The Affordable Care Act (ACA) changed the way that low-income Americans can access healthcare, with Medicaid expansion being one of the most significant parts of the law. However, given that Medicaid is a state-regulated program, every state has chosen to implement—or not implement—the expansion of Medicaid in its own way. Florida is one state that has not expanded Medicaid, even though it has made great use of the creation of the health insurance Marketplace.
The State of Medicaid in Florida
Medicaid in Florida remains much the same as it has since before the creation of the ACA. Currently, only certain categories of people are eligible for coverage, and they must live at or below a certain percentage of the poverty line in order to qualify. Seniors and people with disabilities are eligible at 88 percent of the federal poverty line (FPL), while parents at 32 percent of the FPL, pregnant women living at 196 percent of the FPL and children living at 215 percent of the FPL can also receive assistance. Currently, no childless adults are eligible for Medicaid coverage.
Florida’s decision to reject Medicaid expansion leaves 391,000 people in the coverage gap, which means they aren’t eligible for Medicaid healthcare assistance or government subsidies for a private healthcare plan. According to one study, over 1.3 million people living in Florida would be covered if Medicaid was expanded, and the uninsured rate would drop by 30 percent. By rejecting Medicaid expansion, the state is also turning down over 65 billion dollars in federal healthcare funding over the course of the next decade.
While Florida has rejected the expansion of Medicaid through the ACA, it has adopted another significant piece of ACA healthcare reform: the private health insurance Marketplace. Currently, the Florida Marketplace offers 9 different brands of private insurance plans that people can sign up for if they cannot access healthcare through any other means. During the open enrollment period for 2020 coverage, over 1.9 million people signed up for a private Marketplace plan. This is the largest population of people enrolled through the Marketplace in the country, and it’s also a record number for Florida, which saw a similar record of 1.7 million people enrolled in 2019. So while Medicaid is not able to provide for individuals in the coverage gap, many are still able to get access to healthcare through this part of the ACA.
How DECO Can Help
Medicaid and eligibility for health insurance are complicated topics that many people have a hard time navigating. But at DECO, our job is to help your healthcare organization understand the various paths of revenue cycle management in front of you so you can get reimbursed for your healthcare costs. We also do this by walking patients step by step through the eligibility determination process so they can feel comfortable and confident in their ability to afford the healthcare they’ve received. If you have any questions about Medicaid or any other aspect of the revenue cycle management process, contact us today!