Florida Medicaid pays for doctor visits, inpatient and outpatient hospital care, prescription drugs, lab and X-ray services, behavioral health care, family planning, home health, medical transportation, nursing facility care, and limited dental and vision services. Children under 21 get a broader package that includes full dental care, therapies, private duty nursing, and behavior analysis. Most enrollees get these benefits through the Statewide Medicaid Managed Care (SMMC) program, so your actual coverage comes from a health plan and a separate dental plan rather than from the state directly. Below: what is covered, what has limits, what you may pay, and how the three parts of SMMC fit together.
What Florida Medicaid Covers
The Agency for Health Care Administration (AHCA) runs Florida Medicaid and publishes the full list of covered services, which runs to more than 60 service categories. Its consumer brochure describes the core benefit as the services of doctors, nurse practitioners, physician assistants, chiropractors, podiatrists and nurse midwives, plus prescribed drugs, durable medical equipment and supplies, family planning, emergency and non-emergency transportation, dialysis, some dental care, vision, hospice, transplant, federally qualified health center and rural health clinic care, home health, lab and X-ray services, community mental health services, County Health Department services, inpatient and outpatient hospital care, and nursing facility services.
Here is how those services group together in practice.
| Category | What Florida Medicaid pays for |
|---|
| Doctor and clinic care | Physician visits, ARNP and physician assistant services, specialist care, federally qualified health centers, rural health clinics, County Health Department services |
| Hospital | Inpatient and outpatient hospital services, ambulatory surgical centers, anesthesia, emergency care |
| Prescriptions | Prescribed drug services under the Florida Medicaid Preferred Drug List or a managed care plan's drug list |
| Behavioral health | Assessments, medical and psychiatric services, individual, group and family therapy, rehabilitative services, substance use treatment, targeted case management |
| Diagnostics | Laboratory services, radiology and nuclear medicine |
| Maternity | Prenatal care, delivery, birth center and midwife services, family planning, reproductive services |
| Equipment and supplies | Durable medical equipment, medical supplies, respiratory services, hearing services, visual aid services |
| Therapies | Physical, occupational, speech-language pathology, and respiratory therapy |
| Home and facility care | Home health, hospice, nursing facility, assistive care services, ICF/IID services, PACE |
| Transportation | Emergency transportation and non-emergency medical transportation to covered appointments |
| Dental and vision | Dental services through a separate dental plan, visual care and visual aid services |
| Specialty | Dialysis, transplant services, pain management, oral and maxillofacial surgery, cardiovascular, neurology, orthopedic, and allergy services |
AHCA notes that limitations and prior authorizations may apply to some of these services. A covered service is not the same as an automatically approved service.
Extra Coverage for Children Under 21
Florida Medicaid covers substantially more for enrollees under age 21, which is a federal requirement known as Early and Periodic Screening, Diagnostic and Treatment. On top of the adult benefit, children get comprehensive health screenings, full dental care, therapies, private duty nursing, personal care, medical foster care, early intervention services, prescribed pediatric extended care, community based services, behavior analysis, and school-based services.
Children whose family income is too high for Medicaid may still get coverage through Florida KidCare. Most Florida Healthy Kids enrollees, families between 133 percent and 200 percent of the federal poverty level, pay $15 or $20 a month for health and dental coverage. Families above the subsidy limits can buy the same coverage at full price, listed by Florida KidCare as $276 per child per month with dental, or $256 for families who opt out of dental. Out-of-pocket costs are capped at 5 percent of family gross annual income per plan year.
How Coverage Is Delivered: The Three Parts of SMMC
Most Florida Medicaid enrollees do not get benefits directly from the state. AHCA contracts with plans, and the SMMC program has three components: the Managed Medical Assistance (MMA) program, the Dental Program, and the Long-Term Care (LTC) program.
Managed Medical Assistance. MMA plans provide state plan level services including primary care, acute hospital care, behavioral health, pharmacy, and transportation. AHCA implemented new SMMC contracts on February 1, 2025, and plans now operate in nine regions lettered A through I. MMA plans also offer expanded benefits, which are services the traditional fee-for-service program does not cover. Expanded benefits vary by plan, which is the single biggest reason two Florida Medicaid members can have different coverage.
The Dental Program. Dental is carved out of the medical plan. Florida contracts separately for statewide dental coverage, and members enroll with a dental plan in addition to a health plan.
Long-Term Care. The LTC program covers nursing facility care and home and community-based services for people who need a nursing home level of care.
Some groups are voluntary for managed care, including people receiving prescribed pediatric extended care services, people in the iBudget waiver or its pre-enrollment category, and people with non-Medicare creditable coverage. They can disenroll and stay in fee-for-service Medicaid, where you use your gold card directly at the provider.
You have 120 days after enrollment to change plans, and your enrollment letter explains how. To compare plans or talk to a choice counselor, use flsmmc.com or call 1-877-711-3662.
