Florida Budget Proposals in Brief: 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. Overall, the Senate and House budget proposals for FY 2024-25 are quite similar. Unlike previous years, the joint budget conference committees will not have many significant differences to negotiate. Still, there are some notable variances, and the funding decisions have both fiscal and policy implications for the state.

Introduction

The Florida Senate passed its fiscal year (FY) 2024-25 budget proposal (SB 2500), which totals $115.9 billion and represents a $578 million (or a 0.50 percent) reduction from the current budget.^[1] The Florida House’s FY 2024-25 budget proposal (HB 5001) totals $115.5 billion and represents a $969 million (or a 0.83 percent) reduction compared to the current budget.

The next step in the budget process will be for a Joint Budget Commission to meet and reconcile any differences to propose a General Appropriations Act (GAA) for FY 2024-25. Both chambers will then vote on the proposed GAA, and once it is passed, it will be sent to the governor, who can make line item vetoes and sign the bill into law. The Legislature can then override vetoes if two-thirds of the members, in each chamber, vote to do so. The final budget will be enacted as of July 1, 2024.

Health and Human Services

‘Live Healthy’ Act^[2]

As FPI discussed in a recent blog post, the Florida Senate passed the “Live Healthy” Act (SB 7016 and SB 7018) for the 2024 legislative session — a sweeping health care and workforce package that would cost $768 million in FY 2024-25. The Senate bill, SB 7016 ($716 million) includes a number of provisions that seek to enhance Florida’s health care workforce, primarily by increasing Medicaid reimbursement rates for workers providing preventative care and serving vulnerable populations. This includes services such as dental care; private duty nursing; occupational, physical, and speech therapy; behavioral analysis; and maternal care in labor and delivery.

Additionally, The Florida Senate includes $11.5 million in recurring general revenue for the expansion of Mobile Response Teams (MRTs) — a critical element of crisis care that provides 24/7 on-demand, multi-disciplinary behavioral crisis intervention services in any setting, including homes, schools, and emergency departments. As FPI mentioned previously, this provision includes language to instruct the Agency for Health Care Administration (AHCA) to apply for the enhanced reimbursement offered in the American Rescue Plan Act (ARPA) for MRTs, which could draw down up to $9.7 million in funding for SB 7016’s MRT appropriation, and even more if school districts and local municipalities participate with their MRT programs. The House’s companion bill, HB 1549, mirrors the Senate’s funding levels and includes the ARPA funding provision.^[3]

The other bill, SB 7018 ($51 million) would establish a 15-member health care innovation council that would be given $50 million of non-recurring funds each year between FY 2024-25 and FY 2033-34, for a total of $500 million over 10 years. The council’s main purpose would be to explore innovations in technology and health care delivery models in Florida and use the funds for a revolving loan program for “innovative” proposals. The House’s companion bill, HB 1501, mirrors the Senate’s funding levels.

A heavy investment in Florida’s health care workforce is needed and welcome; however, the state must continue to look towards more comprehensive solutions for impacting health on the ground, while increasing access to care such as expanding Florida’s Medicaid program.

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 budgets reflect an increase in general revenue spending in the Medicaid program ($10.7 billion in the House and $10.6 billion in the Senate) from the $10.1 billion that was spent last year. The Senate proposal reflects a 7.7 percent decrease in federal funds for the program from last year, while the House proposal reflects a 7.8 percent decrease. During the COVID-19 pandemic, Florida’s Medicaid program received a higher FMAP because of rules that were put in place to keep individuals enrolled in Medicaid. The Consolidated Appropriations Act, put in place by the Biden administration in 2023, began to phase out the higher percentage of federal funds for the program. As a result, we see this reflected in the House and Senate budgets. The proposed House and Senate Medicaid budgets for FY 2024-25 are approximately 4 percent less (about $1.3 billion) than the current fiscal year because of the offset of enhanced federal funds. The Senate proposes spending $33.1 billion, while the House proposes $33.2 Billion. This matches the historical spending of the program.

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 28 percent of the Federal Poverty Level, adults who do have children must currently make less than $7,230 annually to qualify for a family of three. A recent analysis by the Center on Budget and Policy Priorities estimates that Medicaid expansion in Florida would have generated an additional $5 billion per year in federal funding from a 90 percent enhanced federal match for Medicaid if the state had adopted the measure in 2023. FPI estimates that expanding Medicaid would save the state about $200 million annually, and would benefit more than 726,000 uninsured adult Floridians. If the state expands Medicaid, it would also receive $2.8 billion in incentive funding from the American Rescue Plan Act over the first two years. Although there are no proposals to 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 income. Florida’s latest social services estimating conference outlines the need for a major increase in state dollars (general revenue) for the program. In 2023, the Florida Legislature passed HB 121, which increased the KidCare eligibility threshold from 200 percent of the Federal Poverty Level to 300 percent, therefore increasing the number of children to be served by Florida’s child health insurance program. Furthermore, during the COVID-19 pandemic, a higher percentage of federal funds was provided for keeping individuals enrolled in Medicaid — including children. These were gradually phased out through December 2023 with the passage of the Consolidated Appropriations Act. The combination of KidCare expansion and the phase-out of additional federal funding increased the need for state spending to offset the increased costs for health care coverage.

