Medicaid Eligibility in Florida: Income Limits & How to Apply
Medicaid Eligibility in Florida
As of 2026, Florida has opted not to expand Medicaid. Florida Medicaid serves a limited population: children, pregnant women, seniors, people with disabilities, and some very low-income parents. Most childless adults below the poverty line cannot qualify.
Coverage gap in Florida: Adults earning below $15,650 per year (100% FPL for an individual) may fall into the coverage gap — too much income for traditional Medicaid but too little to qualify for ACA marketplace subsidies. An estimated hundreds of thousands of Florida residents are affected.
Without Medicaid expansion, coverage in Florida is generally limited to:
- Children in families with income up to 200-300% FPL (via CHIP)
- Pregnant women with income up to 185-200% FPL
- Parents with very low incomes (often well below 50% FPL)
- Seniors and people with disabilities meeting strict income/asset limits
- Adults in the coverage gap have limited options: community health centers, hospital charity care, and free clinics
About Florida Medicaid
If you're in Florida and trying to understand your health coverage options, it's important to know that Florida has not expanded its Medicaid program. This means that most adults, particularly those without children, will not qualify for Florida Medicaid, regardless of how low their income is. The program is primarily available to specific groups: children up to one year old with household incomes up to 211% of the Federal Poverty Level (FPL), children ages 1-18 up to 138% FPL, pregnant women up to 196% FPL (with coverage continuing for 12 months post-birth), and parents with very low incomes, specifically around 26% of the FPL. Individuals who qualify for Supplemental Security Income (SSI) are also automatically eligible. If you are a childless adult with an income below 100% FPL, you will unfortunately fall into what is known as the "coverage gap," meaning you won't qualify for Medicaid or for marketplace subsidies.
If your income is near the Medicaid cutoff, or if you recently lost Medicaid coverage during redeterminations, you might be eligible for subsidized coverage through HealthCare.gov, Florida's federal marketplace. For instance, the benchmark Silver plan in Florida costs around $585 per month. The amount you'd actually pay for a marketplace plan with subsidies depends on your income, with assistance designed to make premiums more affordable as your income decreases. It's crucial to remember that even small changes in your household income can shift your eligibility between Medicaid and marketplace subsidies, so if your financial situation changes, recheck your options. Florida's Medicaid enrollment has seen a decline, with 4,155,487 residents enrolled as of May 30, 2025, a decrease of over 643,000 from January 2024. This means many people who may have lost coverage during the unwinding of continuous enrollment provisions can reapply if they believe they are now eligible.
Florida Medicaid offers comprehensive benefits for those who qualify, typically with little to no cost-sharing. The program covers essential health benefits, including doctor visits, hospital stays, prescription drugs, and more. For seniors and individuals with disabilities, there are specific long-term care Medicaid programs that can help cover the costs of nursing home care, home health care, or assisted living facilities. For example, as of January 2025, the monthly income limit for a single individual for these long-term care programs increased to $2,991, with an asset limit of $2,000. However, for married couples where both are applying, the asset limit is $3,000, and for couples where only one spouse applies, the applicant still has a $2,000 asset limit, but the non-applicant spouse can retain up to $157,920 in assets as of 2025.
If you find yourself in the coverage gap, with an income too high for Florida Medicaid but too low for marketplace subsidies, you still have practical healthcare options. Florida's uninsured rate remains higher than the national average, at 10.9% in 2024 compared to the U.S. average of 8.2%. You can seek care at community health centers, which often provide services on a sliding scale based on your income. Many hospitals in Florida also offer charity care programs for uninsured patients who meet certain income requirements; for example, Baptist Health provides free care for those with household incomes up to 300% of the FPL. Additionally, county indigent programs and free clinics can provide vital services. If your income increases and crosses the 100% FPL threshold, remember to revisit HealthCare.gov, as you would then become eligible for significant marketplace subsidies, making a private health plan much more affordable. There have been ongoing efforts to expand Medicaid in Florida, with a ballot initiative aiming for the 2028 ballot to extend coverage to individuals under 65 with incomes at or below 138% of the FPL.
