Lost Your Florida Medicaid? What to Do Now 2026

Q: What if my income is below 100% FPL and I lose Medicaid in Florida?

This is Florida's coverage gap — one of the most frustrating situations in Florida health coverage. Florida has not expanded Medicaid, so adults below 100% of the Federal Poverty Level who don't fit the traditional Medicaid categories (elderly, disabled, pregnant, or parent meeting strict income tests) don't qualify for Medicaid AND don't qualify for ACA marketplace subsidies, which require income at or above 100% FPL. Options in this situation include Federally Qualified Health Centers (FQHCs) for reduced-cost primary care, hospital financial assistance programs for uncompensated care, and looking for ways to document or establish income above 100% FPL. This is a genuine gap — not a paperwork problem.

Q: Will my children still qualify for KidCare/CHIP if I lose Medicaid?

Possibly yes — children's eligibility is evaluated separately from adults. Florida KidCare (Florida's CHIP program) covers children in families with income up to 200% FPL (and in some cases higher). Even if you lose Medicaid as an adult, your children may still qualify for KidCare based on household income. When you receive Medicaid termination notice, apply for KidCare for your children separately at floridakidcare.org. Don't assume their coverage ends just because yours does.

Q: What documents do I need to enroll in a marketplace plan after Medicaid loss?

The main document you need is written proof of Medicaid termination — typically a letter from the Florida Department of Children and Families (DCF) stating the end date of your Medicaid coverage. HealthCare.gov will ask you to upload or confirm this during the SEP enrollment process. You'll also need to provide your estimated household income, household size, and the basic identifying information for everyone who will be covered on the plan.

Q: Is a Silver plan with CSR better than a Bronze plan after Medicaid loss?

For most people at lower income levels, yes — significantly better. Cost Sharing Reduction (CSR) plans are only available on Silver plans, and CSR provides dramatically reduced deductibles, copays, and out-of-pocket maximums at incomes between 100% and 250% FPL. At 150% FPL, a CSR Silver plan can feel almost as comprehensive as Medicaid in terms of out-of-pocket costs. Bronze plans have the lowest premiums but the highest cost-sharing — if you're likely to use medical care, the CSR Silver plan almost always provides more total value even if the premium is slightly higher.

Florida has been conducting annual Medicaid eligibility redeterminations since the end of the COVID-era continuous enrollment period. Each year, hundreds of thousands of Florida Medicaid recipients receive notices that their coverage is being reviewed — and a significant portion are terminated, either because their income or circumstances have changed, or because of paperwork and administrative issues that can often be resolved.

If you've received notice that your Florida Medicaid is ending, the most important thing to know is this: you have options, and you have a 60-day window to use them. Don't wait.

Step One: Understand Why You Lost Coverage

Before doing anything else, read the termination notice carefully. Florida Medicaid notices from the Department of Children and Families (DCF) should state the reason for termination and the effective end date. Common reasons include:

Income increased above the eligibility threshold for your Medicaid category
Household composition changed (someone moved in or out)
Documentation not received — DCF sent a renewal packet that wasn't returned
Age out of a specific Medicaid category

If you believe you were terminated in error or due to missing paperwork, you have the right to appeal and request continued coverage while the appeal is pending. Contact DCF at 866-762-2237. But even if you're appealing, start the ACA marketplace process simultaneously — appeals take time and coverage gaps are real.

60-Day SEP Window — Don't Miss It

Losing Medicaid or CHIP is a qualifying life event that triggers a Special Enrollment Period (SEP) on the ACA marketplace. You have 60 days from the date your coverage ends to enroll. Missing this window means waiting until open enrollment (November–January) for the following year. Start the process the day you receive your termination notice, not on day 59.

How to Enroll in Marketplace Coverage After Medicaid Loss

The process works like this:

Go to HealthCare.gov and create an account or log into an existing one.
Start a marketplace application. When asked about your situation, select "I lost or will lose health coverage" and note the Medicaid termination as the reason.
Enter your household income. This determines your subsidy eligibility and which plans are available.
Upload your Medicaid termination letter when prompted. This is your documentation for the SEP.
Select a plan and enroll. Coverage typically begins the first day of the month following enrollment, though expedited timelines are available in some cases.

A licensed agent can walk you through this process at no cost. Connect with a Florida agent at GetFloridaCoverage.com — they can help you compare plan options and make sure your enrollment is correctly documented.

Which Plan Should You Choose? The CSR Silver Advantage

If your income is between 100% and 250% of the Federal Poverty Level, paying close attention to Cost Sharing Reduction (CSR) Silver plans is critical. CSR plans are only available on Silver-tier marketplace plans, and they dramatically reduce what you pay when you actually use healthcare — deductibles, copays, and out-of-pocket maximums all drop significantly.

