What Is the Medically Needy Share of Cost in Florida?

The Medically Needy program helps individuals and families with significant medical expenses access Medicaid benefits. This program is for those whose income or assets exceed standard Medicaid eligibility limits. A central component is the “share of cost,” which acts like an insurance deductible. It represents the amount of medical expenses an individual must incur monthly before Medicaid coverage begins.

Understanding Florida’s Medically Needy Program

Florida’s Medically Needy program supports residents with high medical bills who do not qualify for traditional Medicaid due to income or resources, allowing them to “spend down” their income on medical care. Once a threshold of medical expenses is met, Medicaid benefits cover additional healthcare costs.

This program assists families, pregnant women, children, and individuals who are aged, blind, or disabled. The Department of Children and Families (DCF) oversees eligibility determinations for this program, often calling it the “Share of Cost” program.

Determining Your Share of Cost

DCF calculates an individual’s share of cost as the difference between their countable income and the state’s Medically Needy Income Limit (MNIL). In 2025, the MNIL is $180 monthly for a single applicant and $241 for a married couple.

Countable income includes nearly all forms, such as wages, Social Security, pensions, alimony, and investment dividends. Gross income is used, though certain deductions can reduce it.

Allowed deductions include a $20 general income deduction, applicable to unearned or earned income. For earned income, an additional $65 deduction is permitted, plus half of any remaining earned income. These deductions help lower the effective income level, potentially reducing the share of cost.

Medical expenses incurred also reduce countable income. The share of cost is the amount of medical bills an individual must incur monthly to bring their net income to or below the MNIL. For example, if income is $690 and the MNIL is $180, the share of cost is $510.

The program also considers an applicant’s assets, with specific limits. As of 2025, the medically needy asset limit is $5,000 for an individual and $6,000 for a couple. Certain assets are not counted, such as a primary residence (with equity limits), one vehicle, and some burial arrangements.

Meeting Your Share of Cost

Once the Florida Department of Children and Families (DCF) determines an individual’s monthly share of cost, the next step involves meeting this financial obligation. This process, often referred to as “spending down,” requires the individual to incur eligible medical expenses equal to or exceeding their assigned share of cost amount. These medical expenses do not necessarily have to be paid; simply incurring the debt is sufficient.

A variety of medical expenses can be used to satisfy the share of cost. These include costs for doctor visits, hospital stays, prescription medications, and even health insurance premiums, such as Medicare premiums. Transportation costs incurred to receive medical care, like ambulance, bus, or taxi fares, can also contribute. Additionally, medical bills from up to 90 days prior to the application date may be considered.

To demonstrate that the share of cost has been met, individuals must submit proof of these medical expenses to DCF. This can be done through the MyACCESS portal, by fax, mail, or in person at a local office. Once the total allowable medical expenses reach or surpass the share of cost for that month, Medicaid coverage becomes active for the remainder of that specific month.

This process operates on a monthly “budget period,” meaning the share of cost resets on the first day of each new month. Therefore, individuals must re-qualify each month by incurring new medical expenses to meet their share of cost for that period. This monthly cycle ensures that the program continues to serve those with ongoing high medical needs.

Applying for the Medically Needy Program

Applying for Florida’s Medically Needy program involves gathering specific documentation and following a clear submission process. Before initiating an application, prospective applicants should compile proof of identity, such as a driver’s license or birth certificate, and proof of U.S. citizenship or qualified non-citizen status. Evidence of Florida residency, like utility bills or a lease agreement, is also required.

Applicants must provide comprehensive financial information to accurately assess their income and assets. This includes recent pay stubs, Social Security benefit statements, pension details, and other sources of income. Documentation of assets, such as bank statements, investment account summaries, and property deeds, is also necessary. These documents support the financial assessment performed by DCF.

The official application can be accessed and submitted through several methods. The quickest way is often via the MyACCESS online portal, but paper applications are available for download and can be submitted by mail or in person at a DCF customer service center. After submission, applicants may be contacted for an interview to verify information or provide additional details. Application processing time typically ranges from 30 days, though it may be longer if a disability determination is part of the eligibility review.