Last month, Tampa Bay Healthcare Collaborative (TBHC) members discussed two key ways their patients and clients obtain health insurance coverage: Medicaid and marketplace or exchange plans.
These insurance mechanisms help millions of Floridians pay for critical healthcare services, ranging from preventive to acute care. About 3.2 million Floridians are covered by Medicaid, and about 840,000 of them live in Tampa Bay. More than 1.5 million people have coverage through the federal marketplace, with more expected to sign up during the current open enrollment period, which runs through January 31, 2017. However, the deadline for receiving coverage by January 1 is December 15.
It’s not always easy to understand who is eligible for what coverage. To help clarify, Zachary Pruitt, MHA, PhD, CPH, Visiting Assistant Professor, USF College of Public Health, described the current Medicaid landscape in Florida, and Melanie Hall, Executive Director, The Family Healthcare Foundation, provided resources for helping people enroll in marketplace plans during the 2016 open enrollment period.
In Florida, Medicaid is only available for specific groups of people who have low incomes, such as pregnant women and people with disabilities. Those who are not eligible for Medicaid, along with those who do not receive health insurance through an employer, can purchase coverage through the health insurance marketplace. Subsidies to help cover premium costs are available for individuals who make between 100 and 400 percent of the federal poverty level, or between $11,880 and $47,520 per year.
But, those who earn less than $11,880 per year and don’t qualify for Medicaid are left in what is known as the coverage gap. More than a half a million people in Florida are affected. Florida, along with 18 other states, has not accepted federal dollars to expand Medicaid. As a result, people in the gap are left without affordable options for health insurance coverage.
While this is a serious issue, it is not the only challenge related to insurance access in Florida. Many people do not know what coverage options are available to them, in part due to the complicated rules governing Medicaid and marketplace subsidy eligibility. For instance, in Florida, about 15 percent of those who qualify for Medicaid or the state Children’s Health Insurance Plan (which covers children whose families have low incomes) remain uninsured. About half of low income parents don’t know if their kids are eligible, and about a quarter don’t know how to get more information.
Furthermore, people who do have coverage through Florida’s Medicaid Managed Care system face barriers to accessing the services they are entitled to through the program. For example, a recent report from the Georgetown Center for Children and Families found that some Medicaid managed care plan requirements prevented children from receiving treatments or drugs recommended for them. The issue centered around prior authorization, which is a requirement that doctors must receive approval from a patient’s insurance plan before being able to prescribe a certain medication.
At the same time, though, the Florida Agency for Health Care Administration (AHCA) is making efforts to promote quality within the managed care program, especially around access standards. Earlier this year, health care stakeholders compiled several recommendations for AHCA to consider.
It is critical that healthcare and social service providers are equipped to help their clients and patients understand their options and the services they are entitled to through their insurance plan. Several resources are available through from AHCA regarding consumer information and filing complaints. And Covering Tampa Bay has compiled detailed information about helping people enroll in marketplace coverage, including resources related to the current open enrollment period.
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