Florida Medicaid Income Limits 2026
The following table shows the key income thresholds for Florida in 2026:
| Household Size | 100% FPL | 138% FPL | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,650 | N/A | $62,600 |
| 2 | $21,150 | N/A | $84,600 |
| 3 | $26,650 | N/A | $106,600 |
| 4 | $32,150 | N/A | $128,600 |
| 5 | $37,650 | N/A | $150,600 |
| 6 | $43,150 | N/A | $172,600 |
Because Florida has not expanded Medicaid, the 138% FPL threshold does not apply for adult eligibility. Adults earning between 0-100% FPL may fall into the coverage gap. Those earning between 100-400% FPL can access marketplace subsidies.
The benchmark Silver plan in Florida costs about $585/month before subsidies, which is in line with the national average. Subsidies can significantly reduce this cost for qualifying households.
Marketplace Insurance in Florida
Florida residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in Florida costs approximately $585/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in Florida might pay after subsidies:
| Income Level | Annual Income | Expected Contribution | Estimated Monthly Premium |
|---|---|---|---|
| 150% FPL | $23,475 | 4.01% of income | ~$78/mo |
| 200% FPL | $31,300 | 6.52% of income | ~$170/mo |
| 250% FPL | $39,125 | 8.33% of income | ~$272/mo |
| 300% FPL | $46,950 | 9.83% of income | ~$385/mo |
| 400% FPL | $62,600 | 9.83% of income | ~$513/mo |
These are estimates for an individual. Actual premiums depend on your age, household size, tobacco use, and the specific plan you choose. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays.
Residents of Florida shop for marketplace insurance through HealthCare.gov, the federal exchange. The application process screens for Medicaid eligibility first, so you'll be directed to Florida's program if you qualify.
The lack of Medicaid expansion in Florida leaves a gap in the safety net. Residents in the coverage gap — too much income for traditional Florida Medicaid but too little for marketplace subsidies — rely on community health resources and uncompensated care.
How to Get Coverage in Florida
Since Florida has not expanded Medicaid, your path to coverage depends on your income level:
- Income above 100% FPL ($15,650+ for an individual): Apply through HealthCare.gov during open enrollment (November 1 - January 15) or after a qualifying life event. You will qualify for premium subsidies.
- Income below 100% FPL: Check if you qualify for traditional Medicaid categories (children, pregnant women, disabled). If not, look into community health centers, hospital financial assistance, and free clinics in your area.
- Children: Florida's CHIP program covers children in families with income up to 200-300% FPL regardless of expansion status.
Calculate Your Subsidy in Florida
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in Florida.
Check Your Eligibility →Frequently Asked Questions
What are Florida's Medicaid eligibility requirements?
Florida has not expanded Medicaid, so there is no standard income limit for adults. Traditional Medicaid covers specific groups (children, pregnant women, disabled, very low-income parents). Income limits for these groups vary. Children are generally covered up to 200-300% FPL through CHIP.
Has Florida expanded Medicaid under the ACA?
No, Florida has not expanded Medicaid. This creates a coverage gap for adults earning below 100% FPL who do not qualify for traditional Medicaid categories.
Can I get ACA subsidies in Florida?
Yes. Florida residents with household income between 100% and 400% FPL ($15,650 to $62,600 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through HealthCare.gov.
What is the Florida Medicaid program called?
Florida's Medicaid program is known as Florida Medicaid. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and certain other qualifying groups.
What happens if I lose Medicaid coverage in Florida?
If your Florida Medicaid coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through HealthCare.gov. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
I don't qualify for Medicaid or subsidies in Florida — what can I do?
If you're in the coverage gap (earning below $15,650/year but not qualifying for traditional Medicaid), look into community health centers in Florida that offer sliding-scale fees based on income. Many hospitals have charity care programs for uninsured patients. Free clinics and the 211 helpline can connect you with local resources. If your income changes, reapply — even small income increases could qualify you for marketplace subsidies.
What's stopping Medicaid expansion in Florida?
Medicaid expansion has been a politically contentious issue in Florida. The state legislature has not passed expansion legislation, leaving an estimated coverage gap for adults earning below 100% FPL. Advocacy groups continue to push for expansion, and several neighboring states have recently adopted it. Check with Florida's legislative updates for the latest status.
Medicaid Eligibility in Nearby States
- Alabama Medicaid Eligibility — Non-expansion state
- Georgia Medicaid Eligibility — Non-expansion state