State Profiles for Dual-Eligible Individuals
Florida Primary Pathways to Medicaid Eligibility for Dual-Eligible Individuals
How Medicare beneficiaries become eligible for Medicaid
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People are eligible for Medicare if they are ages 65 and older or have qualifying disabilities. Most dual-eligible individuals are enrolled in Medicaid through one of the two federally required (“mandatory”) pathways: enrollment of people who receive Supplemental Security Income and enrollment of eligible beneficiaries in Medicare Savings Programs. Most, but not all, dual-eligible individuals are enrolled in a Medicare Savings Program. There are also optional eligibility pathways for low-income older adults and people with disabilities that states may choose to adopt.
Summary of Eligibility Pathways, Florida
| Indicator | Value |
|---|---|
| Summary Text | In Florida, 61% of full-benefit dual-eligible individuals are enrolled in Medicaid through mandatory eligibility pathways, which is higher than the national share of 57%. The Medicare Savings Program with the largest share of dual-eligible individuals enrolled is QMB Plus (see below for description of Medicare Savings Programs). For Medicare Savings Program eligibility, Florida has income or asset limits equal to the federal limits. Of the optional pathways, the largest share of full-benefit dual-eligible individuals is enrolled through long-term care (LTC) related pathways with 22%. |
State Adoption and Enrollment Through Key Medicaid Eligibility Pathways for Medicare Beneficiaries, Florida
| Indicator | Value |
|---|---|
| Group | Mandatory: Supplemental Security Income |
| Applicable Eligibility Pathways in 2025 | People who meet the social security disability criteria and have limited income and assets |
| Share of Full-Benefit Dual-Eligible Individuals Enrolled in 2021 | 0.57 |
| Share of Partial-Benefit Dual-Eligible Individuals Enrolled in 2021 | N/A |
| Group | Mandatory: Medicare Savings Programs |
| Applicable Eligibility Pathways in 2025 | Medicare Savings Programs |
| Share of Full-Benefit Dual-Eligible Individuals Enrolled in 2021 | 0.04 |
| Share of Partial-Benefit Dual-Eligible Individuals Enrolled in 2021 | 0.95 |
| Group | Optional: Income-related |
| Applicable Eligibility Pathways in 2025 | Older adults and people with disabilities with income above the limit for SSI and up to 100% FPL (Yes) Medically Needy (Yes) Buy-In Program (Yes) Family Opportunity Act (No) |
| Share of Full-Benefit Dual-Eligible Individuals Enrolled in 2021 | 0.12 |
| Share of Partial-Benefit Dual-Eligible Individuals Enrolled in 2021 | 0.00 |
| Group | Optional: Long-term care (LTC) related |
| Applicable Eligibility Pathways in 2025 | Special Income Rule, Institutional LTC (Yes) Special Income Rule, Home LTC (Yes) Katie Beckett (Yes) Other Home Care Expansion |
| Share of Full-Benefit Dual-Eligible Individuals Enrolled in 2021 | 0.22 |
| Share of Partial-Benefit Dual-Eligible Individuals Enrolled in 2021 | N/A |
| Group | None or other |
| Applicable Eligibility Pathways in 2025 | Other/Unknown Pathway |
| Share of Full-Benefit Dual-Eligible Individuals Enrolled in 2021 | 0.05 |
| Share of Partial-Benefit Dual-Eligible Individuals Enrolled in 2021 | 0.05 |
Adoption of enrollment pathways is as of March 2025, except for Florida, which reflects the state’s response to KFF’s 2022 survey and supplemental research. NSD indicates not sufficient data (cells representing fewer than 50 enrollees). Totals may not equal 100% due to data suppression and rounding.
See Medicaid Eligibility Levels for Older Adults and People with Disabilities (Non-MAGI) in 2025 for more details on how pathways are defined.
Source: KFF Survey of Medicaid Financial Eligibility & Enrollment Policies for Older Adults & People with Disabilities, 2025; KFF analytic file of merged 2021 MBSF and 2021 T-MSIS data.
Distribution of Dual-Eligible Individuals by Mandatory and Optional Medicaid Eligibility Pathways, 2021, Florida
| Indicator | Value |
|---|---|
| Mandatory (SSI or MSPs) | 0.77 |
| Optional | 0.18 |
| Unknown/Other | 0.05 |
See Medicaid Eligibility Levels for Older Adults and People with Disabilities (Non-MAGI) in 2025 for details on how pathways are defined. Totals may not equal 100% due to data suppression and rounding.
Source: KFF analytic file of merged 2021 MBSF and 2021 T-MSIS data.
Eligibility Limits for Medicare Savings Programs, 2025, Florida
| Indicator | Value |
|---|---|
| Medicare Savings Program | Qualified Medicare Beneficiaries (QMBs) |
| Definition | Medicaid pays for Part A and B premiums, deductibles, coinsurance, and copayments. Enrollees who also qualify for full Medicaid benefits are referred to as QMB Plus. |
| Income Limit as % FPL | 1 |
| Monthly Income Limit | Individual: $1,304 Couple: $1,763 |
| Asset Limit | Individual: $9,660 Couple: $14,470 |
| Medicare Savings Program | Specified Low-Income Medicare Beneficiaries (SLMBs) |
| Definition | Medicaid pays for Part B premiums and states may choose to cover Medicare Part A and B cost sharing. Enrollees who also qualify for full Medicaid benefits are SLMB Plus. |
| Income Limit as % FPL | 1.2 |
| Monthly Income Limit | Individual: $1,565 Couple: $2,115 |
| Asset Limit | Individual: $9,660 Couple: $14,470 |
| Medicare Savings Program | Qualifying Individual (QI) |
| Definition | Medicaid pays for Part B premiums only. Enrollees do not qualify for full Medicaid benefits. |
| Income Limit as % FPL | 1.35 |
| Monthly Income Limit | Individual: $1,761 Couple: $2,379 |
| Asset Limit | Individual: $9,660 Couple: $14,470 |
* indicates that the limits in a state are higher than the federal limits.
See Medicaid Eligibility Levels for Older Adults and People with Disabilities (Non-MAGI) in 2025 for more details.
Source: KFF Survey of Medicaid Financial Eligibility & Enrollment Policies for Older Adults & People with Disabilities, 2025.
Distribution of Dual-Eligible Individuals by Enrollment in Medicare Savings Programs, 2021, Florida
| Indicator | Value |
|---|---|
| QMB Plus | 0.38 |
| SLMB Plus | 0.02 |
| QMB Only | 0.30 |
| SLMB Only | 0.13 |
| QI or QDWI | 0.08 |
| Full-benefit, not enrolled in an MSP | 0.08 |
| Partial-benefit, not enrolled in an MSP | 0.00 |
Categories with no enrollment or insufficient data will not appear in the figure. Qualified Disabled Working Individuals (QDWIs) and Qualifying Individuals (QIs) are combined for privacy reasons. Totals may not equal 100% due to data suppression and rounding.
Medicare Savings Program categories are mutually exclusive and reflect enrollment in March. Full-benefit dual-eligible individuals are categorized as enrolled in QMB Plus, enrolled in SLMB Plus, or not enrolled in an MSP. Partial-benefit dual-eligible individuals are categorized as enrolled in QMB only, enrolled in SLMB only, enrolled in QI or QDWI, or not enrolled in an MSP.
Source: KFF analytic file of merged 2021 MBSF and 2021 T-MSIS data.