Florida’s Medicaid Redetermination Plan
Frequently Asked Questions
What is a federal Public Health Emergency (PHE)?
A PHE is when the United States Department of Health and Human Services (HHS), a federal agency, declares that a disease or disorder presents a public health emergency or that a PHE otherwise exists due to the significant outbreaks of infectious disease. PHEs can last up 90 days and can be extended at any time by U.S. Department of Health and Human Services (HHS). For the COVID-19 pandemic, the federal government declared a PHE on January 31, 2020.
How does the federal PHE affect eligibility for Florida Medicaid?
The Families First Coronavirus Response Act requires that states maintain continuous Medicaid coverage for enrollees during the PHE. Florida has allowed individuals to remain on Medicaid throughout the PHE even though their household situation may have changed. As a result of federal legislative changes in the Consolidated Appropriations Act, 2023, the continuous coverage provision will end on March 31, 2023. Once the continuous coverage ends, some Medicaid recipients may no longer be enrolled in Medicaid.
When will the continuous coverage end for Medicaid?
The continuous coverage provision will end on March 31, 2023.
What will happen when the continuous coverage ends?
Over the course of 12 months the Department will review all Medicaid cases to ensure recipients are eligible for benefits. Many individuals will be the beneficiary of an automatic review and approval to continue Medicaid eligibility (also called passive renewal or ex parte renewal). In this case, individuals will receive a notice that their Medicaid case has been approved and their Medicaid coverage will continue.
If the Department cannot automatically review an individual's Medicaid coverage because additional information is required, the Department will send a notice 45 days prior to the renewal date with instructions on how to complete the renewal process. Individuals will have the opportunity to provide updated information to Department staff who will evaluate their eligibility for Medicaid. Upon receipt of this notice, it is important that individuals act timely to provide requested information to ensure they do not experience a disruption in Medicaid coverage.
For more information on how to sign up for e-mail notifications visit this link: Going Paperless: Email Notifications and Online Notices (myflfamilies.com)
If recipients have questions regarding their MyACCESS Account or about updating their contact information, please check out the ‘How To’ videos here: Access Florida - Florida Department of Children and Families (myflorida.com).
What should I do when the continuous coverage ends?
You should make sure your address on file is updated by logging in to your MyAccess account. Additionally, be on the lookout for a mailed or emailed notice from the Department to complete your renewal. Upon receipt of that notice, you should renew as quickly as possible by going to https://www.myflorida.com/accessflorida/ to update your Medicaid information. The Department may ask for additional information from you while your case is being reviewed.
What should I do if I am no longer eligible for Medicaid when the continuous coverage ends?
If you are no longer eligible for Medicaid coverage, the Department will send you a notification through your MyACCESS account, and by sending a letter or an email to you. To ensure continuing coverage, applications for individuals not determined eligible for Medicaid, but eligible for a different healthcare coverage program, will automatically be referred to Florida KidCare, the Medically Needy Program, and other subsidized federal healthcare programs. You can check your MyACCESS account to see if your application has been forwarded to one of these agencies.
Florida KidCare provides low-cost health coverage for children based on family income. You can learn more about this program at the following link: www.floridakidcare.org. The Medically Needy Program allows Medicaid coverage after a monthly “share of cost” is met, determined by household size and family income. You can learn more about the Medically Needy program at the following link: Medically Needy Brochure (myflfamilies.com).
If your application is transferred to the Federal Marketplace, you will receive a letter from the United States Department of Health and Human Services with instruction on how to complete an application for healthcare insurance. You can learn more about the Federal Marketplace at the following link: www.healthcare.gov.
What additional information or documentation may the Department need to complete my Medicaid redetermination?
Current Medicaid recipients have already provided verification of some eligibility factors, such as identity, Florida residence, citizenship or eligible immigration status. Example of additional information that may need to be provided includes but is not limited to, information about the members of your household, income and, for certain coverage, asset information.
How long will it take for the Department to review my Medicaid redetermination?
Once all the information needed to make a determination is available, the Department will make a decision on eligibility within 45 days. The Department will review your application to determine if you are eligible for Medicaid and the level of Medicaid coverage you are eligible to receive. If it is determined that you are not eligible for Medicaid, your application will be automatically referred electronically to Florida KidCare, the Medically Needy Program, and other subsidized federal health programs. You can check your MyACCESS account to see if your application has been forwarded to one of these agencies.
Other Medical Help for Those Not Eligible for Medicaid
Individuals who are not eligible for Medicaid may get help with healthcare in their area through:
Individuals who are not eligible for Medicaid may get help with the cost of prescription drugs through:
NOTE: These programs are not administered by the Department of Children and Families and are being provided as a potential healthcare resource for you and your family. The Department and its partners, including the Medicaid Health Plans, stand ready to help families secure other options to receive health care coverage including referrals to the Federally Qualified Health Centers, who provide primary care services on a sliding fee scale to individuals without health insurance.
To speak with a Healthcare Navigator for guidance on navigating the healthcare system, visit My Florida CFO for a contact list of Florida-registered and federally-certified Navigators. A guide on Health Insurance and HMO Overview is also available at My Florida CFO.
What if I think the determination that I am ineligible is wrong?
If the Department determines that you are not eligible for Medicaid and you think the determination is wrong, you have a right to appeal and should do so within 10 days of the date on the denial letter. You can initiate an appeal by making a request to the Office of Inspector General (OIG). While your appeal is in process, you have the choice to retain your Medicaid coverage.