Although KidCare expansion was expected to be implemented in January of 2024, it has been delayed until at least April 2024. The initial delay was due to a misinterpretation of federal procedures regarding changes to states’ Children’s Health Insurance Programs (CHIP). Implementation has been further delayed because the state Agency for Health Care Administration has filed a lawsuit against the Centers for Medicare and Medicaid Services and the U.S. Department of Health and Human Services, claiming that new federal regulations undermine Florida’s KidCare expansion. The new rule requires states to provide 12 months of continuous eligibility to children under 19 who are enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) with no exceptions, including non-payment of premiums. As FPI has stated, the state’s lawsuit seeks to undermine the new continuous eligibility requirement and could “jeopardize the health and wellness of Florida children.”

While litigation regarding KidCare is ongoing, the House and Senate budgets reflect the estimating conference's call for a major increase in spending from last year’s KidCare budget of $563 million. Both the House and Senate fully fund caseloads in the KidCare programs (Florida Healthy Kids, MediKids, and Children's Medical Services) at $787 million in the House and $786 million in the Senate. In terms of differences, the House allocates $1.2 million to increase the income eligibility threshold for KidCare coverage; the Senate does not.

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 and/or mental illness. Massive waitlists and scant annual increases for HCBS have left thousands of Floridians without care for years. 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, several HCBS programs 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:

$4 million proposed by both chambers to serve approximately 275 people from the Alzheimer’s Disease Initiative waitlist.^[4] This matches current-year funding. As of the latest data, there were 17,174 Floridians on this waitlist, and this would serve less than 2 percent.

$6 million in recurring funding proposed by both chambers to serve approximately 900 people on the Community Care for the Elderly (CCE) Program waitlist. This represents a significant permanent increase over current funding — triple the nonrecurring $2 million currently allocated. Still, neither proposal meets the Department of Elder Affairs’ request of $10 million in recurring funds. There are 82,174 Floridians on the CCE waitlist, and this would serve just 1.1 percent.

$2 million from the House and $3.65 million from the Senate in recurring funding to serve approximately 540 and 985 Floridians on the Home Care for the Elderly (HCE) Program waitlist, respectively. The current-year budget establishes a recurring $3 million appropriation for HCE, which both chambers’ proposals add to (totaling $5 million in recurring HCE funding under the House proposal and $6.65 million under the Senate). Moreover, both meet the department’s request of $5 million in recurring funding, with the Senate exceeding it. There are 20,290 Floridians on the HCE waitlist, and even the higher Senate proposal would serve just 5 percent more.

$64.8 million from the Senate to serve approximately 921 Floridians on the Agency for Persons with Disabilities (APD) Waiver waitlist. While this represents a 19 percent reduction from the current-year funding of $79.6 million, the Senate suggests making the funding recurring, which would guarantee a minimum of $64.8 million for the program in future fiscal years. The House does not add any waitlist funds. Currently, there are 23,372 Floridians on this waitlist, so even if the House matches the Senate’s request, APD would only be able to serve 4 percent of its waitlist.

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Notes

^[1] For analysis of top-line budget figures, FPI uses the current General Appropriations Act (FY 2023-24), including vetoes, for sections 1-7, which totals $116.5 billion. However, this does not include back-of-the-bill sections. For the current GAA, including vetoes, plus back-of-the-bill appropriations, supplemental appropriations, and transfer totals, please see the Florida Legislature’s “Fiscal Analysis in Brief: 2023 Legislative Session: Chart 8.”

^[2] While the Live Healthy Act is not reflected in the budget proposals, the bill makes supplemental appropriations that are in addition to the House and Senate budgets.

^[3] Sec. 25 of HB 1549; Sec. 24 of SB 7016.

^[4] ADI, CCE, and HCE costs per person were determined from the Department of Elder Affairs’ 2024-25 budget request, based on projected number of clients served for requested funds (see pp. 27, 29, and 31.) APD costs per person were determined from the Agency for Persons with Disabilities’ 2024-25 budget request, based on the projected number of clients served by the HCBS waiver for requested funds (see p. 22).