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 walks you through 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 closure for procedural reasons usually lands on someone still eligible who did not return the packet in time, which is what the 90-day reconsideration window below is designed to fix.

Florida runs Medicaid through three agencies, and knowing which one handles your renewal saves time. 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 that deliver benefits. 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
• Children's 12-Month Continuous Eligibility
• Long-Term Care and Waiver Renewals
• Returned Mail and Keeping Your Address Current
• Your Fair Hearing Rights
• What Changes After 2026
• Common Recertification Mistakes
• Frequently Asked Questions
• Learn More

How the Florida Medicaid Renewal Cycle Works

Under the federal renewal rules at 42 CFR 435.916, DCF redetermines eligibility for most beneficiaries once every 12 months.1 Your renewal month is set at approval and stays the same every year: approved in October, you renew every October.

Renewal cycles split into two procedural paths depending on 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). With no asset test, MAGI renewals clear automatically far more often. Florida 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. Federal law requires every state to verify assets at renewal through an Asset Verification System (Section 1940 of the Social Security Act, 42 U.S.C. 1396w), so non-MAGI renewals clear automatically less often and usually ask you 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, where the asset test almost guarantees a paperwork packet.

Ex Parte Renewal: The Automatic-Renewal Step

The most important federal rule in modern Medicaid renewal is the ex parte default at 42 CFR 435.916(b)(1). Before DCF asks you for anything at renewal, it must first try to redetermine your eligibility without requiring information from you, whenever it can do so from reliable information already in your account or otherwise available to it, including electronic data sources. Only if it cannot renew on that basis may it ask you.2

In Florida, ex parte renewal 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 you get a notice that coverage continues for another 12 months, with nothing to return.

Ex parte most often 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 need documentation the AVS check cannot pull on its own5
• 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 must give you at least 30 days from the date on that form to respond, add anything missing, and sign. It cannot require an in-person interview to renew. 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 and call DCF if it is unclear.2

How to Complete Your Florida Medicaid Renewal

When a packet does arrive, you can return it any way DCF accepts applications. The fastest and most reliable is online through your MyACCESS account, 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. If you do not have an account, create one with your name, date of birth, and the case number from any DCF notice. 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. If your eligibility is figured using MAGI income rules, federal law gives you 90 days to return the form and have your eligibility reconsidered without reapplying.

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. Ninety days is the federal minimum; a state may elect longer, so treat 90 days as the window you can count on. If you are found still eligible on that reconsideration, your coverage is restored.2 That requirement covers renewals figured under MAGI income rules; for non-MAGI groups, federal law lets a state adopt the same 90-day window but does not require it, so ask DCF whether Florida does.2

So if coverage closes June 30 over an unreturned packet, you have until roughly September 28 to submit the missing paperwork.

A procedural termination (you did not respond, did not send requested documents, or missed a signature) qualifies for the 90-day reconsideration. 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, 2024.1

Once a child is enrolled, coverage is locked in for 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. Limited exceptions allow mid-year termination: 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 your children keep coverage through the rest of their 12-month period.

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, 2023.1 Coverage continues through the end of the month in which the 12th postpartum month falls, regardless of income changes, and the annual renewal cycle resumes after that period ends.

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 the state to verify through the Asset Verification System.5 It measures your income and countable resources against Florida's long-term-care standards:

• 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 2026 income cap is $2,982 a month; income above that requires a Qualified Income Trust (Miller Trust).4
• In 2026, the countable-asset limit for a single Florida waiver applicant is $2,000.4
• For a married couple with one spouse applying, the community spouse is protected by a Community Spouse Resource Allowance, which Florida sets at the federal maximum: in 2026 the range runs from a minimum of $32,532 to a maximum of $162,660.4
• Florida applies the lower federal home-equity limit of $752,000; the homestead is otherwise exempt when you intend to return, a community spouse lives there, or a dependent relative lives there.4

For a nursing-facility resident, 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 first deduction taken before the rest of the resident's income is applied to the cost of care. The $160 is the nursing-facility figure, not the amount for someone at home or in an assisted living facility on the LTC waiver.7

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 whether you still meet nursing-facility level of care. A CARES nurse or assessor reassesses you at no cost and recommends the least restrictive appropriate setting.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, your long-term-care Medicaid ends, though you may continue on standard SSI-related Medicaid if you remain 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.2 Ex parte often works here because Social Security and SSDI income is already in the federal data hub, though 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 that required 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)).8 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, organized across nine regions (A through I); the current roster is in our Florida Medicaid managed care plans guide.9 Your plan's member-contact record is a separate file.

