Florida Medicaid covers doctor visits, hospital care, prescriptions (usually at $0), mental health treatment, dental, vision, hearing, and transportation to appointments. Most members get these Florida Medicaid covered services through three separate managed-care plans at the same time, a medical plan, a dental plan, and, for those who need long-term care, a long-term care plan, each run by a different company under contract with the Agency for Health Care Administration (AHCA). Most people never realize they are enrolled in two or three plans at once, and that gap is why so many covered benefits go unused. Here is what each plan covers in 2026, what it does not, and how to use what you already have.,

In This Guide

What Florida Medicaid covered services include: three plans, one card

Florida delivers nearly all of its Medicaid benefits through the Statewide Medicaid Managed Care (SMMC) program, which AHCA re-procured under "SMMC 3.0" effective February 1, 2025, with contracts running through 2030. SMMC has three enrollment tracks, and most members are in two or three of them at the same time.

Track What it covers How you get it
Managed Medical Assistance (MMA) Doctors, hospitals, prescriptions, mental health and substance-use treatment, transportation, vision, hearing, family planning The general medical plan for most members
Long-Term Care (LTC) Personal care, homemaker, adult day care, assisted living services, nursing facility care, home modifications Separate enrollment for members who meet nursing-facility level of care
Dental (the SMMC dental program) All Medicaid dental services for adults and children Separate dental enrollment alongside your MMA plan

The medical plan is where almost everything happens: the doctor's office, the hospital, the pharmacy. Dental is a separate enrollment alongside it, and LTC has to be qualified for on its own. The active SMMC 3.0 medical plans include Aetna Better Health of Florida, Community Care Plan, Florida Community Care, Humana, Molina Healthcare, Simply Healthcare, Sunshine Health Plan, and UnitedHealthcare, plus the Children's Medical Services (CMS) Plan.,

If this sounds confusing, that is because it is. Enrollment, plan changes, and benefit questions all run through Florida's Medicaid choice counselor at 1-877-711-3662 or flmedicaidmanagedcare.com.

Who must enroll, who chooses, and who is excluded

Millions of Floridians are enrolled in Medicaid, and most full-benefit members must join an MMA plan. You get 30 days to pick a plan in your region; if you do not choose, AHCA auto-assigns one, under Section 409.977(1), Florida Statutes. The state's enrollment broker then tells enrollees they "have 120 calendar days to change to a new plan, if they wish to do so," counted from your enrollment effective date. After that, changes are limited to the annual 60-day open enrollment or to "good cause" under Section 409.969(2), Florida Statutes: poor quality of care, lack of access to necessary specialty services, an unreasonable delay or denial of service, or fraudulent enrollment. AHCA decides whether good cause exists, and if it says no, you can dispute that at a Medicaid fair hearing.

A few groups are handled differently. Dual-eligible members (those with both Medicare and Medicaid) may enroll voluntarily, with Medicare as the primary coverage and Medicaid filling gaps. Certain populations, such as people in the iBudget developmental-disabilities waiver and participants in the Program of All-Inclusive Care for the Elderly (PACE), receive their services another way and are not enrolled in standard MMA. If you are not sure which category you fall in, ask the choice counselor.

What your medical plan (MMA) covers

Florida law, at Section 409.973, Florida Statutes ("Benefits"), sets a minimum benefit package that every MMA plan must cover. Plans can offer more than the minimum (and many do, as "expanded benefits"), but they can never offer less. The statute enumerates 29 mandatory service categories, in paragraphs (a) through (cc). The core ones are:

  • Hospital inpatient services and hospital outpatient services
  • Physician services, including physician assistant services, plus advanced practice registered nurse services
  • Rural health clinic services
  • Laboratory and imaging services; advanced imaging such as MRI, CT, and PET typically needs prior authorization
  • Emergency services, which Section 409.9081(3) also exempts from any cost sharing
  • Nursing care, home health agency services, and medical supplies, equipment, prostheses, and orthoses
  • Family planning and full maternity care, including 12 months of postpartum coverage

Mental health and substance-use treatment are carved in

Behavioral health is part of your MMA plan in 2026, not a separate plan. Your medical plan covers outpatient therapy, psychiatric evaluations and medication management, intensive outpatient and partial-hospitalization programs, crisis stabilization, inpatient psychiatric care, and substance-use disorder treatment, including medication-assisted treatment.

