Florida’s Medicaid enrollment projected to top 5 million

One reason for the increased enrollment is unemployment caused by the COVID-19 pandemic.
BayFront Health St. Petersburg hospital at 701 Sixth Street S in St. Petersburg.
BayFront Health St. Petersburg hospital at 701 Sixth Street S in St. Petersburg. [ DIRK SHADD | Times ]
Published Aug. 5, 2021|Updated Aug. 6, 2021

TALLAHASSEE — By June 2022, more than 5 million Florida residents are expected to be enrolled in Medicaid — the state and federal health program that serves as a safety net for low-income people, according to new estimates by state economists.

As Florida continues to wrestle with the COVID-19 pandemic, the economists predict that about 5.04 million people will be covered by Medicaid by the end of the current fiscal year on June 30. Nearly 80 percent of them will be enrolled in some form of a Medicaid managed-care plan.

The total is up from an estimated Medicaid enrollment of 4.524 million people for the recently completed 2020-2021 fiscal year.

The economists, who work for Gov. Ron DeSantis and the Legislature, update forecasts periodically during the year and released the latest estimates on Wednesday. The estimates become part of a three-year financial “outlook” that lawmakers consider in making budget decisions.

Part of that overview includes figuring out if the state will have to spend more money this year than was anticipated when lawmakers passed a budget in April. The new projections indicate that Medicaid enrollment will be 4 percent higher than the estimate when legislators earmarked about $35 billion in state and federal money for the program in the 2021-2022 budget.

Economists will meet Friday to discuss the fiscal impact that the higher-than-anticipated enrollment will have on costs of the program. But the increases will likely be offset by the state’s decision to tap into additional federal funding through Dec. 31.

That additional funding will come through a 6.2 percentage-point increase in the federal government’s share of the costs of the program. Just how much additional funding that will bring to the state will also be determined by economists on Friday.

Amy Baker, coordinator of the Legislature’s Office of Economic and Demographic Research, told The News Service of Florida on Thursday that the enrollment increases stem, in part, from the “continuing economic effects of unemployment” caused by the pandemic.

Also playing a role is the state’s decision to draw down the additional federal Medicaid money. While the funding helps the state cover enrollment increases caused by the pandemic, it limits Florida’s ability to eliminate people from the program.

During a July 23 meeting of a panel known as the Social Services Estimating Conference, Medicaid director Tom Wallace said the state had an additional 10,000 people a week enrolling in the program between the end of March and middle of July.

While that was down from previous months, Wallace acknowledged that “it’s still 10,000 people.”

The state is seeing spikes in Medicaid enrollment in children ages 14 and older who qualify because they or their families are eligible for the Temporary Assistance for Needy Families program — what was once called welfare. To qualify for the program, people must be unemployed or underemployed; have children who are 18 years old or younger; be pregnant; or be 18 or younger and the head of a household.

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“This is the category we have seen the largest growth in,” Wallace said.

Most of those new Medicaid enrollees are being enrolled in managed-care plans.

Also, because the state is accepting the additional federal money, it is precluded from terminating anyone who was enrolled in the Medicaid program as of March 18, 2020, even if they experienced changes in circumstances that would normally disqualify them, such as new jobs.

“These provisions affect the size of the Medicaid roll for the entire period that the (public health emergency) is in effect,” Baker said in an email to the News Service. “They are part of the reason the pandemic effect lasts into the current year (FY 2021-22) — and then has an abrupt reversal in FY 2022-23.”

In the documents released this week, economists predicted that enrollment would dip by 2 percent in the 2022-2023 fiscal year, with the elimination of the public health emergency, and continue to decline each year through the 2025-2026 fiscal year.

Economists predict enrollment will increase by less than 1 percent in the 2026-2027 fiscal year, totaling an estimated 4,690,357.

Enrollment was 3,814,034 in the 2019-2020 fiscal year, before the full impact of the pandemic was felt in the program.

By Christine Sexton, News Service of Florida