Florida Medicaid termination notices arrived at record volumes in 2025 and 2026, driven by the resumption of annual redeterminations after the COVID-era continuous coverage requirement ended and by new rules under the One Big Beautiful Bill Act (OBBBA), signed July 4, 2025. Florida is one of the 10 states that did not expand Medicaid under the ACA, which creates a uniquely harsh landscape for non-disabled adults losing coverage. During the 2023 to 2024 unwinding period alone, nearly 1.9 million Floridians were disenrolled from Florida Medicaid, and nearly two-thirds of those terminations were for procedural reasons, meaning the state lacked sufficient information to complete the review, not because the person was actually ineligible. If you received a Florida Medicaid termination notice in 2026, understanding your rights and your timelines is essential. You have two urgent tracks to run in parallel: file an appeal with the Department of Children and Families (DCF) if the termination looks wrong, and start a Marketplace Special Enrollment Period application immediately so you do not have a gap in coverage while the appeal resolves.
Florida Medicaid in 2026 covers children through Florida KidCare, pregnant women up to 191% of the Federal Poverty Level, parents and caretakers at an income limit of approximately 30% FPL (about $355 per month for a single parent in 2026), SSI recipients, and aged or blind or disabled adults through the MEDS-AD category. Non-disabled adults ages 19 to 64 who are not parents, not pregnant, and not on SSI or disability are not eligible for Florida Medicaid at any income level because Florida has not expanded Medicaid. The coverage gap affects approximately 800,000 Floridians who earn too much for Florida Medicaid but too little to qualify for ACA Marketplace subsidies, which require at least 100% of the Federal Poverty Level. If your income is above 100% FPL, an ACA Marketplace Silver plan through healthcare.gov can provide comprehensive coverage, often at low cost with premium tax credits. The 2026 subsidy cliff returned after enhanced premium tax credits from the American Rescue Plan Act expired January 1, 2026, meaning subsidies now cap out at 400% FPL for most Florida households.
6 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The most costly mistakes Floridians make after losing Medicaid at renewal:
- Waiting to act until the appeal resolves. Florida Medicaid appeals can take weeks or months. Apply for ACA Marketplace coverage at healthcare.gov simultaneously. If the appeal wins, you can cancel the marketplace plan retroactively or let it lapse.
- Assuming adult non-disabled Floridians can re-enroll in Medicaid regardless of income. Florida has not expanded Medicaid. Non-parent adults ages 19 to 64 without disabilities or SSI are categorically ineligible for Florida Medicaid at any income level.
- Missing the 90-day SEP window. The clock starts on the Medicaid termination date printed in the notice, not the date you read the notice or the date you received it. If you do not know your exact termination date, call Florida DCF at 1-866-762-2237 immediately.
- Forgetting to check children's Florida KidCare eligibility separately. Children can qualify for Florida KidCare at incomes well above the adult Medicaid limit. Even if an adult loses Medicaid, the children in the same household may qualify for free or low-cost KidCare coverage.
- Enrolling in a short-term health plan to bridge the gap. Short-term plans are not ACA-compliant, can deny or limit coverage for pre-existing conditions, and count as a coverage gap for certain employer plan purposes. An ACA Silver plan with premium tax credits is almost always a better choice for Floridians between 100% and 400% FPL in 2026.
- Using prior-year income instead of projected current-year income for ACA subsidy calculations. ACA subsidies are based on your projected Modified Adjusted Gross Income (MAGI) for the current plan year. If your income dropped because of a job change, reduced hours, or other reason, use your actual expected income for 2026.
- Assuming COBRA applies after losing Florida Medicaid. COBRA continuation coverage is a federal right for people who had employer-sponsored insurance. Florida Medicaid is a government program, not employer coverage, so COBRA does not apply after Medicaid loss. Your pathway is the 90-day Marketplace Special Enrollment Period at healthcare.gov, not COBRA.
Florida's Coverage Gap: Who Falls Through and What to Do
Florida's decision not to expand Medicaid under the ACA creates a coverage gap affecting approximately 800,000 Floridians as of 2026. Non-disabled adults ages 19 to 64 who are not parents of minor children, not pregnant, and not on SSI or disability cannot qualify for Florida Medicaid regardless of how low their income is. Parents and caretakers of minor children can qualify but only up to about 30% of the Federal Poverty Level, which is roughly $355 per month for a single parent in 2026, one of the strictest limits in the country. ACA Marketplace subsidies require a minimum income of 100% FPL ($15,960 for a single person in 2026) because the ACA assumed these lower-income adults would be covered by expanded Medicaid. Floridians below 100% FPL who do not qualify for any Florida Medicaid category are caught in the gap: too much income for Florida Medicaid, too little for ACA subsidies.
