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Understanding the Florida Coverage Gap

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health insuranceThe Affordable Care Act has done a tremendous amount of work to help Americans that would not otherwise have health insurance gain access to the insurance marketplace. Unfortunately, the opposition to the Affordable Care Act coupled with the Act itself has also opened up a “coverage gap.” The coverage gap came into existence when a Supreme Court ruling made one of the provisions of the ACA optional for states.

What Went Wrong?

One of the ACA’s provisions was to spread out Medicaid to cover most individuals and families with income at or below 138 percent. While this provision was intended to be federally mandated, the Supreme Court ruled in June 2012 that Medicaid expansion should be optional and each state could choose whether to participate. Since this sector of the population was expected to be covered by Medicaid, another provision of the Act only offered premium tax credits to those with income between 100% and 400% of the poverty level.



States with No Medicaid Expansion

As of September of 2015, 20 states had decided not to expand Medicaid. Florida was among the 20 states and still has not made any move to expand Medicaid. As Medicaid provides cover only to the “worthy poor” who have disabilities, dependent children, and pregnant women, many of those without coverage are working adults with no dependents. The income limit to be eligible for Medicaid in Florida is 44 percent of the poverty limit, or about $8,840 annually for a family of three.

Most Vulnerable Let without Coverage

Approximately 567,000 of the poorest Floridians fall into coverage gap. Those in the coverage gap make too much or otherwise do not qualify for Medicaid, but fall short of the lower limit to be eligible for premium tax credits through the Health Insurance Marketplace. Though these individuals can still technically purchase insurance through the marketplace, without tax credits available the insurance would be far too expensive for these individuals to cover with other living expenses.

Assistance for Those in the Gap

Fortunately, some organizations have come together to help Floridians who fall into the coverage gap. Certain health care providers, health insurance agencies, family assistance agencies, dentist offices, and government assistance programs offer services or guidance for those that fall into the coverage gap. There are resource directories that individuals can use to look for assistance in their local area by inputting their zip code or county.

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