Medicaid provides health care coverage to low-income families and individuals through a partnership of federal and state dollars. It also helps the elderly, people with disabilities, and pregnant women.
However, the “One Big Beautiful Bill Act," developed by House Republicans to support President Donald Trump's domestic agenda, stands to slash nearly $800 billion from the federal contribution over the next decade.
In Florida, more than 4.3 million people are enrolled in Medicaid. But the bill could have bigger impacts on more than just the enrollees.
Joan Alker, axecutive director and co-founder of the Georgetown University McCourt School of Public Policy Center for Children and Families, said she’s never seen cuts of this magnitude.
“It's going to result in eligible people who need health care not being able to get it,” she said.
The legislation, which narrowly passed the House, could undergo changes in the Senate, where it’s being debated. Trump has asked lawmakers to have the bill on his desk by July 4, when the nation marks its 249th anniversary.
Your Florida breaks down how Medicaid cuts could affect Floridians.
Increased financial pressure on the state
Total Medicaid spending in Florida is $34.6 billion each year. About two-thirds of that is from the Washington, D.C., making it the largest source of federal funds for Florida.
The state pays its portion of the program, roughly $10 billion to $12 billion, mostly with sales taxes and provider taxes placed on hospitals and nursing homes. But the federal cuts would force the state to make up the shortfall or reduce services. Alker says that’s “a big problem” for Florida, which already limits how much tax is collected.
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“It will have a nasty impact on the state's ability to raise revenue for its share,” Alker said.
The Center on Budget and Policy Priorities, a nonpartisan institute that analyzes how state and national budgets impact people, said that if the bill passes, Florida could see an increase of 9% to 18% in Medicaid costs.
The center said the state could cut enrollment, roll back “optional” benefits or reduce payments to health care providers to cover the difference.
Strain on health care providers
The Congressional Budget Office, a nonpartisan scorekeeper for Congress, estimates the bill would “increase the number of people without health insurance by 7.8 million” nationally by 2034.
KFF, a nonprofit that provides nonpartisan health policy research, estimates that about 990,000 people would lose coverage in Florida. And with more Floridians uninsured, emergency room use is likely to increase, leading to higher costs for everyone.
Rural hospitals could face closure
Rollbacks could be particularly devastating to hospitals and clinics in rural and underserved areas, which often rely heavily on Medicaid reimbursements for their operations.
“We've talked to many rural hospitals who've said, ‘We're probably going to have to close if these Medicaid cuts go through,’ ” Alker said.
Laura Harker is a senior policy analyst at the Center on Budget and Policy Priorities. Speaking at a Medicaid webinar hosted by Florida Voices for Health, she said that rural residents typically have lower incomes and high levels of hardship, something the legislation would exacerbate.
“Rural hospitals rely more on Medicaid to fill in revenue gaps that they may have, so those cuts to Medicaid would hurt their revenue in terms of money that's already coming in,” Harker said.
Over the past decade, five rural hospitals in Florida have closed, leaving some communities in health deserts. The Center for Healthcare Quality and Payment Reform identified 10 locations “at risk” and two “at immediate risk” for closure in Florida.
Impacts on vulnerable populations
Federal budget reductions would pose a “huge issue” for mothers and babies, particularly if hospitals keep shutting down labor and delivery departments, Alker said.
A 2024 report revealed that most rural hospitals in Florida do not offer maternity services. Additionally, many are closing their units due to insufficient reimbursement from insurance companies and Medicaid.
In April, the labor and delivery department at Cleveland Clinic Martin North in Stuart was relocated to Port St. Lucie in a consolidation, forcing expectant mothers in Martin County to travel south to Palm Beach County or north to St. Lucie County.
“We know that when women have to drive further, it's a risk to their health,” she said. “It's a risk to their baby's health.”
Nationally, Medicaid covers 40% of the cost for births. However, in rural areas, it accounts for 47%, and in some places, even more.
“So this is really a life-or-death issue, and it doesn't matter if your coverage is Medicaid. If you live in a rural area and your hospital goes away, you can have great private employer insurance, but that's not going to matter if there's nowhere to deliver your baby,” Alker said.
Of the state’s Medicaid recipients, 77% are children, seniors, and people with disabilities.
Medicaid also pays for a majority of seniors in nursing homes and is the primary payer for long-term care, according to the program’s website. Care for nursing home residents takes in 58% of Florida’s Medicaid expense.
“We know we have an aging population. We're going to need more long-term care support, not less,” Alker said.
Laura-Lee Minutello, senior public policy analyst for Disability Rights Florida, spoke during the Florida Voices for Health’s Medicaid webinar.
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Minutello said the cuts could affect “optional” services, or home and community-based care. Minutello, who has cerebral palsy, relies on those services.
“I come at it from both ends, so as a policy analyst and as a user,” Minutello said. “So while it is impossible to know exactly what those cuts will ultimately lead to in service reductions, we do expect to see service reductions.”
Root out waste, fraud and abuse
Advocates of the bill say it will root out waste, fraud, and abuse, but opponents disagree.
For example, the legislation would impose work requirements nationally for Medicaid, targeting all able-bodied adults aged 19 to 64 without dependents.
Democratic Rep. Kathy Castor said new work requirements in the bill could affect the most vulnerable populations in the program.
“And that’s where people will lose coverage, because you will be subjected to all sorts of new bureaucratic red tape requirements to justify the fact that you are or are not working,” she said. “It’s really a lot of waste.”
However, a spokesperson for Republican Rep. Gus Bilirakis said pregnant and postpartum women, children, seniors and people with disabilities are exempt from the work requirements.
In an email, the spokesperson said these are the only groups eligible for Medicaid in Florida, so they would not be negatively affected with respect to accessing health care.
Also, nonpartisan government watchdog groups have concerns that administrative mistakes and excessive paperwork may result in lost coverage, similar to what happened in Arkansas in 2018. When that state introduced work requirements, over 18,000 people lost coverage mainly because they did not consistently report their work status or provide documentation for an exemption, as reported by KFF.
Who can, and can’t, access Medicaid
One major provision of the bill is to stop immigrants without legal status from gaining coverage. However, under current law, those immigrants are not eligible to enroll in Medicaid coverage.
“There's one exception to that, and that is for emergency Medicaid,” Alker said. “And that's like, if somebody has a heart attack on the sidewalk or they're delivering a baby, the hospital can't turn them away.”
“So that piece is just to give hospitals some reimbursement, but undocumented people are not eligible for Medicaid. Period, end of story,” she added.
Emergency Medicaid accounts for less than 1% of spending, according to KFF.
“We're hearing so much conversation about undocumented people in this Medicaid fight, but it's largely irrelevant. It's just a talking point. And really, what this bill does is enact the largest Medicaid cut in history,” Alker said. “I've been working on Medicaid a long time, [and I’ve] never seen cuts of this magnitude, and it trips people up in red tape. It's going to result in eligible people who need healthcare not being able to get it.”
Do you want to share your story? Will you be impacted when the Affordable Care Act tax credits expire? Email bowman4@wusf.org to connect with Meghan Bowman and join the conversation with Your Florida.
If you have any questions about the state government or the legislative process, you can ask the Your Florida team by clicking here.
This story was produced by WUSF as part of a statewide journalism initiative funded by the Corporation for Public Broadcasting.
