Health Care
2025 Legislation
State Budget
By
Erica Monet Li, MPH, CHES®
|
September 15, 2025

Florida FY 2025–26 Budget Summary: Health

HEALTH AND HUMAN SERVICES

Current Landscape: Federal

On July 4, 2025, Congress passed the federal reconciliation bill (H.R. 1) which guts nearly $1 trillion from health care spending, including $800 billion expected to come from the Medicaid program, while the other cuts come from the Affordable Care Act (ACA) Marketplace.[1] These proposals largely harm state budgets by making the Medicaid program more difficult to finance. Additionally, it is expected that these proposals will lead to an increase of 14.2 million uninsured people in the United States over the next ten years—an estimated 1.4 to 1.9 million of those individuals being Floridians.[2]

In addition to health care cuts, H.R. 1 slashes billions in federal funding from the Supplemental  Nutrition Assistance Program (SNAP) by forcing most states[3]—for the first time in the history of the program—to contribute a percentage of the cost of providing monthly SNAP grocery benefits to eligible participants depending on the state’s error rate. Most SNAP errors, which include both under- and over-payments, are due to unintentional mistakes made by both families and state agencies.[4] Depending on the state’s error rate in FY 2025,[5] this cost shift could force Florida to pay $1 billion or more to continue providing monthly food assistance to families in need, beginning as early as 2028.[6] However, states with high error rates may qualify for a temporary delay in implementation for up to two years.

Still, shifting the cost of grocery benefits to states is only one of many deep cuts that Congress made to SNAP. Among other cuts, Congress also reduced federal funding for the administrative costs of managing SNAP from 50 percent to 25 percent, which may force Florida to pay over $205 million annually.[7] Federal policymakers also extended harsh work requirements to older people, as well as many parents of minor children, which will put roughly 253,000 people in Florida at risk of losing some, or all, of their food assistance.[8] Lastly, Congress slashed the eligibility of lawful immigrants,[9] which would strip food assistance from thousands of participants in Florida.[10]

Current Landscape: State

Florida ranks near the bottom on a national ranking of health insurance coverage for children and adults.[11] Florida ranks 49th in potentially avoidable hospital use and cost, meaning that that the state pays more than others due to a lack of timely and effective care, preventive care, and health insurance.[12] Lawmakers have not expanded Medicaid to 507,000 uninsured low-income residents . Consequently, an estimated 260,000 Floridians live in the “coverage gap,” meaning that they make too much money to receive Medicaid, and too little money to qualify for Marketplace insurance credits.[13] This contributes to the racial health gap, exacerbating health disparities in communities of color. [14],[15]

Florida lags far behind other states in investments for mental health and substance use disorder (SUD) treatment. In early February 2023, 33.7 percent of adults in Florida reported symptoms of anxiety and/or depression.[16] Adding to the pressure on Florida's already-strained mental health system, the state has an extremely high rate of uninsured people with a mental illness. Mental Health America estimates that there are 516,000 uninsured adults with mental illness in Florida—the seventh-highest percentage among states plus the District of Columbia.[17] Additionally, 12 Floridians die each day due to opioid overdoses.[18] The most recent Medical Examiners Commission Annual Drug Report shows that, in 2023, 43 percent of the deaths that were investigated by Florida’s medical examiners involved drug use.[19] Florida’s state-run mental health facilities have expressed a need for more capacity, given the 25 percent growth in needed mental health support, according to the Department of Children and Families’ latest budget request.[20] In effect, without additional recurring funding, individuals in Florida who are awaiting care will continue to wait for up to 15 days to receive the help they need for their SUD, which is the maximum number of days allowed under the current statutes. They will not receive that help on time.

In addition to waitlists for community mental health and SUD, the demand for home- and community-based services (HCBS) continues to grow. These services are provided to older disabled Floridians and residents who primarily stay in their homes and seek to delay or avoid institutional care. Data shows that one in four adults in Florida have a disability.[21] Furthermore, by 2030, Florida’s Department of Elder Affairs anticipates that one-third of Floridians will be aged 60 or older, increasing the demand for these health care services.[22] However, HCBS waitlists in the tens of thousands grow exponentially each year, keeping these services out of reach for many.

