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Medicaid Enrollment Expected To Top 4.3 Million

Hush Naidoo

Medicaid enrollment will balloon by more than 14 percent during the state’s current fiscal year, with economists predicting an average monthly enrollment of 4.36 million people.

The economists, who met last week to discuss the enrollment trends amid the COVID-19 pandemic, did not estimate the costs associated with the surge in enrollment. They will meet Thursday to look at the financial impact.

But Agency for Health Care Administration Secretary Mary Mayhew predicted last month that there would be a "gap, perhaps significant” between what lawmakers budgeted for Medicaid and the projected costs. 

And it's not just increased enrollment that will drive costs, she said. Mayhew predicted that Medicaid providers on the front lines of the COVID-19 crisis will ask the Legislature for additional money to help offset costs for such needs as personal-protective equipment.

"We are certainly going to have providers coming to the Legislature seeking additional funding because of those costs,” she told The News Service of Florida. 

Florida had an average Medicaid enrollment of 3,816,590 during the 2019-2020 fiscal year, but the number is estimated to increase to 4,360,986 during the fiscal year that began July 1.

The projected 14.3 percent increase is by far the largest in recent history, outpacing an 8.5 percent increase in enrollment that occurred in the 2014-2015 fiscal year, according to the economists’ report.

It comes as millions of Floridians have lost jobs or lost income because of the economic fallout from the COVID-19 pandemic. 

The majority of the new enrollees expected in the program will qualify because they are eligible for Temporary Assistance for Needy Families, a program that temporarily provides cash assistance  to poor families with children and to pregnant women in their last two trimesters of pregnancy. To qualify for the so-called TANF program, children must live in families whose incomes are less than 200 percent of the federal poverty level. 

Economists agreed that Medicaid enrollment won’t begin to decrease until 2022-2023, but even then they predict that  the decline in enrollment will be less than 2 percent. Enrollment is expected to stay above 4 million through the 2025-2026 fiscal year.

Medicaid is jointly funded by the state and federal governments and provides health coverage to poor, elderly and disabled people. Enrollment in the program is countercyclical, increasing in tough economic times and decreasing when the economy is thriving. Prior to the COVID-19 pandemic, enrollment in Florida’s Medicaid program had usually been below 3.9 million people.

Medicaid enrollment increases also come during recessions when the state has less tax revenue to pay for the program, putting strains on the budget. Congress in March agreed to increase what is known as the Federal Medical Assistance Percentages, or FMAP, to pick up more of the tab for states. Congress also directed that the change retroactively apply to health care services that were provided as of Jan. 1. 

Florida economists agreed that after the hike, about 64 cents of every dollar spent on Medicaid in Florida for the recently completed 2019-2020 fiscal year would be paid by the federal government.

And after the Trump administration extended the national public health emergency for COVID-19 through Oct. 24,  the increase will be in effect until Dec. 31, or for the first six months of the 2020-2021 state fiscal year.That means the federal government will pay on average about 65 cents of every dollar this fiscal year.

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Christine Sexton / News Service of Florida