Jeffrey Wade
Florida's decision not to expand Medicaid has left nearly 400,000 people in the state without coverage, as they are ineligible for Medicaid and cannot afford private health insurance. However, it is possible to have both health insurance and Medicaid in Florida. In certain situations, you may be eligible for both, with Medicaid acting as a secondary insurance to cover gaps in primary private insurance.
| Characteristics | Values |
|---|---|
| Medicaid in Florida | Statewide Medicaid Managed Care (SMMC) program |
| Medicaid coverage | Doctor visits, hospitalization, prescriptions |
| Medicaid eligibility | Income, assets, family size, deductions (e.g. child care expenses, child support payments, medical expenses) |
| Medicaid programs in Florida | Medicaid for children, pregnant women, parents, the aged, blind, or disabled |
| Medicaid long-term care programs | Institutional/Nursing Home Medicaid, Medicaid Waiver/Home and Community-Based Services (HCBS), Program of All-Inclusive Care for the Elderly (PACE) |
| Florida's decision not to expand Medicaid | Left nearly 400,000 people in the state without coverage |
| Federal funding for Medicaid expansion | $5 billion in 2023, plus additional American Rescue Plan funding |
| Other healthcare options in Florida | Florida KidCare, Medically Needy Program, Federally Qualified Health Centers, Affordable Care Act (ACA) Marketplace plan |
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What You'll Learn
Florida's decision not to expand Medicaid
Florida is one of only ten states that have refused to expand Medicaid, leaving hundreds of thousands without access to coverage. Florida's decision not to expand Medicaid has left 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.
Florida's economy is negatively impacted by not expanding Medicaid. According to an analysis by the Florida Policy Institute, Florida could save $200 million per year by expanding Medicaid. Additionally, Florida left $5 billion in federal money on the table by not expanding Medicaid in 2023, including additional American Rescue Plan funding. The American Rescue Plan created a provision to give states additional Medicaid funding for two years if they newly expand Medicaid.
There are several reasons why Florida may have chosen not to expand Medicaid. One study found that from 2014 to 2016, Medicaid expansion reduced employment in expansion states by 1.6%. Another study found that public insurance coverage led to a sizable reduction in employment, with an estimated effect size of just over 5 percentage points. A third study found that total employment decreased by 1.2% one year after the expansion of Medicaid. A fourth study examined the effect of Medicaid expansion on the labour supply decisions of older workers and found that insured workers without retirement health insurance decreased full-time work by 7.1%. However, some studies have found smaller or negligible effects on labour supply.
Florida's unemployment rate is exceptionally low—2.7% in August 2023, quite a bit lower than the national unemployment rate of 3.8%. Expanding Medicaid could reduce Florida's advantage in this area. Additionally, expansion would create several other ill effects, including an explosion of improper payments, longer wait times for medical appointments and ambulance response times, and a surge of emergency room use for non-emergent services. Expansion would also take resources from existing Medicaid enrollees, particularly children and people with disabilities. States saw a reduction in providers accepting new Medicaid patients after expansion, and Florida Medicaid enrollees would likely find it increasingly difficult to find providers if expansion were to occur.
Florida's Medicaid program is estimated to cost close to $35 billion in state and federal tax dollars to provide coverage to more than 4 million people. Since the beginning of the Public Health Emergency (PHE), Florida has provided continuous Medicaid coverage and has not disenrolled ineligible recipients. As a result, Florida saw a significant increase in the number of individuals and families seeking Medicaid assistance, from 3.8 million enrolled in March 2020 to 5.5 million in November 2022.
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Medicaid eligibility criteria
In Florida, eligibility for Medicaid is determined by the Department of Children and Families (DCF) or the Social Security Administration (for SSI recipients). The Agency for Health Care Administration (AHCA) administers the Medicaid Program. Each month, the Department processes a large number of Medicaid applications, redeterminations, or requests for additional assistance.
Medicaid provides free or low-cost medical benefits to eligible individuals and families with low incomes. Each state has its own requirements, and in Florida, the income limits for qualification are set by the state and can exceed the minimum levels set by the federal government.
If an individual or family does not qualify for Medicaid, there are other options available. For those with children under the age of 18, low-cost insurance can be purchased through Florida KidCare. The Medically Needy Program allows for Medicaid coverage after a monthly "share of cost" is met, and Federally Qualified Health Centers provide medical care for clients with limited or no health insurance on a sliding scale based on income.
It is important to note that Florida is one of the states that have refused to expand Medicaid, which has left many people in the state ineligible for Medicaid and unable to afford private health insurance. However, there are ongoing efforts to put Medicaid expansion on the ballot in 2026.
