Medicaid is growing in Florida

By: Michael MacLaren |
Published: July 24, 2015
Author at Assurance Health Care Financial Services

TALLAHASSEE — Although lawmakers rejected a plan to expand it, Medicaid continues to grow in Florida.
A new estimate from state economists shows the health care program for the poor and disabled will serve a record 4 million Floridians this year, a 6.6 percent increase over the prior year that ended June 30. The estimate, from the Legislature’s Office of Economic and Demographic Research, also shows Florida’s Medicaid caseload has essentially doubled over the last decade, up from 2.2 million in 2005.
The growth in Medicaid is coming despite the Legislature’s decision in June to reject a broader expansion of the program under the federal Affordable Care Act. The Senate had advanced the Florida Health Insurance Affordability Exchange program that was designed to provide health care insurance to low-income Floridians as way to offset declining federal support for a hospital program that covers uncompensated care.
In the June special session, House members rejected the FHIX program, saying they opposed expanding a flawed Medicaid program. “It’s not compassionate to jam more people into a failing system,” Rep. Matt Gaetz, R-Fort Walton Beach, said during the floor debate.
The new data will provide fodder for both opponents and proponents of the Medicaid system. For opponents, it will allow them to renew their call for limiting the state’s reliance on Medicaid, noting its $23 billion-plus cost represents roughly 30 percent of the state’s $78 billion annual budget. The Florida Chamber of Commerce has called for a 32 percent long-term cap on Medicaid spending.
But as lawmakers return for committee meetings in the fall and their next regular session in January, proponents can use the data to make the case that Medicaid is a vital cog in the state’s health care system, with roughly one out of every five Floridians depending upon the program.
Advocates for expansion will continue to argue that as federal funding for uncompensated care at Florida hospitals declines further next year and will be eliminated in the following year, the state should consider some type of expansion under the federal health care law, which would cover at least 90 percent of the cost in the coming years.
As for the immediate growth in Medicaid caseloads, the state Agency for Health Care Administration, which oversees the program, identified several factors contributing to the growth of an additional 247,327 Medicaid recipients this year, including a rising number of refugees who qualify for a variety of state services, including health care, under the federal law.
In 2014, Florida had 32,717 refugees identified under the federal law, with more than 90 percent coming from Cuba, according to the Department of Children and Families, which handles the refugee services program. In the first six months of this year, DCF reported 22,356 refugees already, with a sharp rise in the number of “advance parolees,” identified as Cuban nationals who are granted advance permission to enter the U.S. by the Department of Homeland Security.
Through the first six months of this year, Florida has 11,787 advance parolees, compared to 4,767 advance parolees in the entire year of 2014, the DCF data shows.
However, while the expansion of the refugee population in Florida has contributed to the rise in the Medicaid caseloads, it does not impact the state budget since all the refugee services are paid for by the federal government.
Other Medicaid caseloads are also growing, which will require an increase in state funding. The caseload for children whose families earn less than the federal poverty level, $24,250 for a family of four, is projected this year to rise to 1.66 million, an increase of 8.7 percent or an additional 133,000 children.
Medicaid is a joint federal-state program, with the federal government paying on average approximately 60 percent of the program’s costs, although it does provide more funding for certain programs.
The overall costs of the program this year are about $23 billion. State economists are scheduled to meet early next month to revise their Medicaid cost estimates, following this month’s adjustment of the program’s caseload estimates.
New estimates show the number of Floridians who rely on Medicaid, the federal-state health care program for the poor and disabled, will top 4 million recipients this year for the first time. The caseloads are projected to expand by 6.6 percent.Here are the recent Medicaid enrollment numbers and growth rates:
• 2015-16: 4 million (6.6 percent)
• 2014-15: 3.75 million (8.6 percent)
• 2013-14: 3.6 million (4.3 percent)
For some perspective, a decade ago in the 2005-06 budget year, Medicaid covered some 2.2 million Floridians, meaning the caseloads have nearly doubled since that time. Growth rates were highest in the years following the Great Recession, reaching a peak of 13.3 percent in 2009-10.
If the caseloads reach the projected 4 million-plus this year, it will mean roughly one out of every five Floridians will be relying on Medicaid for health care coverage. The Medicaid budget is about $23 billion this year, representing just less than 30 percent of the overall $78 billion state budget.
On average, the federal government pays about 60 percent of the costs, with the state paying the rest. But the federal share is greater for some programs, including an expansion plan under the Affordable Care Act that would pay 100 percent of the costs through 2016, gradually dropping to 90 percent in the following years.