The Affordable Care Act gave states the option to expand Medicaid to cover adults with incomes up to 138% of the federal poverty level (FPL). Most states took this option. Florida did not. As of 2026, Florida remains one of roughly ten states that has not expanded Medicaid—and the consequences for low-income Floridians are significant.
What Is the Coverage Gap?
In expansion states, adults earning between 0% and 138% of FPL qualify for Medicaid. ACA marketplace subsidies start at 100% FPL. In non-expansion states like Florida, there's a gap between where Medicaid eligibility ends and where marketplace subsidies begin.
In Florida, traditional Medicaid for non-disabled adults is extremely limited—generally covering only parents of minor children in very low-income households, pregnant women, children, and people with disabilities. A working-age adult without children and without a disability is largely excluded from Medicaid, regardless of how low their income is.
A single adult in Florida earning less than approximately $15,060 per year (100% FPL in 2026) earns too much for Florida's traditional Medicaid but too little to qualify for ACA marketplace subsidies. This is the coverage gap. Estimates suggest over 400,000 Floridians fall into this gap.
Who Falls Into the Gap?
Adults most likely to fall into the coverage gap include:
- Childless adults earning less than 100% FPL
- Parents with incomes below 100% FPL but above Florida's very restrictive Medicaid threshold for parents
- Workers in low-wage service industries (restaurant, retail, hospitality, agriculture)
- Part-time workers without employer benefits
- Gig workers and informal economy participants
What Traditional Florida Medicaid Covers
If you don't fall into the coverage gap, traditional Florida Medicaid (Medicaid managed care plans) covers:
- Children under 19 with family income up to 200% FPL
- Pregnant women up to 196% FPL
- Adults in families with children, at very low income thresholds
- Adults 65+ and people with disabilities (separate eligibility rules)
- Former foster youth up to age 26
FL KidCare: Coverage for Children
Florida's KidCare program covers children who don't qualify for Medicaid. It includes Medicaid for children with incomes up to 100% FPL and the Children's Health Insurance Program (CHIP) for children in families earning up to 200% FPL. KidCare is widely available and an important option for families whose children would otherwise be uninsured. See our detailed article on FL KidCare eligibility.
Options If You're in the Coverage Gap
If your income is below 100% FPL and you don't qualify for Florida Medicaid, your options are limited but not zero:
- Community health centers: Federally Qualified Health Centers (FQHCs) serve patients regardless of ability to pay, using sliding-scale fees. Florida has over 200 FQHC locations. Find one at findahealthcenter.hrsa.gov.
- Free and charitable clinics: Florida has numerous free clinics that provide primary care to uninsured adults. Quality and capacity vary by location.
- Prescription assistance programs: Major drug manufacturers offer patient assistance programs for people without coverage. NeedyMeds.org is a good starting point.
- Income reporting strategy: If your income is close to 100% FPL, discuss with an advisor whether income documentation could qualify you for marketplace subsidies. Some types of income count differently under ACA rules.
Figuring out whether you qualify for Medicaid, marketplace coverage, or KidCare can be confusing. A licensed advisor can help you assess your eligibility and find coverage that works. Call or get a free consultation.