Florida Medicaid - A Guide to the AHCA

Many people in Florida go without basic medical care due to financial issues. Doctor visits, hospital stays, physical therapy, prescription drugs, and other healthcare aspects can cost thousands of dollars over time — money that low-income families do not have. To prevent shouldering the debt of unexpected medical expenses, many Floridians extend their Medicaid coverage to include a more comprehensive range of benefits and services by way of private health insurance.

Here, you’ll learn how you and your loved ones can access affordable healthcare through Florida Medicaid. You can receive the treatment you need and extend your AHCA coverage for a well-rounded health insurance plan.

    What Is Florida Medicaid?

    Florida Medicaid is the federal and state healthcare program that provides coverage for specific groups of people in Florida. Getting medical care can be challenging and even impossible for families with very low incomes, but the Florida Agency for Health Care Administration (AHCA) makes it as inexpensive as possible through its Medicaid plan.

    Thanks to state and federal funding, Florida Medicaid is free or nearly free. Eligible persons do not need to worry about how to receive necessary medical attention and how to pay the bills afterward. You can get the healthcare coverage you deserve at little to no cost.

    What Is a Florida Medicaid Card?

    Florida Medicaid

    When you enroll in Florida Medicaid, you will receive a gold identification card with your name and Card Control Number. This identification number is different from your Medicaid number, which the policy holder (you) and policy provider (the AHCA) keep in a secure file. However, healthcare services will use the Card Control Number to look up your file and verify your eligibility.

    Your ID card is your ticket to accessing a broad range of free or low-cost services. Always keep it with you, even if your membership expires.

    How to Apply for Florida Medicaid

    To apply for Florida Medicaid, submit an online application form through the Florida Department of Children and Families (DCF). You can also fill out a paper form and mail it or deliver it in person to your local AHCA Medicaid Area Office. Application forms are available online or by contacting the DCF at (866) 762-2237.

    If you do not have a computer at home, you can visit your local library, community center, school, or Medicaid office. These locations may offer computers and internet access free of charge upon request.

    Before submitting the application, you’ll need to provide the right documentation. A few documents you may need include the following:

    • Proof of name, birth date, and Social Security Number
    • Rent or mortgage payment history
    • Recent utility bills
    • Recent medical bills
    • Bank statements
    • Pay stubs
    • Medical records that prove your disability or non-healing condition
    • Proof of Florida citizenship

    Eligibility Requirements

    Florida Medicaid is available to low-income residents of the state of Florida. In addition to being below a certain income limit, applicants must meet any of the following criteria to be eligible:

    • Blind
    • Pregnant
    • Responsible for a minor
    • Disabled or living with a disabled household member
    • At least 65 years old
    • In need of nursing home care
    • Enrolled in Medicare
    • Receiving Emergency Medicaid as an alien or refugee

    Getting a Florida Medicaid Card

    Applying for Florida Medicaid and receiving your identification card can be a complicated, time-consuming task. You’ll want to follow a few steps to avoid mistakes and make sure the process goes as smoothly as possible.

    • Determine if you’re eligible: First, you need to know if you are eligible for Medicaid. You’ll want to check national and state-specific eligibility guidelines to confirm that you will qualify for the healthcare program. You may also take a pre-screening test.
    • Gather supporting documents: You do not want to get halfway through the application process before realizing you lack necessary documentation. Always compile the right supporting documents (mentioned above) before applying.
    • Choose your preferred application method: Applicants may submit forms online, through the mail, or in person. To apply online, create an account with the Florida Department of Children and Families (DCF) here.
    • Complete the application process: Submit your application form and the required supporting documents. In some cases, your provider may request additional information that you will also need to submit.
    • Wait for approval: Once you complete the application process, it’s time to wait. Medicaid offices will review your application carefully and send you either an approval or denial letter within a few weeks.

    Renewing or Replacing Your Florida Medicaid Card

    Florida Medicaid coverage does not cease the moment you become ineligible. You can still take advantage of free healthcare until your policy term ends, which could be several more months. However, you will want to renew or replace your Medicaid card (if possible) to continue receiving program benefits.

    As of the disenrollment period beginning in April 2023, the AHCA will redetermine who is and is no longer eligible for Medicaid. You will have the opportunity to renew your identification card if the redetermination process proves your eligibility. Simply submit the proper information upon request to maintain a valid card or get a replacement.

    Florida Medicaid Coverage

    With Florida Medicaid, you can get access to top-quality healthcare services without the financial burden. The state’s Medicaid program comes with a wide variety of coverage options, ensuring that people in need receive the same level of treatment as their more fortunate neighbors.


    Healthy teeth are not just for show — they’re essential to chewing, biting, speaking, and maintaining facial bone structure. However, teeth grow old and wear out over time. With Florida Medicaid, you can get the dentistry services you need to treat dental problems and prevent further damage.

