The program resets each month.
The day your healthcare expenses for the month exceed your share of cost, your Medicaid coverage begins.
From that day until the end of the month, you have full Medicaid coverage.
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Other states have different approaches to Medically Needy Medicaid eligibility.
This amount is related to how much your income exceeds the traditional Medicaid income limits.
The more money you make, the more your share-of-cost will be.
When You Must Pay Share-of-Cost
You dont actually have topaythe healthcare expenses used to reach your share-of-cost.
You just have toowethat much.
Medicaid now pays Cindy’s medical expenses from May 4 through the end of the month.
Medicaid will also pay expenses for care that Cindy receives during the rest of the month.
At all times during the month, it’s important to check that your medical providers accept Medicaid.
Your share-of-cost amount can be from providers that do or don’t accept Medicaid.
You may use expenses from up to 90 days ago.
The medical expenses dont necessarily have to be for you.
Florida Medicaid also notes that it’s possible for you to’t count expenses for over-the-counter medications or supplies.
Maximizing Benefits
Youll have to be organized to maximize your Medicaid coverage.
Does It Work Well?
Medicaid’s share-of-cost works especially well for people with high healthcare expenses that recur every month.
Some people mistakenly believe they have to pay their full share of cost out-of-pocket every month.
They struggle to pay their share of cost themselves, thus paying more than was expected of them.
They end up paying too much out-of-pocket and getting very few days of full Medicaid coverage.
If you dont pay, the provider could refuse to provide the service.
The more bills you rack up, the more likely you are to have coverage that month.
That means theres no incentive for you to keep healthcare costs down.
For 2025 coverage, this lower income limit for a single adult will be$15,060.
The prior year’s federal poverty level is used to determine subsidy eligibility in the Marketplace.
Premium subsidies can be used with Marketplace plans at any metal level.
As income levels increase, premium subsidy amounts decline.
And cost-sharing reduction eligibility ends altogether after a person’s income exceeds 250% of the poverty level.
If you have questions, call the Florida Medicaid office and ask them to explain the details.
This information was accurate when published.
However, the State of Florida may change itsMedicaid Share of Cost programat any time.
Florida Department of Children & Families.Medically needy program.
Choice Mutual.Medicaid Asset Limits By State: Eligibility Guidelines.
June 1, 2024.
State of New Jersey.
Department of Human Services.
Division of Medical Assistance and Health Services.New Jersey Care; Special Medicaid Program, Medically Needy Segment.
Healthinsurance.org.Florida and the ACA’s Medicaid Expansion.
Centers for Medicare and Medicaid Services.
Medicaid.gov.Medicaid, Children’s Health Insurance Program, & Basic Health Program Eligibility Levels.
