Florida Budget Proposals in Brief (FY 2025-26): Health and Human Services

This post is part of the “Florida Budget Proposals in Brief” blog series, where FPI highlights some of the key components of the House and Senate budget proposals — where they align, how they differ, and what it means for Floridians, communities, and the state economy. The difference between the House and Senate proposals is $4.4 billion, the largest difference between the chambers over the past 10 fiscal years. Consequently, policymakers will have to negotiate significant differences as they continue to agree upon a final budget. The proposals also differ from the governor’s $115.6 billion recommended budget for FY 2025-2026, with the Florida House advancing a $113 billion plan and the Senate proceeding with a $117.4 billion proposal.

The blog post below focuses on the proposed education budgets.

Medicaid

Medicaid spending in Florida is a combination of general revenue funds and federal money provided for the program. The federal share for most Medicaid service costs is determined by the federal medical assistance percentage (FMAP). Both chambers’ general revenue appropriations for Medicaid are nearly identical — the House at $11,886,717,094 and the Senate at $11,872,654,517. This is more than a $1 billion increase in general revenue spending in the Medicaid program, compared to $10.7 billion for FY 2024-25. Adding in matching federal Medicaid funding, both chambers propose spending $34.7 billion for FY 2025-26. Both chambers also introduce new proviso language in their Medicaid budgets, including detailed notification and reporting requirements. Among other directives, the Agency for Health Care Administration (AHCA) must also notify the governor’s office, chair of the Senate Committee on Appropriations, and chair of the House of Representatives Budget Committee upon receipt of official communications from the federal government of federal disallowances. Legislators have publicly expressed frustration with AHCA about financial management of the Medicaid program and the agency’s potential $965.6 million liability for non-compliance with federal requirements.

Medicaid Expansion

Florida is one of 10 states that has not provided health care access through Medicaid to low-income adults aged 19 to 64 who do not have minor children or a disability. Because Florida has a strict eligibility requirement that only covers parents up to 26 percent of the Federal Poverty Level, adults who do have children must currently make less than $7,969 annually to qualify for a family of three. An analysis by the Center on Budget and Policy Priorities (CBPP) estimates that Medicaid expansion in Florida would bring an additional $5 billion per year in federal funding from a 90 percent enhanced federal match for the program. FPI estimates that expanding Medicaid would save the state about $200 million annually. Additionally, recent national estimates project that expansion would benefit more than 506,000 uninsured adult Floridians. The state would also receive $2.9 billion in incentive funding from the American Rescue Plan Act over the first two years of expansion. Although there are no legislative proposals that would expand Medicaid this year, there is a statewide ballot initiative that is set for 2026.

KidCare

Florida’s child health insurance program (KidCare) provides health care coverage for families with low and moderate incomes. Both the House and Senate proposals fully fund the projected 168,767 KidCare cases for FY 2025-26 in the amount of $922,744,662 — this includes $270.4 million in general revenue and $652.3 million in federal funds. The caseload projections continue to exclude the fiscal impact of potential enrollment increases due to HB 121,^[1] which raised the federal poverty levels threshold for subsidized recipients. The new law has not yet been implemented, due to pending federal court litigation. The state is challenging a federal requirement to provide 12 months continuous coverage in the CHIP program with no exceptions, including when premiums have not been paid. Although the potential cost of new enrollment under HB 121 is not included in its fiscal projections, Florida’s latest KidCare social services estimating conference (SSEC) highlights the need for a major increase in state dollars for the next fiscal year. There is an anticipated shortfall of $40.1 million in general revenue relative to the current year appropriation. Per the SSEC, this increase is a result of “medical premiums transitioning from calendar year to state fiscal year, carrier premium negotiations, underlying medical inflation, adjustments based on changes in member acuity and enrollment changes…”

Home and Community Based Services (HCBS) Waitlists

Home and community based services (HCBS) provide opportunities for Floridians with low income —including Medicaid beneficiaries — to receive services in their own home or community, rather than institutions or other isolated settings. These programs serve a variety of Floridians, such as older adults and those living with disabilities. For years, massive waitlists and scant annual increases for HCBS have left thousands of Floridians without care. Since the COVID-19 pandemic, the demand has increased substantially — especially among older, homebound adults.

Overall, the Senate includes more funding in its proposal; however, all HCBS programs listed below would get new recurring funding under both chambers’ proposals. Regardless, a large number of people will still not be served. Here is what the Legislature recommends for key HCBS programs:

Alzheimer’s Disease Initiative (ADI)^[2] - The House proposes $3 million to serve approximately 206 people from the ADI waitlist. The Senate proposes $6 million, which would serve approximately 412 people from the waitlist. The FY 2024-25 budget provides $4 million in recurring general revenue and $2 million in non-recurring general revenue. The latest data shows that there were 17,081 Floridians on this waitlist. The House proposal would serve 1.21 percent of individuals on the waitlist, while the Senate proposal would serve 2.41 percent of those on the waitlist.