    Florida Medicaid offers a dental plan to cover the costs of appointments and procedures. Children from birth to 20 years old can receive many services free of charge, including:

    • Cleaning
    • Extraction
    • Fillings and crowns
    • Root canals
    • Exams and X-rays
    • Screenings
    • Sedation

    Medicaid programs offer dental coverage for more than just kids, teens, and young adults. If you’re 21 years old or older, you may be eligible to receive the following dental services through Florida Medicaid:

    • Dentures
    • Problem-focused procedures
    • Fluoride sealants
    • Additional extractions
    • Exams and X-rays
    • Restorations
    • Consultations

    For those who have more serious dental issues and anticipate requiring more visits to the dentists, investing in private dental plans in Florida is advisable.

    Prescription Drugs

    Are you suffering from ongoing pain or discomfort? Do you have trouble sleeping or struggle with depression and anxiety? Prescription drugs enable many patients to find relief and enjoy a higher quality of life. You can get prescription medications through your Florida Medicaid policy.

    Florida Medicaid’s Preferred Drug Program gives enrollees access to most prescription drugs, selected injectable drugs, and some over-the-counter drugs. The Preferred Drug List provides information on available medications and coverage options. If a medicine is on the list, it is available to Medicaid enrollees at zero cost.

    The AHCA’s Pharmacy Policy Unit is responsible for managing prescription drug coverage and reimbursement. This department also monitors pharmacy usage, maintains the Preferred Drug List, and ensures that patients receive the appropriate medications according to doctor recommendations.

    Extended Health Care

    Routine checkups and basic medical treatments will only get you so far. Many patients require additional care, but they go without because of financial concerns, lack of coverage, and restricted access. Investing in quality disability insurance is an excellent way to assist with some of the costs incurred with not being able to work either temporarily or permanently, and to help with the cost of medical needs.

    On top of coverage for prescription drugs and dental work, Florida Medicaid also covers extended health care services.

    Here are some examples of extended health care available through Florida Medicaid and the AHCA:

    • Assistive Care: Physical and cognitive impairments affect many seniors, leaving families no choice but to admit them to a nursing home, assisted living facility, or hospital for long-term care. However, Florida’s Medicaid program helps pay for assistive care services to prevent this scenario. You or your loved one can receive assistance with daily tasks, medication administration, health support, and more.
    • Chiropractic: Musculoskeletal problems like back pain and joint pain are common throughout the United States. Joint misalignments can affect your nerves and muscles, making everyday activities more uncomfortable and challenging. If you’re eligible for Florida Medicaid, you could receive coverage for chiropractic services to diagnose your condition and relieve pain.
    • Physical Therapy: Injuries are scary, especially for those who cannot afford to take time off of work and pay for medical treatment. Rehab and physical therapy might sound like a luxury, but Florida Medicaid offers it to residents in low-income households. Your healthcare program will reimburse you for evaluations, equipment, and treatment related to physical therapy.

    Travel and Out-of-State Coverage

    Florida Medicaid only provides coverage for healthcare within the state. If you travel outside of Florida, understand that your Medicaid plan will not cover doctor’s visits, hospital stays, and other medical services while abroad. However, Florida Medicaid may offer out-of-state coverage or reimbursement in rare cases and emergency situations. If you are traveling outside of Florida for leisure, invest in proper travelers insurance.

    Students and Seniors

    County health departments (CHDs) provide nursing, individual social work, and other services for Florida’s public school system. Medicaid reimburses CHDs for these services, offering school-based medical assistance for students who need it most. To qualify, recipients must be under the age of 21 and enrolled in a public school.

    Florida Medicaid also provides coverage for individuals over the age of 65. Seniors have many health challenges and are more susceptible to injuries, illnesses, and diseases than younger demographics. Through Medicaid, retirees can gain access to healthcare services and make the most of this wonderful stage of life.

    Medicaid’s Program of All-inclusive Care for the Elderly (PACE) offers a long list of well-rounded healthcare services designed for seniors through participating organizations. Recipients can get the care they need at home, in a nursing home or assisted living facility, in the community, and at a PACE center. PACE services include the following:

    • Home-delivered meals
    • Medical supplies and equipment
    • Primary care
    • Personal care
    • Therapy
    • Prescription drugs
    • End-of-life care
    • Counseling
    • Transportation

    What Florida Medicaid Does Not Cover

    Florida Medicaid covers a broad range of healthcare services for eligible persons. However, it does not cover everything. Here are some things your Medicaid card will not cover:

    Healthcare for ineligible applicants
    Cosmetic procedures
    Unnecessary medical care
    All prescription drugs
    Out-of-state medical expenses

    Healthcare for ineligible applicants

    You must qualify for Medicaid or receive redetermination approval to access the program’s coverage. If your annual income is above a certain amount, for example, the AHCA will deny your application. Florida Medicaid does not cover healthcare for non-enrollees.

    Cosmetic procedures

    Cosmetic procedures can help you look amazing and live your best life. However, Florida Medicaid does not cover medical treatments designed to simply improve a patient’s appearance. If you want a tummy tuck, dental veneers, or implants, you will have to pay for it out of pocket.

    Unnecessary medical care

    Florida Medicaid helps low-income individuals and families access the medical care they need. Emphasis on the word need. You will not get coverage for services or medications that are not “medically necessary” according to the AHCA.