Income Level (% FPL)	CSR Effect	Plan Recommendation
100–150% FPL	Strongest CSR — deductible can be near $0, copays minimal	Silver with CSR strongly preferred
150–200% FPL	Strong CSR — deductibles and copays still much lower than standard	Silver with CSR strongly preferred
200–250% FPL	Moderate CSR — meaningful cost-sharing reductions	Silver with CSR usually preferred
250–400% FPL	No CSR (above income threshold)	Compare Silver, Gold, Bronze on premium vs. usage

Many people coming off Medicaid are tempted by Bronze plans because of lower premiums. But if you're likely to use medical care — routine visits, prescriptions, any ongoing conditions — the CSR Silver plan often provides far more total value even if the monthly premium is higher.

Florida's Coverage Gap: When Income Is Below 100% FPL

This is the hardest situation. Florida has not expanded Medicaid under the ACA. Adults who don't fit the traditional Medicaid categories — elderly (65+), disabled (receiving SSI or SSDI), pregnant, or a parent meeting strict income tests — are not eligible for Florida Medicaid regardless of income.

And if your income is below 100% of the Federal Poverty Level (approximately $15,060 for a single person in 2026), you also don't qualify for ACA marketplace premium tax credits — those require income at or above 100% FPL. This is Florida's coverage gap: too much income for Medicaid, too little income for marketplace subsidies. It's not a paperwork problem. It's a policy gap that affects several hundred thousand Floridians.

Options in the Coverage Gap

If you're in the coverage gap, these resources can help: Federally Qualified Health Centers (FQHCs) — community health centers that charge on a sliding fee scale based on income. Florida has dozens of FQHCs statewide. Find yours at findahealthcenter.hrsa.gov. Hospital financial assistance — most Florida hospitals have charity care programs for uninsured patients. Ask the financial counselor when scheduling a visit. Establish income documentation — any income at or above 100% FPL makes you eligible for marketplace subsidies. If you have any income sources, document them carefully.

Don't Forget About Your Children

Children's eligibility is evaluated separately from adults. Even if you don't qualify for marketplace coverage at a subsidized rate, your children may still qualify for Florida KidCare (the state's CHIP program) at incomes up to 200% FPL. KidCare covers preventive care, doctor visits, dental, and vision for children up to age 19. Apply separately at floridakidcare.org — don't assume their coverage ends because yours did.

For personalized help navigating your options after Medicaid loss, GetFloridaCoverage.com connects you with licensed Florida agents who can walk through your specific income and household situation at no cost to you.

Frequently Asked Questions

How long do I have to enroll in a marketplace plan after losing Medicaid?

You have 60 days from the date your Medicaid coverage ends. This Special Enrollment Period is federal law. Don't wait until the last week — start the HealthCare.gov application the day you receive your termination notice. Processing takes time, and you want your new coverage to start as close to your Medicaid end date as possible to avoid a gap.

What if my income is below 100% FPL and I lose Medicaid in Florida?

You're in Florida's coverage gap. Florida hasn't expanded Medicaid, so adults below 100% FPL who don't meet traditional Medicaid eligibility criteria don't qualify for Medicaid OR marketplace subsidies. Options include Federally Qualified Health Centers (FQHCs) for sliding-fee primary care, hospital charity care programs, and documenting income above 100% FPL to qualify for marketplace coverage. This is a genuine policy gap — there's no easy administrative fix.

Will my children still qualify for KidCare/CHIP if I lose Medicaid?

Possibly yes. Florida KidCare covers children in households with income up to 200% FPL. Children's eligibility is evaluated separately from adults. Even if you as an adult don't qualify for Medicaid, your children may still be eligible. Apply at floridakidcare.org separately from any adult marketplace application.

What documents do I need to enroll in a marketplace plan after Medicaid loss?

Primarily your Medicaid termination letter from DCF, which shows the end date of your coverage. HealthCare.gov uses this to confirm your SEP eligibility. You'll also need your estimated household income, household size, and basic identifying information for each person to be covered. Keep your termination letter — if the system requires documentation verification, you'll need it.

Is a Silver plan with CSR better than a Bronze plan after Medicaid loss?

For most people at 100–250% FPL, yes — significantly. CSR Silver plans reduce your deductibles, copays, and out-of-pocket maximum substantially. At 150% FPL, a CSR Silver plan's cost-sharing can be close to Medicaid levels. Bronze plans have lower monthly premiums but much higher cost-sharing — if you'll use healthcare, the CSR Silver plan usually provides more total value even if the premium is slightly higher.

SunState Coverage Editorial Team

Florida-based insurance professionals providing plain-language guidance on ACA marketplace plans and Medicaid transitions. NPN #21249133.

Sources

Centers for Medicare & Medicaid Services (CMS) — Medicaid unwinding guidance
Florida Department of Children and Families (DCF) — Medicaid redetermination process
HealthCare.gov — Special Enrollment Period for loss of Medicaid/CHIP
Florida KidCare — CHIP eligibility for children (floridakidcare.org)
HRSA — Find a Health Center (findahealthcenter.hrsa.gov)
Kaiser Family Foundation — Florida Medicaid coverage gap analysis

Disclaimer: This article is for general informational purposes and does not constitute legal or insurance advice. Medicaid eligibility rules, ACA subsidy thresholds, and CHIP income limits are subject to annual change by Florida DCF, CMS, and HHS. Consult a licensed insurance professional and Florida DCF for guidance specific to your situation.