Medicaid work rules advance through Senate Health Committee

Despite pushback from civil justice advocates who warned the changes could hurt Florida’s most vulnerable people, the Senate Health Policy Committee advanced a bill with an 8-3 vote to add new work requirements for Medicaid and food assistance recipients. 

“If you want to keep your Medicaid benefits and have the taxpayers continue to pay for your health care – gotta go to work,” bill sponsor Sen. Don Gaetz said. “I believe that in public policy discussions of this kind, there’s got to be a distinction drawn …  between those who can’t get up off the couch and those who won’t get up off the couch.”

Under SB 1758, Medicaid recipients who are 19-64 years old would be kicked off Medicaid if they don’t meet new work requirements to work, pursue an education or get training for at least 80 hours a month.

The bill contains several exemptions, including people with disabilities, caregivers, inmates, someone in rehab, people who were once in foster care and younger than 23 years old, as well as postpartum mothers.

The bill would establish a 30-day grace period for people to meet the work or education requirements. People who lost their Medicaid coverage due to the work rules could request a hearing to appeal the decision or reapply for coverage.

The Agency for Health Care Administration (AHCA) operated “under the assumption” that 25% of the 111,789 Medicaid recipients who fit the bill’s target of “able-bodied” adults would lose Medicaid by the 2027-2028 fiscal year to save $80 million, according to Senate staff bill analysis.

Arcadia Jacob, advocacy director with Florida Voices for Health, urged lawmakers to remember that Medicaid and food assistance helped children, people with disabilities and survivors of domestic violence.

“These safety net programs are really a lifeline,” said Jacob. “I just want to encourage you all to be really careful about adding barriers, especially for those who are the most vulnerable, so that they don’t Fall through the cracks.”

Sen. Lori Berman also struck back at Gaetz’s bill, arguing it was a terrible Catch-22. If people worked full-time at minimum wage, they would earn too much to qualify for Medicaid yet still be too poor to afford health insurance. If they didn’t work at all, they risked being kicked off Medicaid under Gaetz’s bill, she said.

“What you’re going to have is increased numbers of uninsured Floridians who are going to not have access to preventative care, and we know what happens,” the Senate Democratic leader said. “They use the emergency room as their doctors, and we end up paying for it on that end. … I have real problems with the work requirements.”

But Sen. Kathleen Passidomo argued that the bill is broader and allows people to pursue educational or job-skills training as well.

“I feel pretty good about this,” the Naples Republican said. “It’s not ‘you got to get a job.’ It’s you can learn to get a job.”

If the bill gets passed into law, it would order AHCA to get federal approval for the work requirements, which could take six months or more, Gaetz said. Meanwhile, AHCA, along with the Florida Department of Children and Families, the Commerce Department and CareerSource would submit a joint business plan to the state by Dec. 1 on how to add the work requirement. The new work rules would not take effect until the Legislature approved the implementation plan, Gaetz added.

During the hourlong discussion on Monday, Democrats also questioned how much adding the new Medicaid requirements would cost the state, from staff training to outreach to inform Medicaid recipients. Gaetz did not provide a number.

The bill also would extend work rules for Supplemental Nutrition Assistance Program (SNAP) recipients. Under the bill, anyone between the ages of 18 and 64 who doesn’t have a child under age 14 would be required to work at least 20 hours a week or be under training to participate in SNAP. Previously, anyone older than 59 and parents of a child under 18 were exempt.

Gaetz’s bill included other reforms included substantial expansion of behavioral health services to help Medicaid recipients with serious mental illness. This bill would order ACHA to seek a federal waiver to provide home and community-based services for people to get therapy, housing assistance, peer support and more.

“By operating under a Medicaid waiver instead of through DCF, the state would also benefit from enhanced federal matching funds, which would cover more than half of the cost,” Gaetz told lawmakers.

Other provisions of the bill focused on SNAP fraud and drug prices. It would also require the state to give SNAP cards with people’s pictures on them.

SB 1758 cleared its first Committee stop with Monday’s vote. Up next is the Senate Appropriations Committee.

Two similar House companion bills have also been filed by Reps. Mike  Redondo and John Snyder, although neither has yet been called to a Committee vote.

Meanwhile, a political committee has regrouped and relaunched its campaign to get a Medicaid expansion on the ballot in 2028. Florida Decides Healthcare (FDH) said it has started collecting signatures again after it faced challenges from a new state law that makes it harder for citizen-led constitutional amendments to get on the ballot.