5 things to know about Florida’s health care budget

The state spends much of its money on health care. Here’s what it’s doing.
A pharmacist portions a dose of the BioNTech COVID-19 vaccine into a syringe on Thursday, Jan. 21, 2021.
A pharmacist portions a dose of the BioNTech COVID-19 vaccine into a syringe on Thursday, Jan. 21, 2021. [ DOUGLAS R. CLIFFORD | Times ]
Published April 28, 2021|Updated April 28, 2021

TALLAHASSEE — Pick a random dollar out of Florida’s $101.5 billion budget, and it’s got a strong chance of going to a health care program.

That means Florida’s health care spending plan sheds a great deal of light on the priorities of state leaders. Who gets coverage under the state’s Medicaid program? Where are billions of federal dollars going? How is the state looking after its most vulnerable citizens?

Last week, state lawmakers answered all of these questions when they came to an agreement over how to spend more than $44 billion in health care money.

Here are five things to know about the budget.

1. There are few major cuts, thanks to the federal government

Initially, the health care budget looked bleak. Taken together, the House and Senate proposed deep cuts to hospitals, nursing homes and Medicaid benefits for 19 and 20-year-olds.

None of those cuts made the proposed budget. Under President Donald Trump, the federal government agreed to give Florida hundreds of millions in extra Medicaid dollars. This was done to make sure that Medicaid, a health care program for the poor and sick that is funded by a combination of state and federal money, did not burn too big a hole in state budgets during the pandemic.

President Joe Biden’s administration announced earlier this month that it would extend the federal public health emergency through July 20, allowing Florida to continue to access extra Medicaid money. The administration is expected to extend the aid at least through the rest of the year.

Related: Florida gets Medicaid funding boost from the federal government

The additional Medicaid cash — at least $400 million — was critical when it came to crafting the state budget.

“It allowed us to completely ameliorate all of the cuts in health care,” said Rep. Jay Trumbull, R-Panama City, the House’s budget chair.

2. Florida extended Medicaid benefits for new moms...

House Speaker Chris Sprowls, R-Palm Harbor, said he would make maternal health care a priority. In March, he announced he planned to extend the period of Medicaid eligibility for new moms from 60 days to one year.

This was a major change. Medicaid covers more than half of all births in Florida. Advocates say giving uninsured new mothers just 60 days of health care coverage is not enough to ensure they will recover properly from childbirth.

“Healthy moms are better positioned to raise healthy and thriving children,” Sprowls said at a March press conference, flanked by female lawmakers from both parties.

Sprowls’ proposal is part of a nationwide bipartisan push for extended maternal Medicaid coverage. Lawmakers in dozens of states, from deep blue Illinois to ruby red West Virginia, have either studied an extension in recent years or plan to implement one.

During budget negotiations, the House and Senate briefly wrangled over the program’s cost: about $89 million in state money, and about another $151 million in federal dollars. Some Florida hospitals balked at an initial House proposal which would have extended Medicaid for new moms while cutting state funding to nine hospitals that offer care to the highest-risk births in the state.

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Related: Florida proposal to help new moms is a sticking point in budget negotiations

But hospitals, Sprowls and health equity advocates all got what they wanted. If Gov. Ron DeSantis does not veto the Medicaid extension, it will become Florida law July 1.

3. ...But Florida did not expand Medicaid under the Affordable Care Act

The federal government would have given Florida more than $3 billion in incentives over the next two years if it had chosen to expand Medicaid under the Affordable Care Act. The expansion of coverage itself would have cost about $1.2 billion, leaving the state about $1.8 billion in the black for those two years.

Democratic lawmakers have argued for years that the state would be foolish not to expand Medicaid. It would provide health insurance to about 790,000 more Floridians, according to the Kaiser Family Foundation, they note. Now that the federal government has alleviated concerns about the program’s cost, there’s no reason for the state government not to take up the policy, Democrats say.

Republican leaders, however, have said they have no interest in expanding Medicaid. They argue the role of government is to encourage self sufficiency, not expand government programs. They also point out the timeline. After the 2023 fiscal year, the federal government would pay for 90 percent of the cost of Medicaid expansion. Republicans say the 10 percent left up to the state would make the program too expensive.

To Anne Swerlick, a policy analyst at the progressive-leaning Florida Policy Institute, opposition to Medicaid expansion makes little sense. How, she wondered, are Republicans so willing to extend Medicaid coverage for new mothers, yet so reluctant to expand it to hundreds of thousands of additional low-income Floridians?

“What happens after that year?” Swerlick said, referring to the year of Medicaid coverage soon to be available to new mothers. “If they’re still at the same income level, they’re going to fall off the cliff of uninsured people again.”

4. Florida is still fighting the scourge of opioid addiction

The state budget includes at least $131 million in opioid addiction outreach and treatment programs. Tens of millions more go to other addiction treatment efforts. The bulk of the opioid-specific money — about $90 million — comes in the form of a federal State Opioid Response Grant. Much of that cash goes to treatments, such as methadone and naltrexone, aimed at getting users off of opioids.

Another large chunk, $11 million or so, would come from McKinsey & Company, which in February reached a nine-figure settlement with 47 states and Washington D.C. over its role in the opioid epidemic. Florida got about $40 million from that deal, Attorney General Ashley Moody announced in February. Much of the portion of that money allocated in this year’s budget will go to the Department of Children and Families for programs that fight opioid abuse.

McKinsey, a global consulting powerhouse, agreed to the settlement after reportedly helping a leading drug company market its deadly and addictive products. McKinsey’s actions helped fuel an addiction crisis that has claimed the lives of hundreds of thousands of Americans, attorneys general around the country claimed. (The settlement document noted that “no part of this Judgment...shall constitute evidence of any liability, fault or wrongdoing by McKinsey.”)

Even with the eight-figure settlement, Moody has acknowledged opioid addiction will remain a formidable challenge for Florida.

“While securing these funds is a great win for Florida, our work is far from over,” Moody said in a February release.

5. One key wait list is getting shorter

More than 20,000 Floridians with developmental disabilities sit on a wait list for at-home health care provided through the state’s Medicaid program. Many have been on the list for years.

In last year’s budget, the state approved more than $30 million in new spending on the “iBudget” waiver program. That money got about 640 people off of the wait list.

This year, the Legislature is more than tripling last year’s output. Lawmakers have proposed $95 million to get even more people with disabilities off the wait list.

Some disability advocates say the state could be doing more for their community. For instance, lawmakers could allow working people with disabilities to buy into the state’s Medicaid program. This would allow many in the disability community to more easily afford the services they need, advocates say.

Still, Republican leaders are touting the dent they’re making this year.

“(This is) a significant amount of increase in funds for folks that are most vulnerable,” Trumbull said Monday.

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