Florida Home Care Agencies and the ACA Employer Mandate: Who Has to Offer Coverage

Is your agency an Applicable Large Employer?

Count full-time employees (30+ hours a week or 130+ a month) and add full-time equivalents from everyone else: total part-time hours in the month ÷ 120. Average the monthly totals over the prior calendar year.

Worked example. A Florida agency has 42 caregivers and office staff at 130+ hours a month, plus 20 part-time caregivers averaging 54 hours a month.

• Full-time employees: 42
• Part-time FTEs: 20 × 54 = 1,080 hours ÷ 120 = 9
• Total: 51 → the agency is an ALE.

Two home care specifics. Entities under common ownership are combined under the controlled-group rules, so multiple agency LLCs or franchise territories with the same owners count as one employer. And caregivers with variable hours can be classified using the IRS look-back measurement method (a 3–12 month measurement period followed by a stability period), which is how most agencies decide who must be offered coverage without re-running the math every month.

IRS, Identifying full-time employees ↗

What an ALE owes if it doesn't comply (2026 amounts)

• 4980H(a), no offer: if you don't offer minimum essential coverage to at least 95% of full-time employees and any one of them gets a subsidy on HealthCare.gov, you owe $3,340 per full-time employee minus the first 30. In the example above: (42 − 30) × $3,340 = $40,080 a year, triggered by a single subsidized caregiver.
• 4980H(b), unaffordable offer: if you offer coverage that's unaffordable or below minimum value, you owe $5,010 for each full-time employee who enrolls in a subsidized marketplace plan.

IRS Rev. Proc. 2025-26 ↗

Why Florida's Medicaid decision changes your exposure

Penalties are only triggered when a full-time employee actually receives a premium tax credit on the marketplace. Who can get one depends on income:

Florida has not expanded Medicaid. Caregivers earning 100-400% FPL can receive premium tax credits - each full-time employee who does so can trigger a $5,010 4980H(b) penalty for a non-offering or unaffordable ALE - while those under 100% FPL fall into the coverage gap. kff.org ↗

Florida uses the federal marketplace, HealthCare.gov, and has the largest marketplace enrollment of any state (roughly 4.7 million in 2025), so a large share of caregivers historically bought subsidized exchange plans. healthcare.gov ↗

With enhanced premium tax credits expired as of 12/31/2025, Florida's marketplace-heavy caregiver workforce faces some of the largest premium increases in the country, making employer MEC/CHOICE (formerly known as ICHRA) offerings a stronger recruiting tool in 2026. kff.org ↗

What counts as "affordable" for a Florida caregiver in 2026

Coverage is affordable if the caregiver's self-only contribution is no more than 9.96% of household income. Since you can't know household income, the IRS provides three safe harbors:

The Florida-specific point: because the state minimum wage is $14.00, the rate-of-pay safe harbor gives Florida agencies far more room than the $129.89 FPL figure most national guides quote. An agency paying $14.00 can charge up to $181.27 a month for self-only coverage and still be safe from the (b) penalty. Use each caregiver's actual lowest hourly rate; where local minimums are higher, the ceiling is higher still.

A CHOICE (ICHRA) counts as an offer of coverage. It's affordable if the caregiver's cost for the lowest-cost self-only silver plan on HealthCare.gov for their rating area, minus your monthly allowance, stays within the 9.96% test.

IRS Rev. Proc. 2025-25 ↗ · IRS HRAs ↗ · minimum wage → see the Florida wage & hour page

2026 federal compliance calendar (Florida adds nothing to this list)

There is no Florida filing, no Florida furnishing deadline, and no Florida penalty. If you also employ caregivers who live in California, New Jersey, Massachusetts, Rhode Island, or DC under a self-insured plan, those states' reporting rules may apply to those employees; see the state-by-state ACA hub.

IRS, Information reporting by ALEs ↗

Florida continuation coverage (mini-COBRA)

The Florida Health Insurance Coverage Continuation Act gives employees of insured groups under 20 employees up to 18 months of continuation coverage (29 months if disabled). flsenate.gov ↗

What Florida does not require

Florida has no state individual mandate or employer 1095 reporting, no auto-IRA mandate, and no paid family leave program; federal rules are the only layer. cri.georgetown.edu ↗

Frequently asked questions

We have 48 full-time caregivers and a handful of part-timers. Are we under the threshold?

Probably not. Add the part-timers' monthly hours and divide by 120. Two part-timers at 120 hours a month between them add one FTE, which puts you at 49; a third pushes you to 50 and ALE status the following year.

Does Florida require us to file anything about health coverage with the state?

No. Florida has no state individual mandate and no state 1095 reporting. Your only filing is federal (1094-C/1095-C) if you're an ALE.

Can a caregiver earning below the poverty line trigger a penalty against us?

Not in Florida. Marketplace credits start at 100% FPL and Florida hasn't expanded Medicaid, so caregivers below 100% FPL can't receive a credit and therefore can't trigger 4980H. Caregivers between 100% and 400% FPL can.

We pay the Florida minimum of $14.00. What's the most we can charge for self-only coverage?

Under the rate-of-pay safe harbor, $14.00 × 130 hours × 9.96% = $181.27 a month in 2026. That's well above the $129.89 FPL figure, so rate of pay is the better harbor for Florida agencies.

Does a CHOICE (ICHRA) count as offering coverage in Florida?

Yes. An affordable CHOICE (ICHRA) satisfies both the 4980H(a) offer requirement and the (b) affordability test, measured against the lowest-cost silver plan on HealthCare.gov for each caregiver's rating area.

We're under 50 FTEs. Is there any reason to offer coverage?

No mandate applies, but agencies under 50 commonly offer a MEC or CHOICE (ICHRA) to reduce turnover, and the same affordability math determines what you can charge caregivers.