The old "45-day inpatient cap" question

Florida's older fee-for-service rules capped adult inpatient hospital days per year, and many out-of-date articles still cite that limit. Under managed care it does not work that way: hospital inpatient services sit inside the Section 409.973 minimum every MMA plan must cover, and plans manage length of stay through concurrent medical-necessity review. If your plan tells you a stay has reached a limit, ask for the written notice and appeal it. Children under 21 are entitled under EPSDT to any medically necessary service that corrects or improves their condition.

Pharmacy: what you pay and how the drug list works

Pharmacy is carved in to MMA: prescription drugs are one of the service categories Section 409.973 requires every plan to cover, so your medical plan administers your drug benefit. The state's preferred drug list (PDL) is developed by the Medicaid Pharmaceutical and Therapeutics Committee, which Section 409.91195, Florida Statutes, creates within AHCA.

In practice, Florida Medicaid members typically pay $0 at the pharmacy in 2026. The statute permits a prescription coinsurance of 2.5% of the drug's cost, capped at $7.50 per prescription, but Section 409.9081(3) bars those copayments for "any individual who is enrolled in a Medicaid prepaid health plan or health maintenance organization," which is what an SMMC plan is.

If your doctor prescribes a drug that is not on the preferred list, your plan will generally require prior authorization first. If it is denied, you have appeal rights through your plan and then through a Medicaid Fair Hearing (see the appeals section below).

Rides to medical care: Non-Emergency Medical Transportation (NEMT)

If you cannot get yourself to a Medicaid-covered appointment, your MMA plan covers transportation. "Transportation to access covered services" is one of the Section 409.973 categories every plan must cover, so rides are your medical plan's responsibility rather than something you arrange outside it.

  • Call the transportation number on your member ID card or in your member handbook. Plans typically ask for at least three business days' notice.
  • Covered modes range from a bus pass or sedan to a wheelchair-accessible van or stretcher van, depending on your needs.
  • Not covered: trips to non-medical destinations such as groceries or social visits. For an emergency, call 911; ambulance care is covered separately as emergency transport.

Dental: a separate plan with expanded adult benefits

Here is the part that confuses the most members: your MMA plan does not cover dental care. Section 409.973, Florida Statutes, directed AHCA to provide dental benefits separately from the rest of SMMC, so dental runs through its own Statewide Medicaid Managed Care Dental Health Program, delivered by prepaid dental plans under contract with AHCA. You enroll in it separately. The two statewide dental plans on the state's current roster are DentaQuest (member services 1-888-468-5509) and Liberty Dental (member services 1-833-276-0850). A third plan, MCNA Dental, was on AHCA's original roster and is no longer listed among the current dental plans, though the state's own dental FAQ page still names it; rely on the two-plan roster.

The state's enrollment broker says flatly that everyone on Medicaid must enroll in a dental plan, including Medically Needy and iBudget recipients. AHCA's program overview is narrower: it lists recipients who are not eligible to enroll in a dental plan, including PACE participants, partial dual eligibles (QMB, SLMB, QI1), and full dual eligibles enrolled in a D-SNP or FIDE-SNP. If you have Medicare as well as Medicaid, confirm with the choice counselor at 1-877-711-3662 whether dental-plan enrollment applies to you before assuming it does.

Adult dental (age 21 and older)

Adult dental is narrower than child dental, but it is not emergency-only. Members 21 and older are eligible for what the state calls all State Plan dental services: limited dental exams, limited X-rays, a problem-focused exam, extractions, dentures, pain management, and sedation.

On top of that base, both dental plans offer the same set of expanded (extra) benefits to members 21 and older, with prior approval from your dental plan: fillings (amalgam restorations), diagnostic X-rays, oral screenings and evaluation, periodontal maintenance, periodontal scaling, prophylaxis (a cleaning treatment), sealants, and topical fluoride and fluoride varnish. Members 65 and older gain more on top of that, crowns (porcelain, ceramic, resin-based, and stainless steel) and endodontic therapy including root canals, which is the single most-missed benefit for older adults in this program. Pregnant members gain periodontal maintenance and extra cleanings. Dollar limits on expanded benefits are not published on AHCA's consumer pages, which say only to contact the plan, so check your plan's member handbook.

