Losing Florida Medicaid coverage is especially complicated because Florida is one of 10 states that has not expanded Medicaid under the Affordable Care Act. Most states cover adults earning up to 138% of the Federal Poverty Level, but Florida Medicaid for parents only reaches approximately 17% FPL (about $355 per month for a single parent in 2026), and non-parent adults between ages 19 and 64 without a qualifying disability are categorically excluded from Florida Medicaid regardless of income. That structural gap means that when you lose Florida Medicaid, the path forward depends entirely on what category you were in, parent, pregnant woman, child, person with disability, or person over 65, and what your current household income is. This guide gives you the Florida-specific decision tree so you know exactly which door to walk through within your 90-day Special Enrollment Period window.
Florida uses its own Medicaid portal, MyACCESS at myaccess.myflfamilies.com, administered by the Florida Department of Children and Families. The Florida marketplace runs through the federally-facilitated platform at healthcare.gov, Florida does not have a state-based exchange. In 2026, the enhanced premium tax credits from the American Rescue Plan Act and the Inflation Reduction Act expired January 1, 2026, so marketplace costs are higher than in 2023 through 2025 for people near the top of the subsidy range. Standard premium tax credits still apply for incomes between 100% and 400% FPL. Approximately 800,000 Floridians fall into the coverage gap, earning too much for Florida Medicaid but too little (under 100% FPL, about $15,960 for a single person) to qualify for marketplace subsidies. If you are in that gap, this guide explains your limited but real options, including community health centers and Florida KidCare for your children.
6 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The most costly mistakes Floridians make after losing Medicaid coverage in 2026:
- Assuming the 90-day SEP works the same as the standard 60-day SEP. Loss of Medicaid gives you 90 days, but the clock starts on the termination date shown in your DCF or AHCA notice, not when you discover the loss.
- Not recognizing the Florida coverage gap. Because Florida has not expanded Medicaid, adults under 100% FPL ($15,960 single in 2026) who are not parents, pregnant, or disabled cannot get Florida Medicaid OR marketplace subsidies. Applying at healthcare.gov when income is under 100% FPL will result in a denial of subsidies, not a referral to Medicaid expansion.
- Waiting to apply for marketplace coverage until after the Medicaid appeal is resolved. Appeals can take 30 to 90 days or longer. Apply for an ACA marketplace plan through healthcare.gov at the same time as your appeal, if the appeal succeeds and Medicaid is reinstated, you can cancel the marketplace plan.
- Forgetting that Florida KidCare (CHIP) is a separate program for children. Even if you as an adult are stuck in the Florida coverage gap, your children under 19 can enroll in Florida KidCare year-round at floridakidcare.org at incomes up to 300% FPL ($99,000 family of 4 in 2026).
- Enrolling in a short-term health plan instead of an ACA marketplace plan. Short-term plans sold in Florida are not ACA-compliant, can deny coverage for pre-existing conditions, and do not count as qualifying coverage under HIPAA. An ACA Silver plan with subsidies is almost always a better choice if your income is between 100% and 400% FPL.
ACA Marketplace vs. Florida Coverage Gap: Which Situation Are You In?
Florida's non-expansion status creates two completely different situations for people who lose Florida Medicaid in 2026. Adults with income between 100% and 400% FPL ($15,960 to $63,840 for a single person) can access ACA marketplace plans at healthcare.gov with standard premium tax credits, making Silver plans $0 to $200 per month for most people in that income band. Cost-sharing reductions on Silver plans apply for incomes under 250% FPL ($39,900 single), cutting deductibles to as low as $150 and out-of-pocket maximums to under $3,000. Florida Blue, Ambetter, Oscar Health, and Molina Healthcare are the main carriers across most Florida counties in 2026. Run a quote at healthcare.gov to see actual plan costs by ZIP code and household size.
