What Is Share of Cost Medicaid in Florida?

Medicaid in Florida provides healthcare assistance to individuals and families with limited financial resources. The “Share of Cost” component is a pathway for those whose income exceeds standard Medicaid eligibility but face substantial medical expenses. This aspect of Florida Medicaid ensures medically needy individuals can access necessary healthcare, even if their financial situation does not allow for immediate, full Medicaid coverage.

What Share of Cost Means

The Share of Cost in Florida Medicaid is not a recurring monthly premium, but an amount of medical expenses an individual must incur each month before Medicaid coverage begins. This functions much like a deductible in private health insurance plans. It is for individuals whose gross monthly income surpasses limits for traditional Medicaid, yet who have significant ongoing healthcare needs. The program acknowledges that high medical costs can effectively reduce a person’s disposable income to a level where they become “medically needy.”

This approach allows individuals to qualify for Medicaid benefits once their out-of-pocket medical expenses reach a predetermined amount within a given month. The Share of Cost program, also known as the Medically Needy Program, serves as a safety net. It provides assistance for those otherwise ineligible for full Medicaid due to income, but whose medical conditions necessitate costly treatments or regular care. Once the monthly Share of Cost is met, Florida Medicaid covers eligible medical services for the remainder of that calendar month.

How Share of Cost is Determined

The determination of an individual’s monthly Share of Cost in Florida involves an assessment of their financial situation, including income and assets, against state standards. The Florida Department of Children and Families (DCF) is the agency responsible for this eligibility determination. This process begins by comparing an applicant’s countable income to the state’s Medically Needy Income Level (MNIL). For 2025, the MNIL in Florida is set at $180 per month for a single applicant and $241 per month for a married couple.

Any amount of an applicant’s countable income exceeding this MNIL becomes their monthly Share of Cost. For example, if a single individual has a countable income of $800 per month, their Share of Cost would be $620 ($800 – $180 MNIL). Various types of income, such as employment wages, Social Security benefits, investment income, and pensions, are considered countable. Assets and income sources are exempt from this calculation, including a primary residence (up to a certain equity limit), one vehicle, personal belongings, household furnishings, and certain retirement accounts in payout status. The asset limit for eligibility in the Medically Needy Program is $5,000 for an individual and $6,000 for a couple.

Managing Your Share of Cost

Once an individual’s monthly Share of Cost has been determined, the next step involves meeting this amount through eligible medical expenses before Medicaid benefits can be accessed for that month. This process requires the individual to incur medical bills equal to or exceeding their calculated Share of Cost. Eligible expenses can include unpaid medical bills, bills paid within the last three months, health insurance premiums, co-payments for services, doctor-prescribed medical services, and transportation costs to and from medical appointments.

To demonstrate that the Share of Cost has been met, individuals must submit documentation of these eligible medical expenses to the Florida Department of Children and Families. This can be done through the MyACCESS portal, by fax, mail, or in person. Track all medical expenses and submit the necessary documentation promptly. Once the Department of Children and Families verifies that the accumulated medical expenses have reached the monthly Share of Cost, Medicaid coverage becomes active for the remainder of that calendar month, covering any further eligible medical services. Since the Share of Cost resets each month, this process of incurring and submitting expenses must be repeated monthly to maintain Medicaid eligibility through this program.