In December, Hillsborough County commissioners unanimously voted to expand the county’s health care plan, a safety net for the vulnerable set of residents who don’t qualify for Medicare or Medicaid yet make too little to afford marketplace insurance.
More than seven months later, though, the program remains less than half-full.
The expansion raised the income cap for the program from 138% of the federal poverty level to 175%, meaning single people making about $1,980 or less a month would qualify. And it added dental coverage, another sign of the program’s robust fiscal rebound after a crisis in the first decade of the 2000s. It was, Commissioner Harry Cohen said at the time, “a great holiday gift to our entire community.”
It seems, though, that many Hillsborough residents who could qualify never unwrapped that gift. The program of late has a monthly average of about 15,000 open spots, a county spokesperson said. Philip Conti, who oversees the plan for Hillsborough County Health Care Services, said monthly enrollment fluctuates but has lately hovered around 13,000, about 1,000 people fewer than last year’s average.
“We really are trying to make this accessible to everyone,” Conti said. “We want more people to take advantage of it. And when we do public events or things of that nature, we do hear from people that, ‘Oh, I didn’t know about this.’ And mind you, this has been around for almost 30 years.”
The program, which began in 1991, offers an array of no-cost medical coverage: primary and specialty care, dental and pharmaceutical services, inpatient hospitalization. It’s meant both to help poor people get basic and preventative care, and as a safety net for people who may otherwise be buried beneath mountainous debt after a medical emergency. Conti mentioned 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, that wouldn’t have happened,” Conti said. “We would’ve covered all of it.”
County Commissioner Gwen Myers was surprised to hear that the expansion hadn’t caught on with residents. Her district includes many minority residents who are financially vulnerable — especially amid skyrocketing housing costs — and who could 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 everyone knows we have this health care program,” she said. “We’re going to change that within a month.”
Florida is one of 12 states that have not expanded Medicaid, exacerbating what health experts call the “coverage gap” of people who make little money but don’t qualify for Medicaid. Researchers have found that the gap disproportionately hurts people of color.
That’s reflected in Hillsborough County, where nearly 30% of those who have been on the plan this year are Black, a portion higher than the county population as a whole. The plan’s demographics also skew older, though, as just 1 in 5 participants are younger than 35. And despite the income cap change — which followed a similar expansion in 2019 — fewer than 15% of participants make above the federal poverty level.
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Conti could only speculate as to why the expansion hasn’t caught on with more residents. One factor might 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 residency, a list of assets and, for the employed, income records. About 1,200 people a month begin the application process, but many don’t follow through.
Given that many who stand to benefit are members of communities that have historically suffered from institutional neglect, he added, there “may be a basic mistrust of county government.”
The plan already gleans participants through social welfare events, outreach through law enforcement agencies and the county jail, as well as the health care providers that make up the plan’s 36-facility network. Conti said his agency is working with the county’s communications department to figure out how to target groups that aren’t taking advantage of the plan.
“It’s our attempt to try to level the playing field when it comes to access to health care,” he said. “It’s not a total solution. But for now, this is probably a better place to be if people take advantage of it.”
How to get help
To get more information or apply for the health care plan, go online to or in person to a Tampa Family Health Center or Suncoast Community Health Center.