Florida Medicaid Dental Coverage
Dental coverage is the sharpest split between children and adults in Florida Medicaid.
| Age group | Dental coverage |
|---|
| Under 21 | Full dental care, including exams, cleanings, X-rays, fluoride, sealants, fillings, crowns, root canals, extractions, and orthodontia when medically necessary |
| 21 and older | A limited, largely problem-focused benefit: problem-focused exams, limited exams and X-rays, extractions, dentures, sedation, and pain management |
Florida's contracted dental plans also offer expanded dental benefits beyond the state plan, and those extras differ by plan. If routine adult cleanings or fillings matter to you, compare the dental plans' expanded benefit lists before picking one, because that is where the difference shows up. Your dental plan's member handbook is the authoritative list for your plan.
Long-Term Care Benefits
The SMMC Long-Term Care program covers 24 home and community-based services plus nursing facility care: adult companion care, adult day health care, assistive care, assisted living, attendant nursing care, behavioral management, caregiver training, care coordination and case management, home accessibility adaptation, home delivered meals, homemaker services, hospice, intermittent and skilled nursing, medical equipment and supplies, medication administration, nutritional assessment and risk reduction, nursing facility, occupational therapy, personal care, personal emergency response system, respite care, physical therapy, respiratory therapy, speech therapy, and transportation to LTC services.
To enroll, you must be 65 or older, or 18 or older and eligible for Medicaid because of a disability, and be determined by CARES, the state's assessment program, to need a nursing home level of care, or a hospital level of care if you have cystic fibrosis. A CARES nurse or assessor usually does the assessment in your home at no cost. The Department of Elder Affairs manages a waitlist and screening scores set priority, so enrollment is not immediate for everyone who qualifies medically.
Pregnancy and Postpartum Coverage
Pregnancy Medicaid covers prenatal care, labor and delivery, and postpartum care. Florida's Department of Children and Families states that eligibility continues throughout pregnancy and for a twelve-month postpartum period, regardless of a change in income. That means a pregnancy-related approval does not end weeks after delivery.
Pregnant women whose income is over the pregnancy Medicaid limit may still qualify through the Medically Needy program. Emergency Medical Assistance can also cover a serious medical emergency, including emergency labor and delivery, for non-citizens who meet the other criteria.
What You Pay: Florida Medicaid Copayments
Florida law (section 409.9081, Florida Statutes) allows small copayments in Medicaid, and AHCA's copayment rule (Florida Administrative Code rule 59G-1.056) sets the amounts adults pay in fee-for-service Medicaid.
| Service | Copayment |
|---|
| Physician or physician assistant | $2 per provider per day |
| Nurse practitioner, optometrist or podiatrist | $2 per provider per day |
| Home health or community behavioral health | $2 per provider per day |
| Hospital outpatient visit | $3 per visit |
| Federally qualified health center or rural health clinic | $3 per clinic per day |
| Chiropractor, independent lab or portable X-ray | $1 per provider per day |
| Non-emergency transportation | $1 per one-way trip |
| Non-emergency use of the emergency department | 5 percent of the first $300 of the Medicaid payment, up to $15 |
The rule sets no copayment for prescription drugs. The statute allows a pharmacy coinsurance of up to $7.50, but AHCA's rule does not include one, and KFF's state survey also lists Florida Medicaid with no pharmacy copay.
The statute exempts several groups from copayments entirely: children under 21, pregnant women for pregnancy-related services through six weeks after delivery, people institutionalized in a hospital or long-term care facility, people receiving emergency services, people seeking family planning services, and anyone enrolled in a Medicaid prepaid health plan or HMO. Because most Florida enrollees are in a managed care plan, most never see these copays, and AHCA lists waived copayments among the expanded benefits plans may offer. AHCA also states that if you do not have your copayment, the doctor cannot refuse to see you for your medical care.
Limits and What Is Not Covered
Service limits exist. AHCA is explicit that Florida Medicaid will not pay a provider when you have met the limit for a service that has one. Several services carry frequency or duration caps, and prior authorization applies to others. AHCA notified providers in a September 2026 health care alert that frequency and duration limits on the community behavioral health and targeted case management fee schedules, waived since 2021, were reinstated effective October 14, 2026. If you use ongoing counseling or case management, ask your plan how many visits your treatment plan now allows.
Out-of-state care is emergency only. If you are traveling outside Florida, Florida Medicaid pays only for emergency care or for care arranged and approved by Florida Medicaid ahead of time. If you move to another state, your Florida Medicaid eligibility stops.
Non-covered services. Florida Medicaid will not pay a provider if the service is not covered, or if you were not eligible on the date of service. Before you get care, ask whether the provider accepts Florida Medicaid and is in your plan's network.