    All prescription drugs

    Before enrolling in Florida Medicaid, it’s important to realize that the program may not provide coverage for every type of prescription medication. Medicaid covers many prescription drugs, but not all of them.

    Out-of-state medical expenses

    Are you planning to travel outside of Florida? You’ll want to take care of any healthcare needs and doctor visits before you leave. Florida Medicaid only covers services in Florida, so you will be on your own to pay for out-of-state medical expenses.


    Florida Medicaid will only put forth $2500 towards the cost of a funeral. Considering the rising cost of burial and related fees, ensure that your family is secured with comprehensive funeral insurance.

    Feel free to contact your local AHCA Medicaid office for more information and answers to any questions regarding coverage options. You can also learn more about Florida Medicaid’s covered services online on the AHCA website.

    Common Procedures and Florida Medicaid Eligibility

    If you’re unfamiliar with Medicaid, you might feel confused and overwhelmed trying to understand what it does and does not cover. Here, we’ve included a breakdown of common procedures and eligibility to help you know what to expect and avoid blindsiding costs.

    X-Rays and Exams Yes
    Wisdom Teeth Yes
    Eye Exams Yes
    Glasses Yes
    Laser Eye Surgery Yes
    Rhinoplasty Yes, if medically necessary
    Breast Reduction Yes, if medically necessary
    Hospital stays Yes
    Ambulance transportation Yes
    Giving birth Yes
    Therapy and Counselling
    You might think therapy and counseling are only for upper-class Florida residents. However, you could argue that low-income individuals need these services even more. That’s why Florida Medicaid offers coverage for restorative therapy and counseling services at the lowest possible cost.
    Sexual Health
    Gynecologist visits Yes (conditions may apply)
    Erectile Dysfunction Yes (conditions may apply)
    Birth Control Yes (conditions may apply)
    Fertility Treatment Yes (conditions may apply)
    Specialist Services
    Keep in mind that your healthcare program might not cover every type of specialist. It also might not cover every visit. You should talk to your healthcare provider before scheduling an appointment to ensure that you will have enough coverage.
    Dermatology Yes (conditions may apply)
    Physiotherapy Yes (conditions may apply)
    Massage Therapy Yes (conditions may apply)
    Podiatry and Foot Care Yes (conditions may apply)
    Allergy Testing Yes (conditions may apply)
    Sleep Physician Services and CPAP Machines Yes (conditions may apply)

    Extending Florida Medicaid Coverage

    Florida is one of the few states to decline the federal Medicaid expansion per the Affordable Care Act (ACA). The ACA implemented this Medicaid expansion plan to make healthcare more affordable and accessible to people below the poverty line. Sadly, many low-income households do not meet the other criteria to qualify for Florida Medicaid and go without adequate healthcare coverage.

    Because of this coverage gap, thousands of Florida residents have little to no way of accessing healthcare services. That’s where third-party, private insurance companies come into play. You can use private insurance providers to fill the gaps in your AHCA Florida Medicaid plan and get the coverage you need. Other types of private insurance, such as life insurance, can help pay for medical costs Medicaid will not cover, especially in the event of your passing.

    Are you concerned about coverage gaps in Florida Medicaid and looking for well-rounded, affordable healthcare? At Insurdinary, we have the tools to help you review your options and choose the best insurance provider with the lowest possible rates. Whatever you’re looking for, we can help you find it. Request a quote to get started today!


    How long does it take to get approved for Florida Medicaid?

    The approval timeline for Florida Medicaid can vary based on individual circumstances. On average, the process takes around 45 days. Urgent cases can be expedited for quicker processing.

    What are the methods to apply for Florida Medicaid?

    You can apply for Florida Medicaid through various avenues: online, in person, by mail, or at a local Department of Children and Families office. Ensure you provide necessary documents like proof of income, household size, and residency when submitting your application.

    Does Florida Medicaid cover the expenses of funerals?

    No, Florida Medicaid primarily provides healthcare coverage and does not include benefits for funeral expenses. If you're seeking assistance with funeral costs, you might want to explore options like funeral insurance.

    Who is eligible for Florida Medicaid?

    Eligibility for Florida Medicaid is determined by factors such as income, household composition, and other considerations. Typically, the program extends coverage to low-income individuals, families, pregnant women, children, elderly individuals, and those with disabilities.

    What is Florida Medicaid?

    Florida Medicaid is a program designed to offer medical coverage to eligible low-income residents of the state. Funded jointly by federal and state resources, its aim is to ensure access to essential healthcare services for those who qualify.

    What other types of insurance does Insurdinary offer?

    Insurdinary, and its network of partners offer many different types of insurance. In addition to health, dental, disability, life, funeral and travel insurance as discussed on this page, you may also be interested to explore the following:


    1. https://www.benefits.gov/benefit/1625
    2. https://www.uhccommunityplan.com/assets/plandocuments/faq/Florida-English-Medicaid.pdf
    3. https://www.healthinsurance.org/medicaid/florida/
    4. https://www.medicaidplanningassistance.org/medicaid-eligibility-florida/
    5. https://www.myflfamilies.com/Medicaid
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