Medicaid Notice Information

The Department of Children and Families (DCF) issues notices to inform individuals about the status of their case and actions taken on applications and reapplications. These actions include approvals, denials, changes, terminations, suspensions of eligibility, increases and decreases in benefits, and more. Individuals may receive notices electronically or via U.S. mail, based on the communications preferences the individual selected on their application. Individuals may view all sent notices by logging into their MyACCESS account at MyACCESS.myflfamilies.com.

Below is an explanation of some of the statuses that may appear on your notice. Please note, this list is not exhaustive.

NEWBORN IS PRESUMPTIVELY ELIGIBLE FOR MEDICAID

If a newborn child’s mother is eligible for Medicaid when the child is born, then the child is presumed eligible for Medicaid until the birth month of the following year.

Example: Mother reports pregnancy in February and is determined eligible for Medicaid. In June, Mother reports the child was born June 1st. Because Mother was Medicaid eligible on June 1 when the child was born, the child is eligible for coverage through May 30 of the following year.

ELIGIBLE FOR TWELVE-MONTH PERIOD OF TRANSITIONAL MEDICAID

Under certain circumstances, households that become ineligible for Medicaid due to new or increased earned income of the parent or caretaker are potentially eligible for continued coverage for up to 12 additional months after the month they became ineligible for Medicaid.

Example: DCF approves mother, father, and minor child for family-related full Medicaid coverage in August. In December, mother reports she started working in November. As a result, mother and father lose their Medicaid coverage, but minor child remains eligible. Under certain circumstances, mother and father could receive transitional coverage through December 31 of the following year.

ENROLLED IN MEDICALLY NEEDY WITH AN ESTIMATED SHARE OF COST

DCF was unable to verify the individual’s monthly income. If an individual is otherwise eligible for full-coverage Medicaid, but the individual’s self-reported monthly income exceeds the limit and DCF cannot verify the individual’s income, then the individual is automatically enrolled in the Medically Needy Program, also known as Share of Cost. This prevents denial of their application and informs individuals they can use this coverage in the future if they provide income verification. Gross income must be verified before the Medically Needy benefit can be utilized.

Example: An individual applies for pregnancy Medicaid and reports earnings that appear to exceed the income limit. DCF sends a letter requesting verification of the last four weeks of the applicant’s income. The applicant does not return the requested information by the due date. The applicant is enrolled in the Medically Needy Program with an estimated share of cost.

YOU ARE RECEIVING THE SAME TYPE OF ASSISTANCE FROM ANOTHER PROGRAM

You are already receiving this government assistance in another case or category, and the duplicate government assistance request has been denied. Individuals cannot have two different full-coverage Medicaid categories open at the same time.

Example: Mother and child apply for Medicaid, and mother is approved for full-coverage Medicaid as a parent. At the following review, mother reports she is pregnant and qualifies for pregnancy-related coverage. The mother’s coverage under the initial eligibility reason (parent-related) is closed because she is now covered under a different eligibility reason (pregnancy-related).

YOU ARE NOT ELIGIBLE FOR DCF MEDICAID BECAUSE SSA FOUND YOU TO BE ELIGIBLE FOR SSI MEDICAID

As a Supplemental Security Income (SSI) recipient and a Florida resident, you already qualify for Medicaid. Your eligibility does not need to be determined through DCF.

ELIGIBILITY REQUIREMENTS NOT MET

In most instances, this relates to “technical” eligibility factors. For example, to be eligible for Medicaid, an individual must be a citizen (or qualified non-citizen) and a resident of Florida and have a social security number (or apply for one). For more information about technical eligibility factors, please click the following link: Family-Related Medicaid Program Fact Sheet.

Example: A family that lives in Michigan comes to Florida for vacation. After a child breaks a leg while in Florida. The family applies for Florida Medicaid. Because the family resides in another state, they do not qualify for Florida Medicaid. Florida residency is a technical factor for Medicaid eligibility. Coverage must be denied.

A HOUSEHOLD MEMBER HAS LEFT THE HOME AND CAN NO LONGER BE INCLUDED IN THIS PROGRAM

DCF cannot determine ongoing Medicaid eligibility for a household member who has left the home.

Example: Mother reports in June that her 19-year-old son has moved out of the home. His Medicaid will be closed effective June 30th.

WE DID NOT RECEIVE ALL INFORMATION NEEDED TO DETERMINE ELIGIBILITY

DCF requested information necessary to determine your Medicaid eligibility, but did not receive it. However, if you return the information within 90 days after the denial, you may ask DCF to reevaluate your eligibility without filing a new application.

Example: A letter was sent to an applicant requesting necessary information to determine Medicaid eligibility. The requested information was not returned to DCF. As a result, eligibility could not be determined. The Medicaid was closed or denied.

NO HOUSEHOLD MEMBERS ARE ELIGIBLE FOR THIS PROGRAM

In most instances, this is related to “technical” eligibility factors. For example, to be eligible for Medicaid, an individual must be a citizen (or qualified non-citizen) and a resident of Florida and have a social security number (or apply for one). For more information about technical eligibility factors, please click the following link: Family-Related Medicaid Program Fact Sheet.

Example: A single adult applies for Medicaid. The applicant is not disabled, is less than 65 years old, is not pregnant, and has no related children under 18 years old in their household. This adult does not fit within any Medicaid eligibility categories and is not technically eligible for Medicaid. The application will be denied.

A CHILD(REN) DOES NOT MEET ELIGIBILITY REQUIREMENTS FOR THIS PROGRAM

Example: Parent applies for Medicaid for herself and her 17-year-old child. DCF cannot independently verify the child’s identity, citizenship, or Social Security Number. DCF asks the parent to provide that information. Parent fails to provide the requested information. The child’s eligibility cannot be determined, and child’s Medicaid is denied.

YOU ARE NO LONGER ELIGIBLE, BECAUSE THE YOUNGEST CHILD IS 18

If an adult is eligible for Medicaid because the adult is a parent or caretaker of a child, then the parent or caretaker loses eligibility for Medicaid once the last child in the household turns 18 years of age.

Example: A parent and their 17-year-old child had been receiving Medicaid. The child turns 18 years old. The parent can no longer be covered. The 18-year-old may continue to be eligible.

ACCOUNT TRANSFER TO FFM/FHK

Children who are determined financially ineligible for Medicaid are automatically referred to Florida Healthy Kids (FHK), while most adults who are determined financially ineligible for Medicaid are automatically transferred to the Federally Facilitated Marketplace (FFM). FHK and FFM can provide healthcare coverage for people who are not eligible for Medicaid.

Example: Father applies for Medicaid for himself and his 8-year-old child. Father verifies income that exceeds eligibility limits for full-coverage Medicaid for both himself and the child. Father and child are enrolled into the Medically Needy Program. Father’s information is forwarded to the FFM, while the child’s information is forwarded to FHK for potential additional coverage options.

YOUR MEDICAID FOR THIS PERIOD IS ENDING

This explanation indicates that an individual’s Medicaid review period has expired without reapplication or has expired due to the individual’s loss of technical eligibility. For example, to be eligible for Medicaid, an individual must be a citizen (or qualified non-citizen) and a resident of Florida and have a social security number (or apply for one). For more information about technical eligibility factors, please click the following link: Family-Related Medicaid Program Fact Sheet.

Example: Mother, father, and two children are approved for Medicaid in June. The following April, DCF prompts the family to complete their annual review. The family does not respond timely, and their Medicaid closes effective May 31.