Low-income adults without children are mostly left out. Florida has not adopted Medicaid expansion, so there is no coverage category for adults ages 19 to 64 based on low income alone. Adults generally need another pathway: pregnancy, disability, SSI, being a parent or caretaker relative within a very low income limit, or former foster youth status. Former foster care youth under 26 who were in Florida foster care and on Medicaid when they aged out have no income limit. Because Florida has no expansion group, the new federal Medicaid work requirement for expansion adults does not create a Florida expansion requirement.
Immigration rules tightened on October 1, 2026. Under the 2025 federal law, full Medicaid and CHIP are limited to citizens and nationals, green card holders, Cuban and Haitian entrants, and citizens of Micronesia, the Marshall Islands and Palau. Refugees, asylees, parolees and other adults without one of those statuses generally no longer qualify for full coverage. Children are the exception. Florida uses the federal option to cover lawfully residing immigrant children, and CMS guidance issued April 8, 2026 says the new limits do not apply to that option, so a lawfully residing child can still qualify for children's Medicaid or KidCare. Emergency Medicaid still pays for emergency care for people who would otherwise qualify, and most adult green card holders must wait five years from the date they got qualifying status.
The Medically Needy Program
If your income or assets are over the limit, Florida's Medically Needy program can still turn on Medicaid in a high-medical-bill month. DCF describes it as a program that allows Medicaid coverage after a monthly share of cost is met. Each month starts without coverage. Once you submit itemized medical expenses that add up to your share of cost, coverage activates for the rest of that month. Allowable expenses include unpaid medical bills, bills paid recently, health insurance premiums, copays, and medically prescribed services.
Share of cost is set by household size and income, so it varies case by case. It is most worth using in months with a hospitalization or surgery.
How to Confirm What Your Own Coverage Includes
- Find out whether you are in a plan. Your enrollment letter names your health plan and dental plan. If you are not in a plan, you are in fee-for-service.
- Read your plan's member handbook. It lists covered services, expanded benefits, prior authorization rules, and service limits for your specific plan.
- Call your plan with benefit questions. AHCA directs plan enrollees to the plan for questions about covered services and service limits.
- Use the Medicaid Helpline for state questions. Call 1-877-254-1055 about covered services, service limits, copays, or appeal rights.
- Keep your gold card. Every eligible adult and child gets a gold identification card. It is permanent, so keep it even if your eligibility ends, and carry it with your plan membership card.
- Appeal a denial. You have the right to appeal any denial, reduction, or termination of services.
For a full picture of Florida programs beyond Medicaid, see our Florida benefits overview. To check whether you qualify in the first place, see Florida Medicaid eligibility and income limits, and for keeping coverage active, see the Florida Medicaid renewal guide.
Frequently Asked Questions
Does Florida Medicaid cover dental for adults?
Yes, but narrowly. Adults 21 and older get a problem-focused dental benefit through a contracted dental plan: problem-focused exams, limited exams and X-rays, extractions, dentures, sedation, and pain management. Routine preventive dentistry for adults is mostly delivered through plan expanded benefits, which differ by dental plan. Enrollees under 21 get full dental care.
Does Florida Medicaid cover eye exams and glasses?
Florida Medicaid covers visual care services and visual aid services. Coverage is broader for enrollees under 21, where vision falls under the comprehensive children's benefit. Adult frequency limits on exams and lenses are set in coverage policy and plan rules, so confirm with your plan first.
Does Florida Medicaid pay for rides to the doctor?
Yes. Both emergency transportation and non-emergency medical transportation are covered. If you are in a managed care plan, the plan arranges non-emergency rides, usually with advance notice. Call your plan's transportation line rather than booking on your own.
Do I have to pay a copay for Florida Medicaid?
Usually no. State law exempts children under 21, pregnant women for pregnancy-related care through six weeks postpartum, hospital and long-term care inpatients, emergency services, family planning, and anyone enrolled in a Medicaid prepaid health plan or HMO. Since most enrollees are in a plan, most pay nothing. Fee-for-service adults can owe $1 to $3 for many services, such as $2 for a physician visit and $3 for a hospital outpatient visit, and up to $15 for non-emergency ER use. AHCA's copayment rule sets no copay for prescriptions.
Can I change my Florida Medicaid plan if it does not cover what I need?
You have 120 days after enrollment to change plans, and your enrollment letter explains how. After that window you generally stay with the plan until your next open change period unless you have a state-approved reason. Use flsmmc.com or call a choice counselor at 1-877-711-3662 to compare expanded benefits first.
Does Florida Medicaid cover nursing home care and in-home care?
Yes, through the SMMC Long-Term Care program. It covers nursing facility care plus 24 home and community-based services, including assisted living, personal care, home delivered meals, homemaker services, respite care, and home accessibility adaptations. You must be 65 or older, or 18 or older and eligible for Medicaid because of a disability, and be assessed by CARES as needing a nursing home level of care, and there is a waitlist managed by the Department of Elder Affairs.
