|
LOW INCOME HEALTH CARE COVERAGE PROGRAMS
This information sheet contains frequently asked questions for low income persons seeking healthcare coverage.
What is a Health Flex Health Plan?
The Health Flex Program was created by Senate Bill 46-E and became effective July 1, 2002. The Legislature found that a significant proportion of the residents of Florida are unable to obtain affordable health insurance coverage. Therefore, it is the intent of the Legislature to expand the availability of health options for low-income uninsured state residents by encouraging organizations to develop alternative approaches to traditional health insurance which emphasize coverage for basic and preventive health care services.
Who is eligible to participate in a Health Flex Plan?
Eligibility to enroll in an approved Health Flex Plan is limited to residents of this state who: (a) are 64 years of age or younger; (b) have a family income equal to or less than 200 percent of the federal poverty level; (c) are not covered by a private insurance policy and are not eligible for coverage through a public health care program, such as Medicare or Medicaid, or another public health program, such as KidCare, and have not been covered at any time during the past 6 months.
What is KidCare? (Florida's Child Health Insurance Program)
The 1998 Florida Legislature created the Florida KidCare Program, which will extend health care coverage to almost 250,000 Florida children. KidCare consists of four programs:
•
MediKids--a health insurance program for children under age 5.
•
Florida Healthy Kids--health care coverage for children ages 5 to 19, available through the Florida Healthy Kids Corporation.
•
TheChildren's Medical Services (CMS) Network, for children birth to age 19, who meet the criteria for children with special health care needs. Behavioral Health Specialty Care Network works with CMS to provide mental health and substance abuse treatment to children with behavioral health needs.
•
Medicaid for lower income children under age 19.
General Information About Medicaid
Medicaid is a program that provides medical coverage to low income individuals and families. The state and federal government share the costs of the Medicaid program. The legal basis for the Medicaid program is Title XIX of the Social Security Act of 1965 and chapter 409, Florida statutes. Medicaid services in Florida are administered by the Agency for Health Care Administration. Medicaid eligibility in Florida is determined either by the Department of Children and Families (DCF) or the Social Security Administration.
•
Low income families with children
•
Children only
•
Pregnant women
•
Non-citizens with medical emergencies
•
Elderly and/or disabled individuals not currently receiving Supplemental Security Income (SSI)
Medicaid for Low Income Families with Children
The State of Florida has several programs designed to provide Medicaid to parents or specified relatives and children in low income families. Specified relatives include grandparents, aunts, uncles, first cousins, and others who are within the fifth degree of relationship to the child.
•
Individuals that are receiving Temporary Cash Assistance (TCA) generally are eligible for Medicaid. Individuals that are eligible for TCA, but choose not to receive it, may still be eligible for Medicaid.
•
Families that lose eligibility for Section 1931 Medicaid due to earned income may be eligible for up to 12 additional months of Medicaid, if they meet certain requirements. This type of Medicaid is called transitional Medicaid.
•
Families that lose eligibility for Section 1931 Medicaid due to child support or alimony may be eligible for 4 additional months of Medicaid. This type of Medicaid is called extended Medicaid.
Medicaid For Children
The State of Florida has several programs designed to provide Medicaid for children only. The income limits for most of these programs vary based on the age of the child. Only the income of the child and parent(s) is counted when determining the child’s eligibility.
•
A child born to a mother who is eligible for Medicaid in the month the baby is born is automatically eligible for Medicaid for one year. This type of Medicaid is referred to as Presumptive Eligibility for Newborns and will remain for a year as long as the child remains in the home with the mother, and the mother continues to reside in Florida.
•
Children under age 1 may be eligible if the countable income is less than 200% of the Federal Poverty Level (FPL). There is no asset limit for this type of Medicaid and the child can be living with the parent(s), specified relative, or non-relative.
•
Children ages 1 through 5 may be eligible if the countable income is less than 133% of the Federal Poverty Level. There is no asset limit for this type of Medicaid and the child can be living with the parent(s), specified relative, or non-relative.
•
Children ages 6 through 18 may be eligible if the countable income is less than 100% of the Federal Poverty Level. There is no asset limit for this type of Medicaid and the child can be living with the parent(s), specified relative, or non-relative.
•
Children ages 18 through 20 may be eligible for Medicaid if they meet the income and asset limits for Section 1931 Medicaid. These children must be living with the parent(s) or specified relative.
•
Children that are in foster care, emergency shelter or the Independent Living program may be eligible for Medicaid.
•
Some children who have been adopted may be eligible for adoption subsidy Medicaid.
Families that wish to apply for Medicaid just for their children may do so through the KidCare program. The KidCare application can be mailed in and does not require an interview with DCF. Children who do not qualify for Medicaid may be eligible for other KidCare coverage if income is less than 200% of the Federal Poverty Level and will be referred to Florida Healthy Kids for this determination.
Medicaid For Pregnant Women
The State of Florida has several programs designed to provide Medicaid for pregnant women. When determining eligibility for pregnant women, the unborn child is always counted when looking at the income limit for the family. Women that are found eligible for Medicaid remain eligible throughout the pregnancy and for the two months following the birth of the child, as long as the mother remains a resident of Florida.
•
Pregnant women with children may be eligible for Medicaid if they meet the income and asset limits for Section 1931 Medicaid.
•
Pregnant women without children may be eligible for Medicaid if they meet the income and asset limits for Section 1931 Medicaid. This coverage type begins in the third trimester of pregnancy.
•
Pregnant women with or without children who are not eligible for Section 1931 Medicaid because their income or assets exceed those limits may be eligible for Medicaid. Their income cannot exceed 185% of the Federal Poverty Level. There is no asset limit for this coverage.
•
Pregnant women may be eligible for temporary Medicaid coverage while waiting for a determination on a regular Medicaid application. This type of coverage is called Presumptive Eligibility for Pregnant Women (PEPW) and only covers outpatient medical care, such as doctor visits and prescriptions. It will not cover labor and delivery costs. Women can apply for PEPW coverage at county health departments, or other designated providers, such as community health centers.
•
Medicaid for Elderly or Disabled
The State of Florida has several programs designed to provide Medicaid to low income individuals who are either elderly (65 or older) or disabled. This is referred to as SSI Related Medicaid. Elderly or disabled individuals with children may be eligible for Medicaid if they are eligible for Section 1931 Medicaid.
•
Elderly or disabled individuals with no children may be eligible for Medicaid if their income is below 88% of the Federal Poverty Level.
•
Elderly or disabled individuals may be eligible to have their Medicare premiums and co-payments covered, depending on their income and assets.
•
Elderly or disabled individuals living in a nursing home, in need of hospice care or community based services may be eligible for Medicaid.
The Social Security Administration determines Medicaid eligibility for elderly and/ or disabled individuals who are eligible for Supplemental Security Income (SSI) cash assistance.
Medically Needy
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.
|