Child dental (under 21)

Children under 21 get comprehensive dental care, including medically necessary dental services: exams, screenings, cleanings, X-rays, fluoride, sealants, fillings and crowns, root canals, periodontics, extractions, dentures and partials, space maintainers, sedation, orthodontics (braces), oral health instructions, and dental care delivered in an ambulatory surgical center or hospital when that is what the child needs. That breadth follows from EPSDT, the federal benefit that requires Medicaid to furnish any medically necessary service that corrects or ameliorates a child's condition.

For more detail, see our guide to Florida Medicaid dental coverage.

Vision and hearing

Vision and hearing are in the MMA package, under minimum limits Florida's coverage policies bind every SMMC plan to. At 21 and older: one frame every two years, two lenses every 365 days, up to two refractions every 365 days, and up to two evaluation and management visits per month.,

Hearing is covered at all ages, unless a service is expressly limited to under 21. With moderate or greater hearing loss, coverage is one new (not refurbished) hearing aid per ear every three years, one fitting and dispensing per ear every three years, one hearing assessment every three years, up to three pairs of ear molds per year, and up to two repairs every 366 days after the one-year warranty expires. Plans may offer more. Under EPSDT, under-21 recipients can exceed these limits when medically necessary.

Children under 21: the EPSDT benefit

Early and Periodic Screening, Diagnostic and Treatment (EPSDT) is the federal Medicaid benefit for members under 21, and Section 409.973(1)(f), Florida Statutes, makes it one of the minimum benefits every MMA plan must cover. Under EPSDT, states must furnish all appropriate and medically necessary services a child needs to correct or ameliorate a health condition, drawn from everything Medicaid may cover under Section 1905(a) of the Social Security Act, even when the service is not in the adult benefit package.

In practice, that means a child on Florida Medicaid is entitled to comprehensive screenings (physical, vision, hearing, dental, developmental, and behavioral), immunizations, and all medically necessary diagnostic and treatment services, including services adults do not get, such as Applied Behavior Analysis (ABA) therapy for autism and medically necessary orthodontia. Your child's pediatrician handles the well-child visit schedule.

Long-term care: what MMA covers and what it does not

This is the distinction that trips up most families. Your MMA medical plan covers short-term, post-acute care, a skilled nursing facility stay after a hospital discharge, and intermittent skilled home health. It does not cover ongoing long-term care. Personal care, homemaker services, adult day care, assisted living services, and nursing-home placement come through the separate SMMC Long-Term Care (LTC) program.,

The LTC program covers a defined catalog of home and community-based services, including personal care and attendant care (hands-on help with bathing, dressing, and transfers), homemaker and adult-companion services, home-delivered meals, home accessibility adaptations, respite care, a personal emergency response system, and nursing facility care. In an assisted living facility or adult family care home, the waiver covers personal care and supportive services but not room and board.

Qualifying for LTC takes two approvals beyond financial eligibility. The Florida Department of Elder Affairs determines functional eligibility (nursing-facility level of care) through its CARES program, and you must meet the LTC income and asset rules, where the income cap is 300% of the Supplemental Security Income (SSI) federal benefit rate, or $2,982 per month for a single applicant in 2026. Because the program runs on a fixed number of funded slots, eligible applicants are placed on a frailty-ranked wait list and released by priority score, not by how long they have waited. The on-ramp is the Elder Helpline at 1-800-963-5337.,,

For a deeper walk-through, see our guides to the Florida Medicaid Long-Term Care waiver and Florida Medicaid eligibility and income limits.

Cost sharing: what you pay out of pocket

What Florida Medicaid can charge you is nominal, and most members are exempt from even that: Section 409.9081(3), Florida Statutes, bars the copayments below for anyone "enrolled in a Medicaid prepaid health plan or health maintenance organization," the category SMMC enrollees fall into. Florida KidCare, the state's separate Children's Health Insurance Program, has its own premium rules and is not part of MMA.