Community Care for the Elderly (CCE) - The House proposes $4 million to serve approximately 616 people from the CCE waitlist. The Senate proposes a larger increase of $8 million to serve approximately 1,233 more people. The FY 2024-25 budget is $6 million. The latest data shows that there are 74,341 Floridians on the CCE waitlist. The House proposal would serve 0.83 percent of the waitlist and the Senate proposal would serve 1.66 percent.

Home Care for the Elderly (HCE) - The House proposes $3.5 million to serve approximately 910 Floridians on the HCE waitlist. The Senate proposes a larger increase of $7 million, projected to serve an additional 1,820 people. The FY 2024-25 budget provides $5 million in recurring funding for HCE. As shown from the latest data, there are 21,755 Floridians on the HCE waitlist. The House proposal would serve 4.18 percent of the waitlist and the Senate proposal would serve 8.37 percent.
iBudget Medicaid Waiver (Agency for Persons with Disabilities Waiver) - The House currently appropriates a total of $987 million to the iBudget Medicaid waiver. Related proviso specifies that $13.3 million in recurring general revenue (which would draw down $17.8 million in matching federal dollars) would be used to serve approximately 400 Floridians on the iBudget Waiver waitlist. The Senate’s total proposed iBudget appropriation is higher — at $1.3 billion. Unlike the House, the Senate’s related proviso language does not specify the amount of funds designated for the waitlist. However, it directs that the funds may be used “as needed, to ensure that individuals in crisis promptly begin receiving waiver services in accordance with s. 393.065 Fla. Stat.” The FY 2024-25 budget provides $64.8 million in recurring funding for the waitlist. As shown from the latest data, there are 23, 372 Floridians on this waitlist. Under the House proposal, only 1.71 percent of this waitlist would be served.
Statewide Medicaid Managed Care Long-Term Care Waiver (SMMC LTC) – Neither the House nor the Senate include funding to take people off the waitlist for the SMMC LTC program. By failing to make this state investment, the state is losing out on millions of federal Medicaid dollars, which could be used to provide more services for seniors. As shown from the latest data, there are 42,111 Floridians on the waitlist for this program.

Rural Health

The Senate passed SB 110, also known as the “Florida Rural Renaissance” legislation. It focuses on improving quality of life in rural communities through a broad range of initiatives, including better access to health care. The bill would provide a total of $72 million in supplemental health funding^[3] to the Department of Health (DOH) and the Agency for Health Care Administration (AHCA). This includes:

$25 million in non-recurring general revenue for DOH to create the “Rural Access to Primary and Preventive Care Grant Program” to help start-up physicians, physician assistants and ARPN practices in rural areas;
$5 million in non-recurring general revenue for DOH to create the “Stroke, Cardiac, and Obstetric Response and Education (SCORE) Grant Program” to increase access to high-quality stroke, cardiac, and obstetric care;
$25 million in non-recurring general revenue for DOH to create the “Rural Hospital Capital Improvement Program” to fund improvements to systems, facilities, and equipment, and to cover the costs of providing mobile units for primary care, behavioral and OBGYN services, and telemedicine kiosks for urgent care in rural areas; and
$7.5 million in recurring general revenue and $10,038,322 in recurring federal funds for AHCA toward “Enhanced Medicaid Payments” to reimburse rural hospitals that provide care for the current Medicaid population, similar to the Medicare reimbursement.

SB 110 has been sent over to the House. There is also companion bill in the House, HB 1427. The legislation provides supplemental health care appropriations that are like those included in SB 110.

Live Healthy Act

During the 2024 legislative session, the “Live Healthy” Act was passed, and it included a sweeping health care and workforce package, costing over $1.2 billion in FY 2024-25. The package included the creation of the Health Care Innovation Council housed within the DOH and a revolving loan program that provides funding for applicants seeking to implement innovative solutions. DOH was appropriated $1 million for the new council and also appropriated $50 million per year over a span of 10 years for the revolving loan program. The House’s health budget conforming bill — HB 5301 — repeals these “Live Healthy” initiatives and other related appropriations. The House’s total $4 billion budget for DOH is $300 million less than the $4.3 billion included in the Senate’s proposed budget.

Agency for Persons with Disabilities

There is a $1.3 billion difference between the House and Senate APD budgets. The House proposes a total APD funding of $1.3 billion, and the Senate proposes $2.6 billion. The difference stems from the House, which excludes $1.3 billion in federal Medicaid match for the APD waiver program from its budget.^[4] The House solely includes the general revenue amount of $973,806,676. While the Senate budget includes nearly the same general revenue amount at $987,166,071, it also includes $1.3 billion of federal match.

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Notes

^[1] Ch. 2023-277, Laws of Florida.

^[2] ADI, CCE and HCE costs per person were determined from the Department of Elder Affairs’ 2025-26 budget request, based on the projected number of clients served for requested funds (see pp. 36,38, 40). APD costs per person were determined from the Agency for Persons with Disabilities’ 2025-26 budget request, based on the projected number of clients served by the HCBS waiver for funds requested (see p. 11).

^[3] While the Florida Rural Renaissance health care initiatives are not reflected in the budget proposals, the bill makes supplemental appropriations that are in addition to the House and Senate budgets.

^[4] Line item 242.