For years, state lawmakers have refused to consider expanding the number of people who are eligible for Medicaid coverage under the Affordable Care Act.
This year, the state is facing a $2 billion budget deficit, and lawmakers already are considering cuts to Medicaid payments.
At the same time, Congress is considering expanding incentives that would provide billions of dollars to Florida and 11 other holdout states to expand Medicaid. Advocates say these incentives could help Florida overcome its budget deficit.
Health News Florida’s Jacob Wentz spoke with Anne Swerlick from the Florida Policy Institute about the possibility for expansion.
How would expanding Medicaid help solve the state's budget deficit?
Well, under normal circumstances, if we did expansion we would get a 90% federal match, which is substantially more than the match that the state normally sees from the federal government in doing its Medicaid program. In getting those increased funds, there will be additional federal money to cover the cost of services, like behavioral health and corrections health services that are currently supported through state funds. We could see savings there if we did expansion and could tap into those federal dollars. Right now, even before the extra incentives might be offered, we've projected that the state could save nearly $200 million a year.
Under current coronavirus relief, the federal government has increased the dollars it's matching for Medicaid. How has that affected Florida's budget?
Right now, the state is getting an extra 6.2% match in the federal match for Medicaid, which has tremendously helped our budget this year. In fact, the projections are that for this fiscal year, we're going to end up with over $500,000 in surplus and in the budget that we had previously allocated. And that's because you're getting this enhanced match that's already available without us doing expansion.
With the COVID relief package that's being considered right now, those federal dollars would be significantly larger. And that, again, is in recognition that we're in this unique time and you've got many more people that need help and are going uninsured because of loss of jobs.
How many Floridians would benefit from expanding Medicaid?
There's some indication that we have more uninsured people now than we did prior to the pandemic and we see that in the increase in Medicaid enrollment right now. But the number that we were looking at prior to the pandemic was about 900,000. There are some projections that we could be up to about 1.5 million at this point. That number is likely to go down as the economy starts to recover.
Republicans say they're opposed to Medicaid expansion because there's no guarantee that the federal government will continue providing the 90% funding match. And if the federal government pulled out, the state would then have to bear the brunt of that deficit. Is that a valid concern?
No. And there's a couple reasons why. First of all, in the over 50 years that the Medicaid program has been in existence, the federal government has never not stepped up to meet its commitment to provide the federal match. That's an indefinite commitment, the 90% by the federal government. Congress would have to change the law to end that. And as I said, they've not done that in the whole history of the Medicaid program.
We've been here in years past, and sure there are more incentives on the table this year, but what are the chances that Medicaid expansion actually happens in Florida?
I think there's a growing popular sentiment that this really needs to happen, and that's not going away. So I'm optimistic that there's a lot of momentum to make this happen and I'm hopeful that we can change some minds of people who may have historically been opposed and convince them that not only is this going to help health coverage for people who are uninsured, but it's also going to help all Floridians by reducing health care costs and making it affordable for all Floridians.
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