Florida's statutory copay maximums, under Section 409.9081, Florida Statutes, are:

Service Statutory maximum
Hospital outpatient visit Up to $3
Physician visit Up to $2
Non-emergency emergency-room use 5% of the first $300 of the Medicaid payment, no more than $15
Prescription drug 2.5% coinsurance, capped at $7.50
Preventive services $0

Section 409.9081(3) exempts whole groups outright: children under 21; pregnant women, for services related to the pregnancy or a condition complicating it, up to six weeks after delivery; institutionalized recipients; managed-care and HMO enrollees; and emergency and family-planning services. Note the two different clocks on pregnancy: the copay exemption runs six weeks past delivery, while Medicaid eligibility itself runs 12 months postpartum.

Appeals: the two-level pathway

If your MMA plan denies, reduces, or terminates a service, you have appeal rights at two levels.

1
Step 1

File a plan appeal

Every plan must run an AHCA-approved internal appeal process, under Section 409.967(2)(h), Florida Statutes. File within 60 calendar days of the date on the Notice of Adverse Benefit Determination. The plan must resolve a standard appeal within 30 calendar days, or within 72 hours if waiting could seriously jeopardize your health. If you request it in time, the plan must continue your services during the appeal.

2
Step 2

Request a Medicaid Fair Hearing

If the plan upholds its denial, request a Medicaid Fair Hearing from the Florida Department of Children and Families Office of Appeal Hearings. Federal rule gives you between 90 and 120 calendar days from the plan's notice of resolution, so go by the deadline printed on that notice and file inside 90 days to be safe. The decision is binding on the plan.

One caveat to know: if you keep services running during an appeal and the appeal is decided against you, the plan may recoup the cost of those continued services. The AHCA Medicaid Helpline at 1-877-254-1055 can help with complaints and the appeals process.

What changed for 2026

A few benefit-relevant updates to know:

  • SMMC 3.0 is in its second contract year, in full operation since February 1, 2025.
  • Adult dental continues to include expanded benefits with prior approval through DentaQuest and Liberty Dental, with an extra set of expanded benefits for members 65 and older. AHCA's dental scope of services was last updated October 1, 2025, under the 2025-2030 dental contract cycle.
  • 12 months of postpartum coverage remains in effect for women on pregnancy Medicaid.
  • Specialty needs that used to require standalone specialty plans (HIV/AIDS, serious mental illness, child welfare) are now handled as "specialty products" carried by the comprehensive plans, while the Children's Medical Services (CMS) Plan continues for medically complex children.,

If you lose full Medicaid (for example, after a household income increase), Florida's Family Planning Waiver may provide limited, income-based family-planning coverage; check the AHCA page or call the choice counselor to confirm whether you qualify.

Common misconceptions about Florida Medicaid coverage

Even members who have had Medicaid for years run into these.

Misconception What's actually true
"My MMA plan covers nursing-home long-term stays" No. MMA covers short-term post-acute skilled nursing; long-term placement comes through the LTC program or institutional Medicaid.
"My MMA plan covers home care if I'm elderly" Only short-term skilled home health. Personal care, adult day care, and assisted living services come through the LTC program.
"Dental is part of my MMA plan" No. Dental is a separate prepaid dental plan (DentaQuest or Liberty Dental); you enroll separately.
"Adult dental is emergency-only" No. Adults get the State Plan dental services plus expanded benefits with prior approval, and 65+ members get more.
"I can switch plans anytime" Only during your 120-day window or annual open enrollment, unless a good-cause exception applies.
"The CMS Plan and CMS (Medicare) are the same" No. Florida's CMS Plan is Children's Medical Services, the state's pediatric plan.

Frequently Asked Questions

How do I find out which Florida Medicaid plan I'm in?

Call the choice counselor at 1-877-711-3662, log in at flmedicaidmanagedcare.com, or check the plan name on your member ID card. The same counselor handles both your medical and your dental plan.

Do I pay a copay for Florida Medicaid prescriptions?

In practice, no. Florida Medicaid managed-care members generally pay $0 at the pharmacy in 2026, even though the statute permits a small prescription coinsurance of 2.5%, capped at $7.50.

Are mental health services covered the same as physical health?

