HIV AIDS Stigma and education

Medicaid

Medicaid

Medicaid is the state and federal partnership that provides health coverage for selected groups of people with low incomes. Its purpose is to improve the health of people who might otherwise go without medical care for themselves and their children. Medicaid also assists aged and disabled people with the costs of nursing facility care and other medical expenses. Eligibility for Medicaid is usually based on a family’s or individual’s income and assets.

WHO IS ELIGIBLE?

The Social Security Administration (SSA) determines eligibility for Supplemental Security Income (SSI). Those who receive SSI are automatically eligible for Medicaid. The Florida Department of Children and Families (DCF) determines eligibility for low income children and families, aged persons, disabled persons, and persons seeking institutional care. Those who receive Temporary Assistance to Needy Families (TANF) are also automatically eligible for Medicaid. In Florida, financial need is determined based on unique income/asset guidelines for each of the 27 different eligibility categories.

There are 3 exemptions to the income/asset guidelines:
  • Homestead property—If individual, spouse, or dependent relative is living in the home or individual states that they intend to return to their home.
  • Burial funds under certain conditions, up to $2,500 of assets.
  • One personal vehicle.

 

Medically Needy Program

Individuals whose income is too high to qualify for other Medicaid programs but who have large monthly medical bills. On a month-by-month basis, the individual’s medical expenses are subtracted from his or her income. If the remainder falls below Medicaid’s income limits, the individual may qualify for Medicaid for the full or partial month, depending on the date the medical expenses were incurred. The individual must be determined disabled, and must have medical bills that exceed their Share of Cost. Share of Cost is calculated by subtracting the Medically Needy Income Limit from the net monthly income. Until the monthly share of cost amount is met, the individual is not Medicaid eligible under this program. Assets are limited to $5,000 for an individual and $6,000 per couple.

Qualified Medicare Beneficiaries (QMB)

This program provides cost-sharing assistance for individuals who are enrolled in Medicare Part A, including payment of premiums, deductibles, and co-pays. Potentially qualified individuals are those with income not exceeding 100% of the Federal Poverty Level and not otherwise eligible for Medicaid. Eligibility requirements include assets less than $5,000 per person and $6,000 per couple. Applicants must have already filed for all other benefits which they are eligible.

Special Low-Income Medicare Beneficiary (SLMB)

This program provided payment of Medicare Part B premiums. Potentially qualified individuals are those with income above 100% but less than 120% of the Federal Poverty Level, who are entitled to Medicare Part A and who are not otherwise eligible for Medicaid. Eligibility requirements include assets no more than $5,000 per person or $6,000 per couple. Applicants must already have filed for all other benefits which they are eligible.

Qualifying Individuals * (QI1)

This program provided payment of Medicare Part B premiums. Potentially qualified individuals are those with income at least 120% but less than 135% of the Federal Poverty Level, who are entitled to Medicare Part A and who are not otherwise eligible for Medicaid. Eligibility requirements include assets no more than $5,000 per person or $6,000 per couple. Applicants must already have filed for all other benefits which they are eligible.

*QI1 program is limited to availability of funding.

CONTACT FOR MORE INFORMATION:

Florida Department of Children and Families
210 N. Palmetto Ave.
Daytona Beach, FL 32114
(866) 762-2237

Social Security Administration
(800) 772-1213

4990 S. Clyde Morris Blvd.
Port Orange, FL 32127
(386) 761-8761

1629 S. Adelle Ave.
DeLand, FL 32720
(386) 734-8300