Floridians in the coverage gap have limited but real options. First, check whether any Florida Medicaid category applies to you: pregnancy, disability, caretaker status, or age 65-plus for Medicare. Second, if you are close to 100% FPL, consider whether any income increase (even a small part-time job) would push you above the threshold and make you subsidy-eligible. Third, federally qualified health centers (FQHCs) offer sliding-scale primary care services for uninsured patients regardless of income. Fourth, Florida has county-level charity care programs and safety-net hospitals that may provide hospital coverage for very low-income uninsured residents. Contact your county health department or the Florida Association of Free and Charitable Clinics at facc.net for local resources. These are not insurance replacements, but they reduce out-of-pocket costs for primary and preventive care.
Florida Medicaid Eligibility in 2026: Who Qualifies by Category
Florida Medicaid covers specific categories of residents with specific income ceilings set for each. Children qualify for Medicaid or Florida KidCare based on age and income: children under age 1 with family income up to 206% FPL, children ages 1 to 5 up to 140% FPL, and children ages 6 to 18 up to 133% FPL. Florida KidCare's subsidized private insurance tier extends coverage for children at higher income levels. Pregnant women qualify up to 191% FPL with coverage continuing for 12 months postpartum as of April 2022. Parents and caretaker relatives of minor children qualify up to approximately 30% FPL for the medically needy pathway. SSI recipients automatically qualify for Florida Medicaid. Adults ages 65 and older or adults with qualifying disabilities qualify through the MEDS-AD category. Long-term care recipients have a separate SMMC-LTC pathway. Non-disabled adults ages 19 to 64 who are not parents, not pregnant, not on SSI, and do not have qualifying disabilities have no Florida Medicaid eligibility at any income level.
Florida Medicaid in 2026 is administered by the Agency for Health Care Administration (AHCA) and delivered primarily through managed care plans under the Statewide Medicaid Managed Care (SMMC) program. Applications for Florida Medicaid go through the Department of Children and Families (DCF) via ACCESS Florida online at myflorida.com, by phone at 1-866-762-2237, or in person at a local DCF service center. OBBBA changes taking effect December 31, 2026 require Florida to conduct redeterminations every six months (instead of annually) for certain Medicaid categories, including parents and caretakers, which will increase the frequency of renewal notices and potential terminations in late 2026 and 2027. Adults who qualified for Florida Medicaid through a pregnancy-related category should note that postpartum coverage ends at 12 months after delivery and requires re-evaluation.
ACA Marketplace Options After Losing Florida Medicaid in 2026
ACA Marketplace coverage is the primary alternative for Florida residents who lose Medicaid and have income between 100% and 400% of the Federal Poverty Level. Florida does not run a state-based marketplace; residents use the federal marketplace at healthcare.gov. Losing Florida Medicaid triggers a Marketplace Special Enrollment Period of 90 days from the termination date, longer than the standard 60-day qualifying life event SEP. Florida marketplace plans must cover the 10 ACA essential health benefits including mental health, prescription drugs, preventive care, and emergency services. Pre-existing conditions cannot cause denial or higher premiums under ACA rules. The 2026 Marketplace out-of-pocket maximum is $10,600 for individuals and $21,200 for families. Standard premium tax credits (not the enhanced ARPA credits, which expired January 1, 2026) apply for incomes between 100% and 400% FPL. At 200% FPL ($31,920 single in 2026), a Silver plan typically costs $50 to $150 per month after the premium tax credit, with cost-sharing reductions that lower the deductible to roughly $500 and the out-of-pocket maximum to around $2,700.
Documents Needed to Enroll After Florida Medicaid Loss
Gathering the right documents before starting your ACA Marketplace application will speed up the enrollment process significantly. The Florida Medicaid termination letter or Notice of Case Action from DCF is the primary proof of your qualifying life event for the 90-day SEP. Healthcare.gov will ask you to upload this document within 30 days of selecting a plan. Social Security numbers for everyone in your household who is applying for coverage are required for identity verification and subsidy eligibility. Proof of 2026 income such as recent pay stubs, an employer letter, a 2025 tax return for self-employed applicants, or a state unemployment award letter establishes your projected annual MAGI for the premium tax credit calculation. Current Florida address and ZIP code determine which specific marketplace plans are available in your county. Birth certificates for dependents you are adding to coverage are required when adding children who were not previously listed. Florida does not require separate enrollment for marketplace coverage in Spanish; healthcare.gov offers a fully Spanish-language interface.
