Florida’s Medically Needy Program: An Alternative Path to Healthcare Coverage (2025 Guide)

If you’ve been told your income is “too high” for Medicaid but you’re struggling with overwhelming medical bills, Florida’s Medically Needy Program might be your lifeline. Also known as the “Share of Cost” program, this often-misunderstood healthcare option helps thousands of Floridians access vital medical care they couldn’t otherwise afford.

At Berg Bryant Elder Law Group, we regularly guide clients through the maze of healthcare coverage options. The Medically Needy Program is one of the most complex but potentially valuable resources for those caught in the healthcare gap.

What is Florida’s Medically Needy Program?

The Medically Needy Program is Florida’s safety net for people who:

• Make too much money to qualify for regular Medicaid
• Don’t have adequate health insurance
• Face significant medical expenses they cannot afford
• Meet all other Medicaid eligibility requirements except income

Think of it as a specialized type of Medicaid with a monthly “deductible” (called a share of cost) that you must meet before coverage begins.

How the Medically Needy “Share of Cost” Program Works

Unlike traditional health insurance that provides continuous coverage, the Medically Needy Program works on a month-by-month basis with a unique “spend-down” approach.

The Basics: Your Monthly Share of Cost

Your “share of cost” is essentially a threshold of medical expenses you must incur each month before Medicaid coverage kicks in. This amount is calculated based on:

• Your household size
• Your gross monthly income
• How much your income exceeds the standard Medicaid income limit

For example, if your income is $500 above the Medicaid limit, your share of cost will be approximately that amount each month.

The Monthly Cycle: How Coverage Activates

Here’s how the process works each month:

1. You begin each month without Medicaid coverage
2. You track your medical expenses as they occur
3. You submit documentation of these expenses to the Department of Children and Families (DCF)
4. Once your expenses exceed your share of cost for the month, Medicaid coverage activates
5. Coverage continues until the end of that calendar month
6. The process starts over on the first day of the next month

This cyclical nature is what makes the program both challenging and uniquely valuable for those with high medical costs.

What Medical Expenses Count Toward Your Share of Cost?

Understanding which expenses can help you meet your monthly threshold is crucial for maximizing this benefit.

Eligible Expenses Include:

• Unpaid medical bills that haven’t been used in previous months
• Medical bills you paid within the last three months
• Health insurance premiums (excluding fixed indemnity plans)
• Medical services prescribed by a doctor
• Transportation costs (ambulance, bus, taxi) to medical appointments
• Co-pays for medical services
• Medical bills for any household member whose income was used to determine eligibility

Expenses That Don’t Count:

• Premiums for insurance policies that pay you money for hospitalization
• Over-the-counter medications or supplies (bandages, cold remedies, etc.)
• Bills already used to meet a previous month’s share of cost
• Bills older than 90 days

Who Benefits Most from the Medically Needy Program?

This program works particularly well for:

• People with predictable, recurring medical costs – If you have monthly expenses that regularly exceed your share of cost (like expensive prescriptions or regular treatments), you can plan to receive Medicaid coverage for a predictable portion of each month
• Those experiencing temporary medical crises – If you’re facing a sudden illness or injury with substantial costs, the program can provide crucial financial protection
• Individuals in the “coverage gap” – If you earn too much for regular Medicaid but cannot afford private insurance, this program provides access to care

Maximizing Your Benefits: Strategic Tips

Using this program effectively requires organization and strategy:

1. Time Your Medical Services Strategically

Schedule expensive treatments or procedures early in the month when possible. This allows you to meet your share of cost sooner and maximize the number of days you have Medicaid coverage each month.

2. Keep Meticulous Records

Maintain a file of all medical expenses, including:

• Doctor bills
• Prescription receipts
• Lab work costs
• Transportation expenses to medical appointments
• Health insurance premium statements

3. Submit Documentation Promptly

You can submit proof of medical expenses through:

• The MyACCESS portal (MyACCESS.myflfamilies.com)
• Fax
• Mail
• In-person at a DCF service center

Always include your name and case number on all documentation.

