Georgia’s decision not to expand Medicaid eligibility under the Affordable Care Act may leave more than 400,000 Georgians without health insurance coverage next year, according to a new report.

The Kaiser Family Foundation, a nonprofit health policy research organization, concluded that more than 5.1 million Americans in 26 states could fall into a “coverage gap” because their states have opted to take advantage of a U.S. Supreme Court ruling that made the law’s Medicaid expansion provision optional rather than mandatory.

Of that total, 409,350 are Georgians, third highest behind Texas and Florida, according to the report.

The numbers represent adults whose incomes are too high to qualify for Medicaid but not high enough to make them eligible for the health insurance premium tax credits the Affordable Care Act provides to help Americans purchase coverage.

Read the full report here