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. This is the Medicaid/CHIP loss Special Enrollment Period, which is longer than the standard 60-day SEP for other qualifying life events. Log in to healthcare.gov, select 'I lost qualifying health coverage,' choose Medicaid or CHIP as the coverage type lost, and enter your Florida Medicaid termination date. Your 90-day clock starts from that termination date, not the date you received the notice.
Can I appeal a Florida Medicaid termination from a 2026 renewal?
Yes. Florida DCF is required to provide a fair hearing process for all Medicaid terminations. Request a fair hearing within 90 days of the Notice of Case Action by emailing appeal.hearings@myflfamilies.com, calling 1-866-762-2237, or visiting a local DCF office. If you appeal before coverage ends, you may be entitled to continuation of Medicaid benefits during the appeal process. A 2024 federal court order also required Florida to revise termination notices that were found constitutionally inadequate, so if your notice is unclear about the reason for termination, note that in your appeal.
Does Florida expand Medicaid? Can I re-enroll after losing coverage?
Florida has not expanded Medicaid under the ACA. Non-disabled adults ages 19 to 64 who are not parents or caretakers of minor children, not pregnant, and not on SSI or qualifying disability are categorically ineligible for Florida Medicaid at any income level. If you were covered through a pregnancy-related category, coverage typically ends 12 months after delivery. If you were covered as a parent of a minor child, the income limit is roughly 30% FPL (about $355 per month for a single parent in 2026). Re-enrollment is only possible if you still fit one of Florida's narrow Medicaid eligibility categories.
What is the Florida coverage gap and am I in it?
The Florida coverage gap affects roughly 800,000 Floridians who earn too much for Florida Medicaid (above the very low Florida limits for parents and caretakers, roughly 30% FPL) but too little for ACA Marketplace subsidies (below 100% FPL, which is $15,960 for a single person in 2026). ACA subsidies were designed assuming Florida would expand Medicaid to cover adults under 138% FPL, so people below 100% FPL in non-expansion states have no pathway to subsidized coverage. If you are in the gap, your options include federally qualified health centers with sliding-scale fees, county health department programs, and safety-net hospitals.
What is the deadline to appeal a Florida Medicaid termination?
Florida gives you 90 days from the Notice of Case Action to request a fair hearing with DCF. This is the same 90-day window as the ACA Marketplace Special Enrollment Period, so both deadlines often run simultaneously. File your appeal as soon as possible. If you appeal before your coverage actually ends, you may qualify to continue receiving Medicaid benefits while the appeal is pending. Contact Florida DCF at 1-866-762-2237 or go to myflfamilies.com for the fastest submission.
What happens to my children's coverage if I lose Florida Medicaid?
Children's Florida KidCare eligibility is evaluated separately from adult Medicaid. Even if an adult in the household loses Medicaid, children may qualify for Florida KidCare (the CHIP program) at incomes up to 200% FPL for the Medicaid-funded tier, with the KidCare subsidized private insurance tier extending higher. Apply at floridakidcare.org or through healthcare.gov. Florida KidCare enrollment is year-round with no deadline, premiums are very low or free for families below 150% FPL, and the program covers comprehensive pediatric benefits including dental and vision.
How do the 2026 OBBBA changes affect Florida Medicaid renewals?
The One Big Beautiful Bill Act (OBBBA), signed July 4, 2025, requires states to conduct Medicaid redeterminations every six months (instead of annually) for certain adult categories starting December 31, 2026. For Florida, this affects parents and caretaker relatives who currently get annual renewals. OBBBA work requirements for Medicaid expansion adults do not apply to Florida because Florida did not expand Medicaid. OBBBA also reduces retroactive Medicaid coverage from 3 months to 1 to 2 months starting January 1, 2027, which means claiming coverage for medical bills incurred before your enrollment date becomes harder.
What if I miss the 90-day window to enroll in an ACA Marketplace plan?
If you miss the 90-day SEP after losing Florida Medicaid, you generally must wait until ACA Open Enrollment, which runs November 1 through January 15 for the following plan year. For 2027 coverage, OEP runs November 1, 2026 through January 15, 2027. One exception: another qualifying life event (marriage, birth, job change, move to a new county with different plan availability) opens a new SEP. You can also re-apply for Florida Medicaid year-round through ACCESS Florida at myflorida.com if your circumstances change and you qualify under a Florida Medicaid category.
