Florida Medicaid Renewal and Recertification (2026)

Many families lose Florida Medicaid not because they became ineligible, but because they missed a renewal packet. Renewal runs on a 12-month cycle: the Department of Children and Families (DCF) rechecks your financial eligibility once a year, and federal law (42 CFR 435.916) requires the state to try an automatic renewal from data it already holds before it asks you for a single document. Whether your packet just arrived or you already missed it, this guide covers what to do, including the 90-day window to recover coverage.

Renew online through MyACCESS · Long-term-care questions: Elder Helpline 1-800-963-5337

Renewal is the most consequential operational moment in a beneficiary's relationship with Medicaid: eligibility is set once at application, but under 42 CFR 435.916 it is redetermined every 12 months thereafter.1 A procedural closure usually lands on someone still eligible who did not return the packet in time, which the 90-day reconsideration window below is designed to fix.

Three agencies run Florida Medicaid: DCF, through the ACCESS Florida (MyACCESS) system, determines financial eligibility and runs the annual redetermination for every pathway; the Agency for Health Care Administration (AHCA) is the single state Medicaid agency and operates the managed-care plans; and the Department of Elder Affairs (DOEA) handles the clinical side of long-term-care cases.3

In This Guide

• How the Florida Medicaid Renewal Cycle Works
• Ex Parte Renewal: The Automatic-Renewal Step
• How to Complete Your Florida Medicaid Renewal
• The 90-Day Reconsideration Window
• Long-Term Care and Waiver Renewals
• Returned Mail and Keeping Your Address Current
• Your Fair Hearing Rights
• Common Recertification Mistakes

How the Florida Medicaid Renewal Cycle Works

Under 42 CFR 435.916, DCF redetermines eligibility for most beneficiaries once every 12 months, and the rule's two halves favor MAGI beneficiaries: paragraph (a)(1) caps how often the agency may put them through it at all, "once every 12 months, and no more frequently than once every 12 months," while for non-MAGI beneficiaries (age, disability, long-term care, Medicare cost-sharing, medically needy) paragraph (b) requires a redetermination "at least every 12 months" and sets no ceiling.1 Your renewal month is set at approval and never moves: approved in October, you renew every October.

Renewal splits into two procedural paths by eligibility category:

• MAGI populations (children, pregnant women, and parents or caretaker relatives): renewed on Modified Adjusted Gross Income methodology, a straight income-and-household test with no asset check, verified through the federal data services hub (Social Security Administration records, Internal Revenue Service tax filings, commercial wage data). Florida is one of ten states that has not adopted ACA Medicaid expansion, so there is no expansion-adult MAGI group here.4
• Non-MAGI populations (SSI-related Aged, Blind, and Disabled; the Institutional Care Program; the SMMC Long-Term Care waiver; Medicare Savings Programs; MEDS-AD): renewed under rules that include an asset test. Section 1940 of the Social Security Act (42 U.S.C. 1396w) requires every state to run an electronic Asset Verification System and use it "for purposes of determining or redetermining" eligibility for people who qualify as aged, blind, or disabled. Because it reaches recipients at redetermination and not only applicants, the asset check applies at renewal, which is why these packets ask for bank and retirement-account statements, life-insurance documentation, and a signed AVS authorization.5

Most seniors and people with disabilities in Florida are non-MAGI, so plan on the asset side of the renewal.

Ex Parte Renewal: The Automatic-Renewal Step

The most important federal rule in modern Medicaid renewal is the ex parte default in 42 CFR 435.916, rewritten in its entirety by CMS effective July 31, 2026: before DCF asks you for anything, it must first try to redetermine your eligibility without requiring information from you. For MAGI beneficiaries, paragraph (a)(2) requires it to renew without asking you "if able to do so based on reliable information contained in the individual's account or other more current information available to the agency," and only if it cannot may paragraph (a)(3) open the paperwork step. For non-MAGI beneficiaries paragraph (b) requires the ex parte redetermination "if sufficient information is available to do so."1

In Florida it pulls from Social Security Administration earnings, retirement, SSDI, and SSI records; Internal Revenue Service tax filings; commercial wage databases; and other benefit programs such as SNAP. If that data confirms you remain within the income threshold for your category and your household has not changed, the renewal processes automatically and coverage continues for another 12 months with nothing to return.

