Florida is one of 10 states that has not expanded Medicaid under the ACA. This creates a coverage gap for adults earning between 100% and 138% of the Federal Poverty Level — too much for traditional Florida Medicaid, but low enough that ACA marketplace subsidies technically don't apply either. Understanding exactly who qualifies for Florida Medicaid in 2026 — and what happens to those who don't — is essential for every low-income Florida resident making healthcare decisions.
| Household Size | 100% FPL 2026 | Florida Medicaid Limit (Adults) | ACA Subsidy Threshold |
|---|---|---|---|
| 1 | $15,060 | $15,060 (marketplace only) | $15,060+ |
| 2 | $20,440 | $20,440 | $20,440+ |
| 3 | $25,820 | $25,820 | $25,820+ |
| 4 | $31,200 | $31,200 | $31,200+ |
| Pregnant (1) | ~195% FPL | ~$29,367 | N/A |
| Child (1) | ~210% FPL | ~$31,626 | N/A |
Florida Medicaid covers certain categories of low-income residents, but adult eligibility is extremely limited without Medicaid expansion. The following groups can qualify:
Childless adults in Florida generally do not qualify for Medicaid at any income level, absent a disability — this is the heart of the coverage gap.
Comparing ACA plans in Florida
About 800,000 Floridians fall into the coverage gap: earning more than the Florida Medicaid limit for adults (often around 31% FPL for parents) but less than 100% FPL where ACA marketplace subsidies begin. These individuals cannot get Medicaid, and the ACA's APTC only applies at 100% FPL and above.
The practical effect: a single adult in Florida earning $10,000–$15,000 per year has no subsidized insurance option through the ACA system. Florida voters passed Amendment 4 in 2022 directing Medicaid expansion, but implementation remains in legal and legislative limbo as of 2026.
Children in households earning too much for Medicaid (above 210% FPL) may qualify for Florida KidCare/CHIP, which covers children under 19 at income levels up to 210% FPL. Premiums for KidCare are low — $15–$20/month per child for higher-income bands. Florida KidCare covers the same essential health benefits as marketplace plans, including vision, dental, and mental health.
Applications are processed through the Florida Department of Children and Families (DCF) ACCESS Florida system at myflorida.com/accessflorida. Unlike ACA marketplace enrollment, Florida Medicaid has no enrollment window — you can apply year-round. Eligibility determinations typically take 45 days (90 days for disability-based claims). Emergency Medicaid coverage for non-citizens may also be available for acute care.
We assess your situation and help you apply for the right coverage — Medicaid, CHIP, or ACA marketplace — at no cost to you.
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