4. Verify Provider Participation

Before scheduling appointments, always confirm that your healthcare providers accept Florida Medicaid. Even if they accept regular Medicaid, some providers may be reluctant to see patients in the Medically Needy program until their share of cost has been met for the month.

Common Challenges and How to Address Them

Challenge #1: Misunderstanding the Program

Many people mistakenly believe they must pay their entire share of cost out-of-pocket. In reality, you only need to incur (not necessarily pay) the required amount of medical expenses.

Solution: Work with a Medicaid specialist or elder law attorney who can explain exactly how your obligations work.

Challenge #2: Provider Acceptance Issues

Some healthcare providers are hesitant to accept patients enrolled in the Medically Needy program due to the monthly uncertainty of coverage.

Solution: Develop relationships with providers who regularly work with the program and understand its nuances. Community health centers and federally qualified health clinics often have experience with the Medically Needy Program.

Challenge #3: Monthly Uncertainty

The monthly reset can make healthcare planning difficult, especially for those with fluctuating medical needs.

Solution: For predictable expenses, schedule services early in the month. For ongoing care needs, discuss payment options with providers for services received before your share of cost is met.

Comparing Your Options: Is the Medically Needy Program Right for You?

While the Medically Needy Program provides vital access to care for many, it’s worth considering whether other options might better suit your needs:

Alternative #1: Marketplace Insurance Plans

If your income is between 100% and 400% of the federal poverty level, you may qualify for subsidized health insurance through Healthcare.gov. With Florida’s decision not to expand Medicaid, individuals with income as low as 100% of poverty level may qualify for heavily subsidized plans.

Pros: Continuous coverage, potential for lower out-of-pocket costs with subsidies Cons: May still have premiums, deductibles, and copays

Alternative #2: Hospital Charity Care

Many hospitals offer financial assistance programs for uninsured or underinsured patients.

Pros: Can significantly reduce or eliminate hospital bills Cons: Usually limited to services at that specific hospital, doesn’t help with ongoing care

Alternative #3: Federally Qualified Health Centers (FQHCs)

These centers provide care on a sliding fee scale based on your ability to pay.

Pros: Affordable primary care, often include dental and behavioral health services Cons: Limited specialist care, may have waiting lists

How Berg Bryant Elder Law Group Can Help

Navigating Florida’s Medically Needy Program can be overwhelming, especially when you’re already dealing with health challenges. At Berg Bryant Elder Law Group, we help clients:

• Understand eligibility requirements for the Medically Needy Program
• Determine if the program is the best option for their specific situation
• Develop strategies to maximize benefits and minimize out-of-pocket costs
• Address denials or problems with coverage
• Explore all available healthcare coverage options

Frequently Asked Questions About Florida’s Medically Needy Program

Will my share of cost amount ever change?

Yes, your share of cost may change if your income or household size changes. Report any changes to DCF promptly to ensure your share of cost is calculated correctly.

Can I use old medical bills to meet my share of cost?

You can use unpaid medical bills from previous months if they haven’t been used before to meet a share of cost. However, bills older than 90 days cannot be used.

What happens if I meet my share of cost late in the month?

Your Medicaid coverage will begin on the day you meet your share of cost and continue through the end of that month. The later in the month you meet your share of cost, the fewer days of coverage you’ll have.

Can I use my spouse’s medical expenses to meet my share of cost?

Yes, if your spouse’s income was included in determining your Medicaid eligibility, their medical expenses can count toward your share of cost.

How do I apply for the Medically Needy Program?

You can apply through Florida’s Department of Children and Families:

• Online at MyFLFamilies.com
• By visiting a DCF service center in person
• By mail using a paper application

Take Action: Getting Help with Florida’s Medically Needy Program

If you or a loved one is struggling with medical expenses and may benefit from the Medically Needy Program, don’t navigate this complex system alone. The experienced team at Berg Bryant Elder Law Group can help you understand your options and develop a strategy to access the care you need.

Contact us through our website to schedule a consultation with our elder law attorneys who specialize in healthcare access and benefits planning.

This blog post is for informational purposes only and does not constitute legal advice. Medicaid regulations change frequently, and eligibility is determined on a case-by-case basis.