Ex parte fails, and a packet follows, when:

• Income is hard to verify from data (self-employment, gig, cash, or seasonal work missing from wage databases)
• An asset test applies, because ABD, ICP, and long-term-care renewals turn on resources, and 42 CFR 435.948(a) has the agency pull financial data from the listed sources only "to the extent the agency determines such information is useful"5
• Household composition changed (a new baby, a spouse's death, a marriage or divorce)
• Income sits near the cutoff, so small discrepancies trigger a manual review

When ex parte fails, DCF must send a renewal form carrying the information it already has, and give you at least 30 days from the date on it to respond, add anything missing, and sign. It cannot require an in-person interview. Under 42 CFR 435.916(a)(3) that package is a federal requirement if your eligibility is based on modified adjusted gross income (MAGI); for non-MAGI groups Florida may follow the same procedure but is not required to, so go by the deadline on your notice.1

How to Complete Your Florida Medicaid Renewal

Return the packet any way DCF accepts applications. The fastest is online through MyACCESS, which shows your case, accepts document uploads, and confirms receipt in real time.

MyACCESS is Florida's self-service portal for Medicaid, SNAP, and cash assistance. Create an account with your name, date of birth, and the case number from any DCF notice, and update your contact information while you are in there so future packets reach you.

The 90-Day Reconsideration Window

If your coverage closed because you missed the renewal paperwork, you may not have to start over. Under 42 CFR 435.916, if you lose Medicaid for failure to return the renewal form or necessary information (a procedural termination, not an eligibility-based one), DCF must reconsider your eligibility on the basis of that late-returned renewal if you submit it within 90 days of the termination date, without requiring a new application, and restore coverage if you are found still eligible. Ninety days is the federal minimum; a state may elect longer, so treat 90 days as the window you can count on. That requirement covers renewals figured under MAGI income rules; for non-MAGI groups a state may adopt the same window but is not required to, so ask DCF whether Florida does.1 Close June 30 over an unreturned packet and you have until roughly September 28.

A procedural termination (you did not respond, did not send requested documents, or missed a signature) qualifies. An eligibility-based termination (DCF found you over the income or asset limit, or no longer categorically eligible) does not; your remedy there is a new application or an appeal.

Children's 12-Month Continuous Eligibility

Section 5112 of the Consolidated Appropriations Act, 2023 requires every state to give children under 19 enrolled in Medicaid or CHIP 12 months of continuous eligibility from enrollment, effective January 1, 2024.2

Coverage is locked in for those 12 months regardless of changes in family income: if a parent loses Medicaid mid-year because income rose, the children stay covered until their next renewal. Only a few things end it early: the child turns 19, moves out of Florida, dies, the family disenrolls, or there is fraud. So report an income increase accurately; it protects you from later fraud allegations and the children keep coverage regardless.

Florida also keeps a woman who was eligible for Medicaid while pregnant enrolled for a full 12 months after the end of the pregnancy (s. 409.903(5), F.S.),6 under the permanent state option created by the American Rescue Plan Act of 2021 and made permanent by the Consolidated Appropriations Act, 2023.2 Coverage runs through the end of the month in which the 12th postpartum month falls, regardless of income.

Long-Term Care and Waiver Renewals: Two Reviews at Once

If you receive Medicaid long-term care (a nursing facility through the Institutional Care Program, or home and community-based services through the SMMC Long-Term Care waiver), your renewal has two independent components, and both must stay current.

The financial redetermination (DCF)

DCF runs this on the 12-month cycle, including the asset test federal law requires it to verify through the Asset Verification System, measuring income and countable resources against Florida's long-term-care standards:5

• The gross-income cap for the Institutional Care Program and the SMMC LTC waiver is 300% of the SSI Federal Benefit Rate. With the 2026 SSI FBR at $994 a month, the cap is $2,982 a month; income above it requires a Qualified Income Trust (Miller Trust). The countable-asset limit for a single Florida waiver applicant is $2,000.7
• For a married couple with one spouse applying, the community spouse may be protected by a Community Spouse Resource Allowance of at least $162,660 in 2026, a floor rather than a cap. Rule 65A-1.712(4)(c) sets the Florida allowance at "the maximum resource allocation standard allowed under 42 U.S.C. §1396r-5 or any court-ordered support, whichever is larger," so the operative figure is the federal maximum, and the $32,532 federal minimum is not what Florida applies; a court order for the community spouse's support, or a fair hearing under 65A-1.712(4)(e), can take it higher still. Check one limit first: 65A-1.712(4) applies spousal impoverishment to an institutionalized individual with a community spouse and states that these policies are not applied to people applying for or receiving services under Florida's HCBS waiver programs, apart from the Familial Dysautonomia and Model (Katie Beckett) waivers. A couple on the SMMC Long-Term Care waiver rather than in a nursing facility is outside it.7
• Florida's DCF manual keys its home-equity test to "the current year's spousal impoverishment standards for the minimum home equity limit," which for 2026 is $752,000.8 Above that, an applicant is ineligible for long-term-care services unless the spouse, a child under 21, or a blind or disabled child of any age lives in the home, or the state waives it for hardship.7 The home itself is excluded as an asset regardless of value while it is the principal place of residence, and DCF states outright that "[h]ome equity is not an asset test."8

