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Florida and the ACA’s Medicaid expansion

Florida is one of the remaining holdouts to Medicaid expansion

No ACA Medicaid eligibility expansion in Florida

Florida is one of 12 states that has not expanded Medicaid eligibility as allowed under Affordable Care Act (ACA). The ACA doesn’t provide subsidies for people with income below the poverty level, because the law called for them to have Medicaid instead. But in states that have refused Medicaid expansion people who aren’t eligible for Medicaid and whose income is too low for exchange subsidies are in what’s called the coverage gap.

Federal poverty level calculator

Unfortunately, people in the coverage gap have little in the way of affordable access to healthcare. In Florida, 415,000 people were in the Medicaid coverage gap as of 2019. Only Texas had more people in the coverage gap.

Republicans control Florida’s House and Senate as well as the governor’s office. Democrats in the Florida legislature have been pushing for Medicaid expansion for years, but have consistently been blocked by Republicans. Health officials have joined Democrats in a renewed push for expansion of Medicaid in Florida in 2020 amid the coronavirus pandemic. While expansion legislation has not advanced, Florida did seek and receive federal approval of a waiver to ease some administrative constraints for its Medicaid program.

Who is eligible for Medicaid in Florida?

To qualify for federal funding, state Medicaid programs are required to cover certain populations, such as low-income children and pregnant women. States can also choose to cover optional coverage groups, like low-income adults without dependents.

Each state sets its own income limits for qualification, based on minimum levels set by the federal government. Florida has set below-average limits for the mandatory coverage groups, and since the state has not accepted federal funding to expand Medicaid, the eligibility rules have not changed with the implementation of the ACA. Able-bodied, non-elderly adults who don’t have dependents are not eligible for Medicaid in Florida, regardless of how low their income is.

Florida’s eligibility standards are:

  • Children up to 1 year old: 206% of the federal poverty level (FPL)
  • Children ages 1-5: 140% of FPL
  • Children ages 6-18: 133% of FPL
  • Pregnant women: 191% of FPL
  • Adults with dependent children: 27% of FPL

People who qualify for Supplemental Security Income (SSI) automatically qualify for Medicaid in Florida. See more information in the SSI-Related Programs Financial Eligibility Standards.

How does Medicaid provide financial help to Medicare beneficiaries in Florida?

Many Medicare beneficiaries receive Medicaid financial assistance that can help them with Medicare premiums, lower prescription drug costs, and pay for expenses not covered by Medicare – including long-term care.

Our guide to financial assistance for Medicare enrollees in Florida includes overviews of these programs, including Medicaid nursing home benefits, Extra Help, and eligibility guidelines for assistance.

Florida has not accepted federal Medicaid expansion

  • 4,956,941 – Number of Floridians covered by Medicaid/CHIP as of September 2021
  • 1,378,000 – Number of additional Florida residents who would be covered if the state accepted expansion
  • 415,000 – Number of people who have NO realistic access to health insurance without Medicaid expansion
  • $6.6 billion – Federal money Florida is leaving on the table in 2022 by not expanding Medicaid

How do I enroll in Medicaid in Florida?

Review Florida’s eligibility criteria, and if you believe you are eligible to enroll in Medicaid you have several options:

  • Enroll at (if you’re under 65 and don’t have Medicare).
  • Apply online at ACCESS Florida, or fill out a paper form. Use this application for low-income children, pregnant women, families, and aged or disabled individuals who are not currently receiving Supplemental Security Income (SSI).
  • Use this application to apply for food or cash assistance in addition to Medicaid. You should also use this form if you currently receive SSI or if you are applying for home-based and community services, hospice care, or nursing home care.
  • Submit a paper application submitted by mail, fax or in person to a local service center.

For help with the application process, call 1-866-762-2237.

Florida Medicaid enrollment numbers

Although Florida has not expanded Medicaid under the ACA, enrollment in the state’s program has continued to grow. Enrollment stood at 2.2 million in 2005, and had grown to 3.7 million by the end of 2013. By September 2021, total Florida Medicaid and CHIP enrollment was almost 5 million.

History of Florida’s Medicaid program

Florida was one of the later states to implement a Medicaid, not adopting the program until January of 1970 (the first states to implement Medicaid did so in early 1966).

Florida Medicaid spending grew 13.5% on average every year between 1980 and 2004. In an effort to slow that trend, Florida applied for and received approval for an 1115 waiver for its Medicaid Reform pilot. The pilot implemented managed care in two counties in 2006 and added three more counties in 2007; the waiver was extended several times.

In 2013, the federal government approved an amendment for statewide expansion of managed care; the amendment also renamed Medicaid Reform as Managed Medical Assistance (MMA). Ninety percent of all Florida Medicaid beneficiaries are now enrolled in managed care plans, like health maintenance organizations (HMOs). The state hopes to improve quality through better coordination of care and save money through smaller networks of providers.

Part of the reason Medicaid enrollment has grown is the extensive outreach on the part of ACA navigators; some residents were already eligible for Medicaid or CHIP prior to 2014 (and still are), but weren’t aware of their eligibility until enrollment outreach efforts under the ACA. But since Florida hasn’t expanded Medicaid, the newly insured population is covered according to the normal state/federal split.

If Florida had expanded Medicaid, coverage for the newly eligible population would have been fully funded by the federal government through the end of 2016. The state’s portion would then gradually increase to ten percent by 2020, remaining at that level going forward.

As originally written, the Affordable Care Act included Medicaid expansion as a key strategy to reduce the number of uninsured people in the U.S. The ACA allowed the federal government to reduce funding for states’ existing Medicaid programs if they did not expand Medicaid to cover adults with household income up to 138% of the federal poverty level.

However, the U.S. Supreme Court ruled in 2012 that the withholding of funds for existing Medicaid programs was unconstitutional. Medicaid expansion was left as an option for states, and Florida did not implement it. As of August 2020, Florida is one of 12 states that have not expanded Medicaid.

Florida’s decision not to expand Medicaid leaves nearly 400,000 people in the state in the coverage gap — ineligible for Medicaid and also ineligible for tax subsidies to help them afford private health insurance (people with income over 100% of the poverty level are currently eligible for premium subsidies in the exchange, but those with income between 100% and 138% of the poverty level would switch to Medicaid eligibility if Florida were to expand coverage).

Florida’s economy is negatively impacted by not expanding Medicaid. According to an analysis by the Robert Wood Johnson Foundation and the Urban Institute, Florida was projected to lose out on $66.1 billion in Medicaid funding  — more than any other state — over the decade beginning in 2014 as a result of their decision to not expand Medicaid.

Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

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Apply for Medicaid in Florida

Online at ACCESS Florida, or submit a paper application by mail, fax or in person to a local service center. For help with the application process, call 866-762-2237.

Eligibility: Children up to 1 year old with family income up to 206% of FPL; children 1-5 with family income up to 140% of FPL; children 6-18 with family income up to 133% of FPL; pregnant women with family income up to 191% of FPL; young adults 19-20 with family income up to 30% of FPL; adults with dependents with family income up to 30% of FPL. People who qualify for Supplemental Security Income automatically qualify for Medicaid. For information: SSI-Related Programs Financial Eligibility Standards

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