Political insiders explain how Medicaid expansion can help close the coverage gap in Florida


Shane Ersland


Florida lawmakers passed around 200 bills during the 2023 legislative session, which ended on May 5th. But political insiders took note that Medicaid expansion was not among the new health-related policies that are set to be initiated.


Stay one step ahead. Join our email list for the latest news.



Experts discussed the session during the 2023 Florida State of Reform Health Policy Conference. Florida is one of only 10 states that has not expanded its Medicaid program under the Affordable Care Act to adults ages 19-64 with incomes under 138% of the federal poverty level (FPL).

Florida Voices for Health Executive Director Scott Darius noted that parents must earn less than 30% of the FPL to qualify for Medicaid in the state. 

“So if you happen to make more than that, you fall into the coverage gap,” Darius said. “And I think what we’re looking for are incentives for people to stay engaged in the workforce, to be more ambitious, and work that much harder. But working that much harder is the very thing that puts you into that coverage gap.”

Darius said the legislature did not consider Medicaid expansion during this year’s session, adding that it hasn’t discussed proposals to expand the program since 2016.

“It’s at least worth having the debate,” he said. “ It’s the biggest thing hanging out there in front of our state.”

Holly Bullard, chief strategy and development officer at the Florida Policy Institute, referenced a recent Mason-Dixon Polling & Strategy, Inc., poll that showed that 76% of participants support expanding Medicaid to adults ages 19-64 with incomes under 138% of the FPL. 

“So that is really interesting in where we are right now,” Bullard said. “And I think it points to where we are in urgency. One of the things that didn’t happen in the legislature was extensive discussions and hearings [about it].”

Bullard said the state’s Medicaid redetermination process is proof that Medicaid expansion is needed. More than 50 organizations and US House Democrats have requested a pause in the process, as nearly 250,000 Floridians have lost their health coverage since the unwind began in March. 

“The unwind is not going well,” Bullard said. “About a quarter million have dropped off of Medicaid. Over 200,000 are for red-tape reasons—for administrative reasons. They didn’t answer questions or they didn’t respond. So that is super concerning, especially since we don’t have expansion in Florida, a huge portion of those are kids. There’s no reason why we should be pushing them off. Especially for red-tape reasons.”

Darius said Medicaid expansion would save the state approximately $200 million annually in general revenue savings. It would also improve access to care, which would be especially important in north central Florida where the Shands Live Oak and Shands Starke hospitals recently closed, he said.

“Shands was actually the primary care location for about 70% of the people in that area who now don’t have a place to access care,” Darius said. “But on top of that, (they) also are facing higher rates of uninsured. We know Medicaid expansion would bring a lot of money into the state and help us secure rural hospitals, which is why we saw the legislature in North Carolina take this up a couple weeks ago.”

North Carolina Gov. Roy Cooper signed House Bill 76 into law on March 27th. The legislation will expand Medicaid, which is expected to provide health coverage for more than 600,000 residents, and bring billions of dollars in federal revenue into the state.

While Medicaid expansion was not achieved during the 2023 session, panelists applauded several initiatives that were approved by lawmakers. Darius said HB 391 will benefit children by requiring home health agencies to ensure that tasks delegated to home health aides for medically fragile children meet specified requirements. The bill also provides exemptions for costs associated with specified training.

“Caretakers can now be reimbursed by the plans to actually provide some of that care,” Darius said.

Kyle Simon, director of government affairs and communications at Home Care Association of Florida, also applauded the passage of HB 391.

“HB 391 (creates) an opportunity to keep families together, to keep kids who are medically fragile in homes instead of institutions,” Simon said. “This creates an avenue for the mom or the caregiver to be able to provide those services with training, background screening, and so on, (for) up to eight hours a day.”

Simon also noted that the legislature passed HB 299, which requires the Drug Enforcement Administration to offer educational materials about Alzheimer’s Disease and related forms of dementia to the general public.

“This has been a multi-year effort from the Alzheimer’s Association to create a forum statute for (Alzheimer’s Disease Research) training,” he said.