The renewal also confirms the patient-responsibility math. In 2026, a Florida Medicaid nursing-facility resident (Institutional Care Program or institutionalized MEDS-AD) keeps a monthly Personal Needs Allowance of $160, the floor of what they keep rather than the whole of it. It is the first of four deductions, sharing that step with half of any therapeutic wages up to $111, then the community-spouse, family-member or dependent's allowance, then the month-of-admission and month-of-discharge protections, then uncovered medical expenses. What remains is the patient responsibility, so a resident with a community spouse, a dependent or unpaid medical bills retains more than $160. Three groups owe none at all: ICP children aged 3 to 17 in an ICF/DD, QMB individuals at or under 100% of the federal poverty level in a nursing home during a Medicare coinsurance period, and SSI recipients whose only income is a $30 SSI payment. The $160 is the nursing-facility figure, not the amount for someone at home or in assisted living on the LTC waiver.9

The clinical reassessment (DOEA CARES)

Florida's Comprehensive Assessment and Review for Long-Term Care Services (CARES) program, run by the Department of Elder Affairs with AHCA, determines medical (level-of-care) eligibility for Medicaid nursing-home and waiver services. A CARES nurse or assessor reassesses you at no cost and recommends the least restrictive, most appropriate placement.3

The two reviews are independent: you can pass the financial redetermination and fail the clinical one, or the reverse. If the CARES level-of-care determination is not renewed, long-term-care Medicaid ends, though you may continue on standard SSI-related Medicaid if otherwise eligible.

Medicare Savings Program Renewals

Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualified Individual (QI) coverage, branded in Florida as Medicare Buy-In, is redetermined on the same 12-month non-MAGI cycle, with DCF attempting an ex parte renewal first.1 Social Security and SSDI income is already in the federal data hub, but the asset test can still trigger a paperwork request.5 Keeping QMB, SLMB, or QI also matters for your Medicare Part D Low-Income Subsidy (Extra Help), so if it changes, check your Extra Help status with Social Security.

Returned Mail and Keeping Your Address Current

If your renewal packet comes back to DCF as undeliverable, that can lead to a termination. The federal rule requiring the agency to search for a new address before acting, 42 CFR 435.919, was removed effective July 31, 2026. Federal law now says only that DCF may act without advance notice when your whereabouts are unknown, so no warning may reach you (42 CFR 431.213(d)), and that coverage must be reinstated if your whereabouts become known while you are still eligible (42 CFR 431.231(d)).10 Florida may still have its own procedures, so call DCF if your mail has come back.

Keeping your managed-care plan updated is a separate job from updating DCF. Under Statewide Medicaid Managed Care 3.0, effective February 1, 2025, most Florida Medicaid members get their benefits through one of the state's contracted plans across nine regions (A through I), and your plan's member-contact record is a separate file from DCF's; the roster is in our Florida Medicaid managed care plans guide, which also covers plan changes through AHCA's broker at 1-877-711-3662.11

So after any move, update your address in MyACCESS and with your managed-care plan, and file a USPS change-of-address form. Updating Social Security does not update DCF.

Your Fair Hearing Rights

If your renewal is denied or your coverage is terminated, you have a federal right to a fair hearing under Section 1902(a)(3) of the Social Security Act and 42 CFR 431.220. That regulation reaches six categories of person, two of which matter especially to older readers: an individual who believes the agency acted erroneously on eligibility, benefits, a spend-down determination, cost sharing or a prior authorization decision; and any resident who believes a skilled nursing facility or nursing facility has erroneously determined that he or she must be transferred or discharged. It is not unconditional: 42 CFR 431.220(b) says the agency need not grant a hearing where the sole issue is a federal or state law requiring an automatic change affecting some or all beneficiaries.2 Under 42 CFR 431.221(d) the agency must allow a reasonable time to request the hearing, not to exceed 90 days from the date the notice of action is mailed. That is a ceiling, not a floor: a shorter state deadline is enforceable, so the deadline that controls your case is the one printed on your own notice of action.12

