Medicare Buy-In by completing a Medicaid/Medicare Buy-In Application. The completed form must be printed and mailed or faxed to a local Customer Service Center.

Individuals eligible for full Medicaid or a Medicare Savings Program are automatically enrolled in Social Security’s Extra Help with Part D (Low Income Subsidy) benefit for the remainder of the year. An individual may also apply directly with Social Security for the Medicare Extra Help Program.

Income and asset limits for Medicaid for aged or disabled individuals may be found on the SSI-Related Programs Financial Eligibility Standards. Important information for individuals seeking Medicaid to cover long term care services in a nursing home or community setting is available in the Qualified Income Trust Fact Sheet.

Prescription Help for Those who are not eligible for Full Medicaid

Individuals who are not eligible for full Medicaid may receive help with the cost of prescription drugs through the Florida Discount Drug Card Program.

Medically Needy Program

Individuals that are not eligible for Medicaid because their income or assets exceed the Medicaid program limits may qualify for the Medically Needy program. Individuals enrolled in Medically Needy must incur a certain amount of medical bills each month before Medicaid can be approved. This is referred to as a “share of cost” and it varies depending on the household’s size and income. Once an individual incurs enough medical bills to meet the share of cost for the month, the individual should contact DCF to complete bill tracking and approve Medicaid for the remainder of the month. Information about this program can be found in the Medically Needy Program Brochure.