In December, Hillsborough County commissioners voted unanimously to expand the county’s health care plan, a safety net for the vulnerable group of residents who don’t qualify for Medicare or Medicaid but do too little to afford insurance in the marketplace.
More than seven months later, however, the program remains less than half complete.
The expansion raised the income limit for the program from 138% of the federal poverty level to 175%, meaning singles earning about $1,980 or less a month will qualify. And it added dental coverage, another sign of the program’s strong fiscal recovery after a crisis in the early 2000s. It was, Commissioner Harry Cohen said at the time, “a great holiday gift for our entire community.”
However, it appears that many Hillsborough residents who could have qualified never opened that gift. The latest program has a monthly average of about 15,000 open spots, a county spokesman said. Philip Conti, who oversees the plan for Hillsborough County Health Care Services, said monthly enrollment fluctuates but has recently hovered around 13,000, about 1,000 fewer people. than last year’s average.
“We’re really trying to make this accessible to everyone,” Conti said. “We want more people to benefit from it. And when we do public events or things of that nature, we hear from people that, “Oh, I didn’t know about that.” And mind you, this has been around for almost 30 years.”
The program, which began in 1991, offers a range of medical coverage at no cost: primary and specialty care, dental and pharmaceutical services, hospitalization. It is intended to help poor people get basic and preventive care, and as a safety net for people who might otherwise be buried under mountains of debt after a medical emergency. Conti cited a recent Tampa Bay Times story about a Pasco County man who faced $170,000 in bills after an ankle injury.
“If he was in Hillsborough County, this wouldn’t have happened,” Conti said. “We would have covered them all.”
County Commissioner Gwen Myers was surprised to hear the expansion hadn’t caught on with residents. Her district includes many minorities residents who are financially vulnerable – especially amid high housing costs – and who can benefit from the plan. She said she took the news as a personal challenge to spread the word through churches and community organizations.
“I’m going to make sure that everybody knows that we have this health care program,” she said. “We’ll change it in a month.”
Florida is one of 12 states that has not expanded Medicaid, exacerbating what health experts call the “coverage gap” of people who earn little money but don’t qualify for Medicaid. Researchers have found that the gap disproportionately harms people of color.
This is reflected in Hillsborough County, where nearly 30% of those on the plan this year are black, a higher share than the county’s population as a whole. The plan’s demographics also skew older, however, as only 1 in 5 participants are younger than 35. And despite the change in the income limit – which followed a similar expansion in 2019 – less that 15% of participants are above the federal poverty level.
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Conti can only speculate as to why the expansion has not caught up with more residents. One factor may be that, in a rapidly growing region, newcomers are simply unfamiliar with the county’s social services. He also noted that getting into the plan requires a form of identification, proof of residence, a list of assets and, for employees, income records. circle 1,200 people a month start the application process, but many don’t follow through.
Given that many of those who could benefit are members of communities that have historically suffered from institutional neglect, he added, “there may be an underlying mistrust of county government.”
The plan already recruits participants through outreach events, outreach through law enforcement agencies and the county jail, and health care providers that make up the plan’s network of 36 facilities. Conti said his agency is working with the county’s communications department to figure out how to target groups that aren’t benefiting from the plan.
“It’s our effort to try to level the playing field when it comes to access to health care,” he said. “It is not a total solution. But for now, this is probably a better place if people take advantage of it.”
How to get help
To get more information or to apply for a health care plan, go online to https://tbtim.es/hillshealthcare or in person at Tampa Family Health Center or Suncoast Community Health Center.