Which office hears your case depends on what was decided, and your notice names it. Eligibility decisions by DCF, the kind at issue in most renewals, go to DCF's Office of Appeal Hearings by mail, email, online form, or phone at (850) 488-1429. Service denials by AHCA or your managed-care plan go instead to AHCA's Medicaid Hearing Unit at (877) 254-1055, which s. 409.285(2), F.S. puts there by statute; that track starts with the plan's own internal appeal, filed within 60 calendar days of its Notice of Adverse Benefit Determination. And anything administered by the Agency for Persons with Disabilities is a third route: s. 409.285(3), F.S. sends APD-administered Medicaid appeals to s. 393.125, F.S.13 Our Florida Medicaid appeals and fair hearings guide has the managed-care track in full.

Keeping benefits during the appeal. Federal law (42 CFR 431.230) continues your Medicaid during the appeal only if you request the hearing before the date the action takes effect, and in Florida you must also ask to continue services during intake. Miss that date and 42 CFR 431.231(a) still lets the agency reinstate where you request the hearing within 10 days of the date of action. Under 42 CFR 431.231(c) it must reinstate and continue services until a decision where all three are true: the action was taken without the advance notice the rules require; you request the hearing within 10 days of receiving the notice (receipt is deemed 5 days after its date unless you show otherwise); and the action resulted from something other than the application of federal or state law or policy. Cut off with no advance notice, you have a right to reinstatement, not merely a hope of it. If the action is later sustained, the agency may recoup the cost of services furnished solely by reason of the continuation.14

A renewal can also turn on citizenship or immigration status. Where the agency cannot promptly verify a declared U.S. citizenship, national, or satisfactory immigration status, 42 CFR 435.956 requires a reasonable opportunity period of up to 90 days to produce documentation, during which it may not delay, deny, reduce, or terminate benefits for a person it otherwise finds eligible.15

What Changes After 2026: Toward 6-Month Renewals

Section 71107 of the 2025 federal budget-reconciliation law (H.R.1, Public Law 119-21) added subparagraph (L) to section 1902(e)(14) of the Social Security Act, requiring states to redetermine eligibility once every 6 months instead of every 12 for renewals scheduled on or after January 1, 2027. It reaches two groups only: people enrolled under section 1902(a)(10)(A)(i)(VIII), the ACA expansion adult group, and people described in that subsection enrolled instead under a state plan waiver giving everyone in it coverage equivalent to minimum essential coverage. The one exemption turns on a state determination: an Indian or Urban Indian, a California Indian, or anyone otherwise determined eligible as an Indian for the Indian Health Service. Territories are outside the mandate entirely.2 Because Florida has not adopted ACA Medicaid expansion, it has no expansion-adult group subject to the new cadence.4

The same law shortens retroactive eligibility for applications filed on or after January 1, 2027, to two months before the application month for most enrollees, down from three.2 The practical lesson is unchanged: ex parte catches more eligible beneficiaries without paperwork, but the renewal packet remains the failsafe.

Common Florida Medicaid Recertification Mistakes

1. Ignoring the packet because the envelope looks like junk mail, or assuming ex parte handled it. Open anything from DCF, AHCA, or MyACCESS the day it arrives.1
2. Updating your address with Social Security or your health plan but not DCF. DCF does not auto-sync with SSA, and no federal rule makes it check your plan's records when mail is returned.10
3. Reapplying from scratch instead of asking for reconsideration, which needlessly restarts the clock inside the 90-day window.1
4. Missing the asset-verification signature for ABD or long-term care. The consequence is sharper than a stalled file: 42 U.S.C. 1396w(f) provides that if you refuse to give the financial-records authorization, or revoke one you gave, "the State may, on that basis, determine that the applicant or recipient is ineligible for medical assistance." It expires on a final adverse decision, on the end of your eligibility, or on your own written revocation, and the state must tell you its duration and scope; the records are obtained at no cost to you.5
5. Forgetting the clinical reassessment on long-term-care cases, which runs alongside the financial renewal.3
6. Treating the 90 days on a hearing notice as guaranteed. It is the maximum a state may allow; go by your own notice.12

For the wider picture, start at the Florida Medicaid hub or Brevy's Medicaid guide.

Learn More

Find help completing your Florida Medicaid renewal at brevy.com.

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.