Adults in the Florida coverage gap, earning under 100% FPL ($15,960 single in 2026) while not qualifying as a parent, pregnant woman, or person with a disability, face a harder path. Florida Medicaid for non-disabled adults without children has essentially no income pathway, and the ACA marketplace does not offer subsidies below 100% FPL in non-expansion states. Three practical options exist for people in this gap: (1) Federally Qualified Health Centers (FQHCs) across Florida provide primary care on a sliding-fee scale regardless of insurance status, call 211 to locate the nearest FQHC; (2) Emergency Medicaid covers true medical emergencies even for people otherwise ineligible; (3) if income rises above 100% FPL at any point during the year, a qualifying life event or mid-year income report to healthcare.gov can trigger a Special Enrollment Period for ACA marketplace coverage.
Florida Medicaid Eligibility by Category in 2026
Florida Medicaid in 2026 covers several distinct eligibility categories, each with its own income limit. Parents and caretaker relatives: income up to approximately 17% FPL (about $355 per month for a single parent in 2026). Pregnant women: income up to 196% FPL ($31,282 for a single pregnant woman in 2026). Children up to age 18: income up to 214% FPL through Medicaid plus KidCare CHIP. Adults age 65 or older: separate SSI-linked income rules apply. People with qualifying disabilities receiving SSI or SSDI: separate eligibility pathway. Non-parent adults aged 19 to 64 without disabilities: categorically excluded from Florida Medicaid regardless of income. If you lost Medicaid from one of the covered categories, for example, a child who aged out or a parent whose income changed, you may be able to re-apply to the same or a different category if your circumstances qualify.
Florida implemented a redesigned Statewide Medicaid Managed Care (SMMC 3.0) program as of February 2025, which moved most Medicaid recipients into managed care plans. If your Florida Medicaid was terminated during or after the SMMC 3.0 transition, the termination reason matters for your appeal. Administrative errors during managed care plan transitions have been a known source of incorrect terminations. Request your complete case file from DCF at (850) 300-4323 before filing your appeal to confirm whether the termination was based on an eligibility determination or a data-transfer error.
Documents You Need to Enroll After Losing Florida Medicaid in 2026
Gathering the right documents before starting your ACA marketplace application at healthcare.gov prevents delays and speeds up verification. Required items include your Florida Medicaid termination notice (shows termination date and reason, this is the qualifying event documentation), Social Security numbers for everyone applying for coverage, recent pay stubs or a tax return to estimate 2026 projected household income, and current Florida mailing address and ZIP code (plan availability varies by county in Florida). If adding dependents: birth certificates for children, and marriage certificate if adding a spouse. For the appeal process at MyACCESS, gather any documents related to the stated reason for termination, income verification, work-requirement compliance records, or proof of documents previously submitted to DCF.
- Florida Medicaid termination letter or DCF/AHCA notice (proof of qualifying life event for the 90-day SEP)
- Social Security numbers for all household members applying for coverage
- Recent pay stubs or most recent federal tax return (Form 1040) for projected 2026 income
- Florida ZIP code (plan options vary by county, Florida Blue may dominate some counties while Ambetter or Oscar lead others)
- Birth certificates for dependent children (if adding to an ACA plan or enrolling in Florida KidCare)
- Proof of immigration status if applicable (for non-citizen applicants who are lawfully present)
Florida KidCare: Protecting Your Children's Coverage in 2026
Florida KidCare is Florida's branded CHIP program for children under 19. KidCare covers children even when the adults in the household are not eligible for Florida Medicaid or marketplace subsidies, making it the most important safety net for families in the Florida coverage gap. Children qualify for Florida KidCare at incomes up to 300% FPL. For 2026, that means $64,920 for a family of 2, $81,960 for a family of 3, and $99,000 for a family of 4. Families between 133% and 200% FPL pay $15 to $20 per month for all eligible children. Above 200% FPL, premiums increase but coverage remains comprehensive. Apply at floridakidcare.org or call 1-888-540-5437. KidCare enrollment is year-round with no SEP deadline, apply at any time.