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Medicaid and private insurance in Florida
In Florida, Medicaid and private insurance serve as crucial safety nets, ensuring that individuals and families have access to essential healthcare services. While Medicaid is a joint federal and state program catering to low-income individuals and families, private insurance is typically obtained through employers or purchased directly, offering flexibility and a broader network of healthcare providers. Understanding the eligibility criteria and unique features of both options is essential for Florida residents seeking comprehensive healthcare coverage.
Medicaid in Florida, sometimes referred to as the Statewide Medicaid Managed Care (SMMC) program, provides a safety net for low-income individuals and families. The eligibility criteria for Medicaid are based on income levels, household size, and other factors, with certain deductions allowed for childcare expenses, child support payments, and medical expenses. Florida has various Medicaid programs with different income limits, catering to specific groups such as children, pregnant women, parents, and the elderly, blind, or disabled. The Agency for Health Care Administration (AHCA) in Florida administers Medicaid, covering essential services like doctor visits, hospitalization, and prescriptions, making healthcare more accessible to vulnerable populations.
Private insurance in Florida offers an alternative approach to healthcare coverage. It is usually provided through employers or purchased directly by individuals and families, featuring various forms, including employer-sponsored plans, individual plans, and marketplace plans. One of the key advantages of private insurance is the flexibility it provides in choosing healthcare providers and services, giving individuals greater control over their medical care options. Additionally, private insurance often grants access to a wider network of doctors, specialists, and hospitals, facilitating personalized and comprehensive healthcare solutions.
In certain situations, it is possible for Florida residents to have both Medicaid and private insurance simultaneously. Medicaid can serve as secondary insurance, filling the gaps in coverage left by primary private insurance. This scenario is particularly beneficial if an individual's private insurance has high deductibles, copayments, or limited coverage for specific services. However, it is important to note that Medicaid may only cover services that are not already covered by the primary insurance or those for which the primary insurance has limited coverage.
Florida's decision not to expand Medicaid has left a significant number of people in the state without coverage. This decision has also impacted the state's economy, with Florida missing out on potential savings and additional funding that could be invested in other areas. Despite this, Florida continues to offer various Medicaid programs and pathways to eligibility, ensuring that vulnerable residents have access to the healthcare services they need.
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Florida KidCare
Florida has not expanded its Medicaid coverage, which means that hundreds of thousands of people are left without access to health insurance. The state's economy is negatively impacted by this decision, and Florida could save $200 million per year by expanding Medicaid.
If you are not eligible for Medicaid, Florida KidCare is an option for low-cost insurance for your children. Florida KidCare is the state's children's health insurance program for uninsured children who meet income and eligibility requirements. The program was created in 1998 in response to the passage of Title XXI of the Social Security Act in 1997. It provides health insurance to children in families with incomes up to 200% of the federal poverty level.
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Medically Needy Program
Florida's Medically Needy Program is a type of health insurance for people who make too much money to qualify for regular Medicaid but not enough to pay for their healthcare needs. This program allows individuals to subtract their medical expenses from their income and qualify for Medicaid when their medical expenses reach a certain amount. This is known as the "share of cost" program, where the amount of healthcare expenses incurred by an individual must be met before Florida Medicaid coverage is provided for the month.
The program is intended to help those who are not eligible for "full" Medicaid due to income or asset limits. Eligibility for the program is determined on a monthly basis, with the monthly "share-of-cost" amount related to how much an individual's income exceeds the traditional Medicaid income limits. For instance, if an individual's income increases, their "share-of-cost" will also increase. Notably, individuals do not have to pay the healthcare expenses used to reach their "share-of-cost"; they simply need to owe that amount.
The Medically Needy Program is one of the options that individuals who are not eligible for Medicaid may be referred to. Other options include Florida KidCare, which provides low-cost health coverage for children based on family income, and Federally Qualified Health Centers, which offer medical care on a sliding scale based on income.
It is important to note that Florida's Medically Needy Program has faced some challenges. One significant issue is the lack of understanding among beneficiaries about how the program works. This has resulted in individuals paying more than expected or receiving fewer days of full Medicaid coverage than anticipated. Additionally, finding healthcare providers who accept the program has been difficult for some beneficiaries.
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Frequently asked questions
Yes, in certain situations, you may be eligible for both Medicaid and private insurance in Florida. Medicaid can act as a secondary insurance that covers the gaps left by your primary private insurance.
Medicaid is a health care program for low-income individuals of any age. It is jointly funded by the state and federal government but administered by the state.
Medicaid eligibility in Florida is determined by either the Department of Children and Families (DCF) or the Social Security Administration (for SSI recipients). Eligibility is based on income and assets, with certain deductions allowed. Each state sets its own income limits for qualification.
Florida has different Medicaid programs with different income limits, such as Medicaid for children, pregnant women, parents, and the aged, blind, or disabled. Some programs include the Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) Program and the Program of All-Inclusive Care for the Elderly (PACE).
