May 12, 2022

Demystifying Florida’s Medicaid/KidCare Income Eligibility Criteria

Thousands of Florida families  risk losing health coverage once the federal COVID public health emergency ends. 

Now more than ever, it is critical that people have access to accurate and understandable information on Medicaid and KidCare income eligibility requirements. These programs are lifelines for uninsured Floridians who need health care, particularly in the time of COVID-19.

However, Florida's child health program, KidCare, is already extraordinarily fragmented and complex. It includes four distinct components: Medicaid, MediKids, Florida Healthy Kids, and Children's Medical services, each with different age and income eligibility limits.

Adding to the complexity is the state's published information on income limits for each of these program components. The information is confusing — in some cases misleading — and inaccessible for most of the public.

For example, a  2021 KidCare annual income table specifies that families with income above 200 percent of the federal poverty level (FPL) are not eligible for subsidized child health care coverage and must pay the full cost of the monthly premium. (Notably, as of the date this blog post was published, the KidCare income table posted on the website has not been updated to reflect the 2022 updated 200 percent FPL.)

Additionally , the percentage of income cut-off for subsidized premiums is actually higher — it is 215 percent of the FPL.  Parents in a three-person household reading the table will justifiably think that if their annual income exceeds $43,920 (200 percent of the 2021 FPL), they will not qualify for subsidized premiums. Yet, in fact they could  have annual income up to $49, 514  per year — 215 percent of the 2022 FPL — nearly  a $6,000  difference from what the state publishes.

Here is why this is so important: subsidized coverage costs just $15-$20 per month covering all children in the household. In contrast, “full-pay” families are required to pay $243.50 per month for each child.  

Similarly, the state’s table incorrectly specifies that families can only have household income up to 133 percent of the FPL — $29,208 per year or $2,434 per month for a three-person household — to qualify for free child health coverage under Medicaid. Above that level, the table shows that a family would have to pay a premium of $15 per month.

Again, the actual Medicaid income limit for children and youth is higher than what is specified in the state’s KidCare table:

  • For infants 0 to 1, parents/caretakers can have income up to 211 percent of the FPL ($4,050 monthly for a three-person household, or  $1,616 more than the state’s published limit).
  • For children aged 1-5, parents/caretakers can have income up to 145 percent of the FPL ($2,783 monthly for a three-person household, or $349  more than the state’s published limit).
  • For children aged 6-18, parents/caretakers can have income up to 138 percent of the FPL ($2,525 monthly for a three-person household, or $215 more than the state’s published limit). 

Another confusing aspect of the state’s KidCare table is that it includes annual income limits but not monthly ones. When determining eligibility for new applicants, the state is required to look at current monthly income. With many  low wage workers  experiencing  monthly fluctuations in their household income, this omission is likely deterring some eligible families from applying.

A different Medicaid income eligibility chart published by the Department of Children and Families titled "Family-Related Medicaid Income Limits" — also intended for public consumption — is incomprehensible to most. Rather than publishing straightforward income limits by household size, it includes multiple columns of figures including technical terms and acronyms, such as “standard disregard” and “MAGI disregard.”

These terms are code for Medicaid/KidCare income eligibility changes made under the Affordable Care Act that have been in effect since January 1, 2014. This included raising income limits for pregnant women, parents, and children, even in non-expansion states like Florida.

Florida already has one of the highest rates of uninsured residents in the country, and the rate is climbing. Even before the pandemic, researchers projected that 42,000 uninsured adult Floridians were Medicaid eligible but not enrolled. Likewise, the uninsured rate for Florida children has been climbing.

Expanding Florida's Medicaid program would be the simplest and most cost-effective way to reverse these trends.

However, short of that, transparent, concise, and accurate public information on Florida's current Medicaid/KidCare income eligibility limits is an essential first step. Floridians deserve no less.

Click the download button to access information on the increased income limits for Florida Medicaid/KidCare.

Downloadable Resources

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