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Florida · Medicare and Medicaid

Medicare and Medicaid in Florida

Florida splits the work: AHCA runs Medicaid and DCF decides who qualifies. Here are the program names, how long-term care works, and Florida's 2026 figures.

Last updated October 23, 2026 · 7 min read

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By Alexander James, Licensed Independent Insurance Agent · NPN 19291077

Part of our guide to Medicare and Medicaid together. For general Medicare help in Florida, see Medicare in Florida.

Florida at a glance

  • Medicaid is run by

    Agency for Health Care Administration (AHCA)

  • Current state programs

    Statewide Medicaid Managed Care (SMMC); MEDS-AD; Institutional Care Program; Medically Needy; PACE

  • Published Medicaid figures

    7 figures below, each with the date it applies

  • Federal change, January 1, 2027

    One D-SNP per area for full-benefit duals, generally, where a company also offers a Medicaid plan

Sources: the Agency for Health Care Administration (AHCA) (linked below) and 42 CFR 422.514.

Florida's Medicaid program for people with Medicare

Medicaid in Florida is run by the Agency for Health Care Administration (AHCA). The state decides who qualifies for Medicaid; a Medicare plan or an agent cannot. The Florida Department of Children and Families (DCF) decides Medicaid eligibility; apply through MyACCESS.

Statewide Medicaid Managed Care (SMMC)
Florida's Medicaid managed care program. Managed Medical Assistance (MMA) covers medical care; the Long-Term Care (LTC) program covers nursing-facility and home- and community-based care.
MEDS-AD
Full Medicaid for people who are 65 or older or have a disability, within Florida's income and asset limits.
Institutional Care Program
Medicaid coverage for nursing-home care, with a higher income limit than MEDS-AD.
Medically Needy
A share-of-cost program: people over the income limit can qualify once their medical bills reach a monthly share of cost.
PACE
The Program of All-Inclusive Care for the Elderly.

How Medicare and Medicaid fit together in Florida

Florida delivers full Medicaid through Statewide Medicaid Managed Care. On the Medicare side, CMS lists Florida among the states with integrated D-SNP options (FIDE SNPs, HIDE SNPs or applicable integrated plans) for 2025, alongside other D-SNPs.

AHCA keeps a page about Medicare D-SNPs for people with Medicaid. Which D-SNPs and integration levels are offered depends on your county. The federal rule that starts January 1, 2027, under which a company that also runs a Medicaid managed care plan in an area may generally offer only one D-SNP for full-benefit duals there, applies in Florida as it does everywhere.

Long-term care in Florida

According to AHCA, nursing-home residents are enrolled in the SMMC Long-Term Care program automatically, while people living at home join through a waitlist screened by their local Aging and Disability Resource Center. Florida's eligibility rules review assets transferred within the last 60 months for long-term care applicants.

If you have QMB, SLMB or QI only

AHCA says partial duals (QMB-only, SLMB-only and QI) are not enrolled in SMMC's medical or long-term care programs. Whether a particular Florida D-SNP accepts partial duals depends on the plan and its state contract, so ask before you decide.

Florida Medicaid figures, as the state publishes them

These are the figures Florida DCF publishes. Medicare Savings Program figures are shown as Florida lists them, before the $20 income disregard.

Florida: published Medicaid figures, with the date each applies

Your own eligibility depends on your full situation and is decided by the state. Federal figures that apply in every state are in our guides to the Medicare Savings Programs, Extra Help and Medicaid long-term care.

What works the same in every state

Some rules are federal. Medicare pays first and Medicaid pays last. Since 2025, people with Medicaid or Extra Help have a once-a-month option to change drug coverage, and full-benefit duals have a once-a-month option to join an integrated plan that matches their Medicaid plan. Starting January 1, 2027, federal rules generally limit companies to one D-SNP per area for full-benefit duals where they also offer a Medicaid plan. Our guide to integrated D-SNPs explains each step, and Will I lose my Medicaid if I join a D-SNP? covers what changes when you join one.

Who pays first when you have Medicare and full Medicaid

  1. Step 1

    You get a Medicare-covered service

    A doctor visit, a hospital stay or a prescription that Medicare covers.

  2. Step 2

    Medicare pays first

    Through Original Medicare or your Medicare plan. Your prescription drugs are covered by a Medicare drug plan, not by Medicaid.

  3. Step 3

    Medicaid pays last

    After Medicare and any other health insurance you have. Medicaid can also cover some services Medicare does not, depending on your state.

Source: Medicare.gov, “Medicaid” (people who have both Medicare and full-benefit Medicaid).

Before you change anything

FAQ

Medicare and Medicaid questions from Florida

Sources

Each page was read on October 23, 2026.

Guides for other states

Continue learning

Related reading

Questions about Medicare and Medicaid in Florida?

A licensed agent can explain how the plans they offer in your area work with your Medicaid and check your doctors first. No pressure, and no obligation to enroll.

Talk with a licensed agent Schedule a consultation

Or call (954) 601-3544.

Educational content. Insurance products are subject to underwriting; rates and availability vary by health, age, state, and carrier. Licensed Insurance Advisor | NPN: 19291077 | Licensed in 25+ states.