Frequently Asked Questions
How long do I have to enroll in an ACA plan after losing Florida Medicaid?
You have 90 days from the date your Florida Medicaid coverage ended to enroll in an ACA marketplace plan at healthcare.gov. This is longer than the standard 60-day SEP for other coverage losses. Log in to healthcare.gov, select 'I lost qualifying health coverage,' choose Medicaid or CHIP as the type, and enter your Florida Medicaid termination date. Your 90-day clock starts from that termination date, not when you received the notice.
Does Florida have Medicaid expansion? What is the Florida coverage gap?
Florida has not expanded Medicaid under the ACA. Florida Medicaid for adults in 2026 is limited to parents and caretaker relatives earning under approximately 17% FPL (about $355 per month), pregnant women under 196% FPL, and people with qualifying disabilities. Non-parent adults aged 19-64 without disabilities are categorically ineligible regardless of income. The Florida coverage gap refers to approximately 800,000 Floridians who earn above the Medicaid limit but below 100% FPL, they do not qualify for Florida Medicaid or ACA marketplace subsidies.
What if my income is under 100% FPL in Florida after losing Medicaid?
Adults in the Florida coverage gap (under 100% FPL and not a parent, pregnant, or disabled) face limited options. ACA marketplace subsidies require income at or above 100% FPL in non-expansion states like Florida. Practical options include Federally Qualified Health Centers (FQHCs) that offer sliding-scale primary care, call 211 to locate the nearest FQHC in Florida. Emergency Medicaid covers true emergencies. If your income increases above 100% FPL, you can enroll in a marketplace plan with subsidies at healthcare.gov.
Can I appeal a Florida Medicaid termination?
Yes. Florida allows 90 days from the notice date to request a fair hearing. Call DCF at (850) 300-4323 or submit a fair hearing request through your MyACCESS account at myaccess.myflfamilies.com. If you request the hearing before your coverage ends, you may be entitled to continuation of benefits during the appeal process. File your appeal AND apply for ACA marketplace coverage simultaneously through healthcare.gov, do not wait for the appeal outcome.
What is Florida KidCare and how does it help after losing Medicaid?
Florida KidCare is Florida's CHIP program covering children under 19 at incomes up to 300% FPL, $99,000 for a family of 4 in 2026. KidCare enrollment is year-round with no SEP deadline. Families between 133% and 200% FPL pay just $15 to $20 per month for all eligible children. Even if you as an adult fall into the Florida coverage gap, your children can enroll in KidCare any time at floridakidcare.org or by calling 1-888-540-5437.
What is the 2026 subsidy cliff and how does it affect Florida marketplace plans?
The 2026 subsidy cliff means that ACA premium tax credits cut off abruptly at 400% FPL ($63,840 for a single person in 2026). Enhanced premium tax credits from the American Rescue Plan Act and Inflation Reduction Act expired January 1, 2026. If your income is between 100% and 400% FPL, standard PTCs still apply. If your income is above 400% FPL, you pay full marketplace premiums, typically $400 to $900 or more per month for individual coverage in Florida in 2026.
What documents do I need to enroll in ACA marketplace coverage after losing Florida Medicaid?
Required documents for your healthcare.gov application include your Florida Medicaid termination letter or DCF/AHCA written notice (this is your qualifying event documentation), Social Security numbers for all household members, recent pay stubs or tax return to estimate 2026 projected income, and your Florida ZIP code (plans vary by county). For children, have birth certificates ready. You must upload your termination notice to healthcare.gov within 30 days of selecting a plan to complete verification.
What if I miss the 90-day SEP after losing Florida Medicaid?
Missing the 90-day SEP window after losing Florida Medicaid means you generally must wait until the next Open Enrollment Period, November 1, 2026 through January 15, 2027 for coverage starting in 2027. One exception: if another qualifying life event occurs (job change, marriage, birth, move to a new county with different plan availability), you get a new Special Enrollment Period. Children can always enroll in Florida KidCare year-round regardless of missed SEP windows.