Yes. Behavioral health is carved into MMA in 2026, so your medical plan covers therapy, medication management, intensive outpatient and partial-hospitalization programs, crisis stabilization, and substance-use treatment alongside physical health care.

Does Florida Medicaid cover dental for adults?

Yes, through a separate prepaid dental plan (DentaQuest or Liberty Dental). Adults get the State Plan dental services plus expanded benefits with prior approval, and members 65 and older also get crowns and root canals as expanded benefits. Children under 21 get comprehensive, medically necessary dental care.

How do I appeal a denied service?

File a plan appeal within 60 calendar days of the denial notice. If the plan upholds it, request a Medicaid Fair Hearing from the DCF Office of Appeal Hearings; federal rule gives you between 90 and 120 calendar days from the plan's notice of resolution, and the notice states your exact deadline.

Does my MMA plan cover long-term care at home?

Only short-term skilled home health. Ongoing personal care, homemaker services, adult day care, and assisted living services come through the separate SMMC Long-Term Care program, which requires meeting nursing-facility level of care and the LTC financial rules.,

Get help with your Florida Medicaid benefits

Medicaid Choice Counselor Enrollment, plan changes, and benefit questions for both your medical and dental plan. 1-877-711-3662 flmedicaidmanagedcare.com
AHCA Medicaid Helpline Complaints, fair hearings, and the appeals process. 1-877-254-1055
Elder Helpline (age 60+) Entry point for long-term care and elder support. 1-800-963-5337 elderaffairs.org
Florida Senior Legal Helpline Free legal advice for Floridians age 60 and older. 1-888-895-7873
DentaQuest Dental plan member services (one of two statewide plans). 1-888-468-5509
Liberty Dental Dental plan member services (one of two statewide plans). 1-833-276-0850
DCF ACCESS Florida Financial eligibility and application. 1-866-762-2237 myflfamilies.com

Florida Medicaid covered services: the bottom line

Florida Medicaid in 2026 covers doctors, hospitals, prescriptions (usually at $0), mental health and substance-use care, dental (through a separate plan), vision, hearing, transportation to appointments, family planning, and maternity care with 12 months of postpartum coverage, and, for children, anything medically necessary under EPSDT. Those Florida Medicaid covered services run across three tracks, MMA for medical, a statewide dental program, and LTC for long-term care, and most members enroll in two of them.,

If you have been on Medicaid for a while and never used your dental, vision, or hearing benefits, call your plans. If you have been denied a service, file an appeal. If you need long-term care, start with the Elder Helpline. The benefits are yours, and the choice counselor at 1-877-711-3662 is the entry point for almost every question, change, or enrollment.

Learn More

MedicaidFlorida Medicaid Programs OverviewHow Florida Medicaid works for seniors: SMMC 3.0 plans, eligibility, income limits, LTC waiver, estate recovery, and the three-agency application process. MedicaidFlorida Medicaid Eligibility & Income LimitsFlorida Medicaid has six income limits, not one. The 2026 rules for ICP, the SMMC LTC waiver, MEDS-AD, Medically Needy, MSPs, and the Miller Trust workaround. MedicaidHow to Apply for Florida MedicaidHow to apply for Florida Medicaid: the six pathways, the three agencies (DCF, AHCA, DOEA), documents you need, processing timelines, and how to appeal a denial. MedicaidFlorida Medicaid Managed Care PlansEvery Florida Medicaid managed care plan by region for SMMC 3.0 (effective 2/1/2025), with plan choice rules, phone numbers, and the AmeriHealth exit. MedicaidFlorida Medicaid Dental CoverageFlorida Medicaid dental runs through a separate statewide dental plan, not your MMA medical plan. The 2026 plans are DentaQuest and Liberty Dental. MedicaidFlorida Medicaid Long-Term Care WaiverFlorida LTC waiver in 2026: how the 8-rank frailty waitlist works, the covered home and community-based services, hiring a spouse through PDO, and how to apply. MedicaidFlorida Medicare Savings ProgramsFlorida Medicare Savings Programs 2026: QMB, SLMB, and QI income and asset limits, what each pays, automatic Part D Extra Help, and how to apply through DCF.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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