Florida Medicaid: eligibility, benefits, and how to apply

Last verified: June 2026

What is Florida Medicaid and who runs it?

Florida Medicaid provides health coverage to low-income Floridians who meet specific eligibility categories. The Agency for Health Care Administration (AHCA) administers the program. The Department of Children and Families (DCF) determines eligibility for most applicants — SSI recipients have their eligibility determined directly by the Social Security Administration.

Enrollment stood at approximately 3.8 million before the COVID-19 pandemic and climbed to a peak of roughly 5.5 million during the continuous enrollment period, per DCF data. After the 2023–2024 unwinding process, enrollment returned closer to pre-pandemic levels. As of 2025, AHCA reports roughly 4 million Floridians enrolled in the program.

Florida is one of ten states as of 2026 that have not adopted Medicaid expansion under the Affordable Care Act. That policy decision creates what policy researchers call the "coverage gap" — adults who earn too much to qualify for Florida Medicaid but not enough to receive marketplace tax credits.

The coverage gap: who gets left out

In expansion states, non-elderly adults qualify for Medicaid up to 138% of the Federal Poverty Level (roughly $21,000/year for a single person in 2025). Florida does not cover that group. A 35-year-old working adult earning $15,000 per year with no children does not qualify for Florida Medicaid and falls below the income floor for marketplace subsidies — leaving them uninsured unless they can access employer coverage or a Federally Qualified Health Center.

Per KFF research, approximately 200,000 Floridians fell into the coverage gap as of early 2025. This is a smaller number than in prior years due to a temporary federal policy extending marketplace subsidies to that income range — but those subsidies are not permanent and may expire depending on federal legislation.

Parents with dependent children do qualify, but at very low income thresholds. A family of three with a parent earning more than about $1,047 per month does not qualify as a parent under Florida Medicaid's income rules, per DCF eligibility standards.

How Florida delivers Medicaid: the SMMC program

Most Florida Medicaid enrollees receive their care through the Statewide Medicaid Managed Care (SMMC) program, not through traditional fee-for-service. AHCA manages the SMMC program. As of February 1, 2025, AHCA launched SMMC 3.0 — new five-year contracts with health and dental plans operating in 9 regions across the state (reduced from 11 regions in the prior contract period).

SMMC has four components:

To compare health plans in your region, visit flmedicaidmanagedcare.com or call 1-877-711-3662 to speak with a choice counselor.

Who qualifies for Florida Medicaid?

Florida covers specific eligibility categories. These are the main groups, per DCF eligibility rules:

• Children under age 19, up to 200% FPL through Medicaid; up to 210% FPL through Florida KidCare (CHIP)
• Pregnant women at income limits above Medicaid may qualify for the Medically Needy program
• Parents and caretaker relatives of dependent children — income limits are very low (non-expansion state)
• SSI recipients — automatic Medicaid eligibility
• Elderly individuals (65+) and people with disabilities who meet SSI-related income and asset rules
• Former foster care youth under age 26 — no income limit
• Non-citizens in medical emergencies — emergency Medicaid only

Adults without children and without a disability generally do not qualify — this is the direct result of Florida's decision not to expand Medicaid.

Florida Medicaid eligibility at a glance

FPL = Federal Poverty Level. 2025 federal poverty guidelines from HHS. Limits shown are gross income unless noted. Asset tests do not apply to MAGI-based groups.

Florida's managed care system: SMMC

Florida delivers Medicaid primarily through the Statewide Medicaid Managed Care (SMMC) program, which transitioned to SMMC 3.0 on February 1, 2025. Most enrollees receive care through contracted managed care organizations (MCOs). SMMC has four components:

After approval, enrollees have 120 days to select an MCO plan in their region. If no plan is selected, Florida automatically assigns one. For plan comparison and enrollment, visit flmedicaidmanagedcare.com or call the choice counseling line at 1-877-711-3662.

Florida Medicaid guides