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

If you want to change plans as well, AHCA's enrollment broker gives new enrollees 120 calendar days from their enrollment date to switch for any reason. After that, you can switch during the annual 60-day open enrollment, or at any time for good cause, which s. 409.969(2), F.S. defines to include poor quality of care, lack of access to necessary specialty services, unreasonable delay or denial of a service, and fraudulent enrollment. The agency decides whether good cause exists, and if it decides it does not, it must tell you of your right to a Medicaid Fair Hearing to dispute that finding. (The broker calls this a "For Cause" change.) Choice counseling: 1-877-711-3662.9

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 431.220.1 Under 42 CFR 431.221(d) the agency must allow you a reasonable time to request that hearing, not to exceed 90 days from the date the notice of action is mailed. That 90 days is a ceiling, not a floor: a state may set a shorter deadline, and a shorter one is enforceable. The deadline that controls your case is the one printed on your own notice of action, so count from the mailing date.10 A managed-care service denial runs on a separate track: you request the plan's own internal appeal within 60 calendar days of the plan's Notice of Adverse Benefit Determination, and after the plan issues its notice of resolution you must be given no fewer than 90 and no more than 120 calendar days from that notice to request a Medicaid Fair Hearing (42 CFR 438.402(c)(2)(ii) and 438.408(f)(2)).6

In Florida, which office hears your case depends on what was decided, and your notice of hearing rights names the responsible office:

• Eligibility decisions by DCF (the kind at issue in most renewals) are appealed to DCF's Office of Appeal Hearings, part of the Office of Inspector General. You can request a hearing in writing by mail or email, by phone at (850) 488-1429, or through DCF's online form.11
• Service denials, reductions, or terminations by AHCA or by your managed-care plan go to AHCA's Medicaid Hearing Unit, reachable at (877) 254-1055. For managed-care members, the plan's own internal appeal comes first, and the fair-hearing notice follows the plan's appeal decision.11

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, after the agency sends its advance notice.12 In Florida, you must also ask to continue services during the intake process.11 If you miss that date, a separate rule (42 CFR 431.231) lets the agency reinstate services if you request the hearing no more than 10 days after the date of action. If the action is later sustained, the agency may recoup the cost of services furnished solely by reason of the continuation, not the cost of everything you received while the appeal was open.12

A renewal can also turn on citizenship or immigration status. When you declare that you are a U.S. citizen, U.S. national, or in a satisfactory immigration status and the agency cannot promptly verify that from its data sources, federal law (42 CFR 435.956) requires it to give you a reasonable opportunity period to produce documentation. The period ends at the earlier of verification and 90 days after the agency's notice, and it can run past 90 days for someone declaring a satisfactory immigration status who is making a good-faith effort to obtain documents. During that period the agency may not delay, deny, reduce, or terminate benefits for a person it otherwise finds eligible, and it may not cap how many reasonable opportunity periods one person receives.13

What Changes After 2026: Toward 6-Month Renewals

Section 71107 of the 2025 federal budget-reconciliation law (H.R.1, Public Law 119-21) requires states to redetermine eligibility once every 6 months instead of every 12 for the ACA expansion-adult population, for renewals scheduled on or after January 1, 2027. The statute's one exemption is narrow: an Indian or Urban Indian, a California Indian, or anyone otherwise determined eligible as an Indian for the Indian Health Service.1 Because Florida has not adopted ACA Medicaid expansion, it has no expansion-adult group subject to the new cadence, so the change reaches Florida beneficiaries far less directly than it reaches expansion states.4

The same law also shortens retroactive eligibility for applications filed on or after January 1, 2027, to two months before the application month for most enrollees, down from the long-standing three.1 The practical lesson does not change: 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. Open anything from DCF, AHCA, or MyACCESS the day it arrives.
2. Assuming ex parte will handle everything. It clears only a portion of Florida cases, least often in the non-MAGI group with its asset test; the rest need the packet back by the deadline printed on the form.2
3. 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. Update MyACCESS yourself, and your managed-care plan too.8
4. Reapplying from scratch instead of asking for reconsideration. A procedural closure can be undone within the 90-day window, so reapplying needlessly restarts the clock. For non-MAGI coverage the window is a state option, so ask DCF first.2
5. Missing the asset-verification signature for ABD or long-term care. Without your signed AVS authorization, DCF cannot run the required bank-record check and the renewal stalls.5
6. Forgetting the clinical reassessment on long-term-care cases. A CARES level-of-care review runs alongside the financial renewal, and both must stay current.3
7. Assuming children lose coverage when a parent does. They don't; a child's 12-month continuous eligibility runs independently of the parent's case.1
8. Treating the 90 days on a hearing notice as guaranteed. It is the maximum a state may allow; go by the deadline printed on your own notice.10

For the wider picture, start at the Florida Medicaid hub or Brevy's Medicaid guide, and use how to apply for Florida Medicaid to check whether you remain eligible at renewal.

Learn More

Find personalized 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.