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FL in Last Place for ACA Grants

Stethoscope on a pile of dollars.
Creative Commons

Florida ranks last in the country in per-person funding from the Affordable Care Act, a new study shows, and that doesn’t even include the billions of dollars the state is forfeiting by saying no to Medicaid expansion.

The Center for Healthcare Research & Transformation at the University of Michigan performed the analysis of ACA grant totals between the time the law was signed in March 2010 and the end of September 2013.

Judging by the grant totals of other states, Florida appears to have forfeited at least $100 million and possibly $300 million or more.

“Florida is 51st in per capita funding, last among all the states and the District of Columbia,” said Josh Fangmeier, health policy analyst at the Center. In a study released by the same group a year ago, Florida had been 48th.

Over the study period, the average nationwide funding per person was $47.67, the Center's charts show. By contrast, Florida’s per-capita funding was just $18.04.

The reason for Florida's low grant totals can be traced to November 2010, when Rick Scott was elected governor and other staunch conservatives backed by the Tea Party took control of the House. One of their first orders to state agencies was not to participate in ACA-funded programs.

Leah Barber-Heinz, executive director for the consumer group Florida CHAIN and an ACA advocate, said officials’ position doesn’t make sense. “It’s really unfathomable to continue to see our state continue to reject these dollars, our tax dollars, that are now going to other states.”

Some of the grants that Florida did not apply for are well-known, such as those funding state-run health exchanges and ramped-up insurance regulation.  Others are less so, including those to  help the frail elderly and disabled remain independent, explain to confused consumers how insurance works, send health professionals to areas of critical need and finance more training slots for primary-care doctors.

As of the end of September, the Michigan Center’s study showed, Florida had received $353 million in grants through the ACA. While it’s impossible to calculate exactly what Florida would have taken in if state agencies had been encouraged to apply for grants, one can draw conclusions by looking at other states.

Consider: Florida as of 2013 had about 19.6 million people, same as New York.  The latter brought in $1.1 billion over the study period, more than three times as much as Florida.

But New York's funding was high in part because it created its own health exchange, which Florida did not. So consider two other states that decided not to build an exchange: Illinois and Ohio.

Both have fewer than 13 million residents, but brought in far more in ACA grants:  $546 million for Illinois, $432 million for Ohio.

Several states with very conservative political leaders also ended up near the bottom in per-capita grants.  Texas came in 50th, with $632.5 million. Pennsylvania was 49th with $334 million.

States that ranked the highest in per capita grants -- Vermont, District of Columbia and Hawaii -- were among the states that chose to build their own health-insurance exchanges. They were costly to set up and didn't always work, as Heartland Instituterecently wrote.

While some exchanges have succeeded, the cost per enrollee was much greater than with the federal exchange, Kaiser Health Newsreports.

The result makes Florida’s decision not to create an exchange look prudent. As Sunshine State News reported in February 2013, Sen. David Simmons, R-Altamonte Springs, said, “It just seems there are too many unanswered questions for the state to be jumping into this without letting the federal government show us the way for at least the first year.”

Sen. Jeff Brandes, R-St. Petersburg, added: “I have no desire to be first.”

But grants were available for less-risky, much more popular services, such as maternal-child health and school clinics, according to the Michigan Center.  One $35.7 million grant the state wouldn't usewould have helped people stay out of nursing homes; another would have paid for a consumer help linefor health insurance questions.

“We need those resources," said consumer activist Barber-Heinz, "especially now that we have so many newly-insured people that have a lot of questions.”

When the state stepped away from ACA grants, non-profit groups rushed to fill the void, especially community health centers. Last week, in fact, Community Health of South Florida, a network of health centers, received $2 million to train primary-care doctors through grants from the Health Resource and Services Administration.Two more rounds of grants have application deadlines this week.

Florida's non-profit groups did such a good job of enrolling people that the state ended up with the lowest cost per enrollee: nearly 1 million signed up through the federal exchange at a cost of just $76 per enrollee, as Statehouse News reported.

--Health News Florida is part of WUSF Public Media. Contact Editor Carol Gentry at 813-974-8629 (desk) or e-mail at For more health news, visit

Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.