Anne Swerlick
June 10, 2020

Demystifying Florida’s Medicaid/KidCare Income Eligibility Criteria

This post was last updated on July 22, 2021. As new policies are announced, FPI will update this page.

As Florida’s response to COVID-19 takes front and center, concern grows for low-income families who struggle to take precautions against the spread of the virus. Although Congress has passed the Families First Coronavirus Response Act to address, at least in part,  the public health crisis and economic fallout from COVID-19, many barriers continue to keep struggling families from accessing the assistance they need during the pandemic. As Florida initiates policies implementing the Act and addressing other barriers to the safety net, FPI will update this form. When available, hyperlinks are provided to agency documents or statements that provide greater detail  about the new policy.
On March 22, 2020, FPI and 44 other organizations sent a letter to Governor DeSantis, leadership in the Legislature and agency heads to urge action on 47 specific policy changes to reduce unnecessary barriers for Florida’s safety net programs in response to the COVID-19 pandemic. See the letter here.

Thousands of Florida families are losing health coverage due to the economic downturn. 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 needing health care, particularly in the time of COVID-19. 

However, the state's published information on Medicaid and KidCare income limits is confusing — in some cases misleading — and inaccessible for most of the public.  

For example, a 2020 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. But in fact, the income cut off for subsidized premiums is higher -  215 percent of the FPL.

Parents in a three-person household reading the table will justifiably think that if their annual income exceeds $43,440 (200 percent of FPL), they will not qualify for subsidized premiums. Yet, their annual income could actually be up to $46,698 per year — 215 percent of the FPL — which is more than a $3,000 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 $157 per month for each child aged 0-5 and $230 per month for each child aged 6-18.    

Similarly, the state’s table incorrectly specifies that families can only have household income up to 133 percent of the FPL to qualify for free child health coverage under Medicaid. (That is $2,408/month for three-person household.) Above that level, the table shows that a family would have to pay a premium of $15 per month.

But again, the actual Medicaid income limit for children and youth is higher:

·  Infants 0-1, 211 percent FPL ($3,820 monthly for a three-person household, $1,412 more)

·  Children 1-5, 145 percent FPL ($ 2,626 monthly for a three-person household, $218 more)

·  Children 6-18, 138 percent FPL ($2,499 monthly for three-person household, $91 more)

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 middle-income families now experiencing sudden reductions in income due to job loss, 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 which 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 in the country and it 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.

You can access information on the increased income limits for Florida Medicaid/KidCare in the table below.

Downloadable Resources

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