Concerning the well-being of children and families, policymakers continue to allow the Temporary Assistance for Needy Families (TANF) program to languish. Florida’s TANF program, the state’s core program for providing families with children the means to meet basic needs, does an inadequate job of reaching and assisting struggling families. Even though 21 other states raised TANF benefit levels in 2022–2023, lawmakers in Florida have kept benefits in the state’s TANF program at the same amount for over 30 years. Today, Florida’s TANF benefit payments, which have dropped by over 46 percent when adjusted for inflation and are only 13.6 percent of the federal poverty level (FPL), puts Florida’s benefit payments among the bottom 10 states in the country.[23]

SNAP benefits are critical to meeting the basic needs of the 13 percent of Floridians who participate in the program, often after experiencing hardships such as loss of income, divorce, or a medical crisis.[24] Yet, policymakers are taking only a few steps to address food insecurity statewide, provide public assistance to recipients with meaningful benefit levels, and/or educate and train public assistance recipients with the skills they need to get and keep good-paying jobs.

Budget

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The total Health and Human Services (HHS) budget is $47.5 billion, an increase of $1 billion from the FY 2024–25 budget (See Table 1). Florida’s Medicaid program, which is administered by the Agency for Health Care Administration (AHCA), accounts for roughly $35.1 billion (74 percent) of the entire HHS budget.[25] AHCA uses most of these Medicaid funds (about $26.2 billion) for the Statewide Medicaid Managed Care program,[26] which is responsible for providing care to over 4.1 million beneficiaries.[27] Finally, approximately 66 percent of the Medicaid budget is financed through federal funding.

After years of diminishing federal government support, due to the phasing out of enhanced federal payments to support higher caseloads during COVID-19 (known as the Federal Match Assistance Percentage, or FMAP), Florida has seen a leveling of funds for its Medicaid program (See Figure 1).

Broadly, Florida’s Social Services Estimating Conference expects a 7.9 percent increase in spending on total Medicaid services in FY 2025–26 as compared to FY 2024–25, from approximately $33 billion to $35.6 billion.[28] Of those funds, the federal share increases by 9 percent from $18.4 billion to $20 billion, while state spending would increase by 6.5 percent from $14.6 billion to $15.6 billion. Furthermore, the number of people enrolled in the Medicaid program is expected to decrease by roughly 2 percent in FY 2025–26, from 4.3 million people to 4.2 million people.[29]

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KIDCARE

The budget funds caseloads in the KidCare programs (Florida Healthy Kids, MediKids, and Children's Medical Services) at approximately $923 million.[30] This is an increase from last year’s KidCare budget of $787 million.[31] The Social Services Estimating Conference (SSEC) reconvened in July 2025 to discuss the estimates from February. They noted that due to growing caseloads and increased need for Behavioral Analysis services and prescription drugs, the KidCare program is set to experience a $47.3 million general revenue shortfall. The need for additional general revenue rises from $82.5 million in FY 2027–28 to $175.4 million in FY 2030–31.[32] The February 2025 conference stated that the costs for administering the program will also increase due to new carrier premium negotiations, underlying medical inflation, and enrollment changes within the subsidized and full-pay programs.[33] These budget shortfalls were significantly higher than those projected in the December 2024 SSEC, which were higher than those projected from the conference before.[34] After years of experiencing budget shortfalls, it remains questionable whether the funds requested will be sufficient to provide the best care for Florida’s children. This is particularly important, as state policymakers look to cut spending.

Florida’s Legislature voted to expand the KidCare program in 2023 under HB 121. This law raised the income threshold from 210 percent to 300 percent of the Federal Poverty Level for program participants. The expansion was granted preliminary federal approval, but the state is fighting a provision which requires that children who are enrolled receive twelve months of continuous coverage if the families are unable to pay a monthly premium. As the state awaits the final determination, the expansion of KidCare remains delayed, and the current SSEC forecasts do not account for these projected costs and caseloads. Broadly, this means that spending on the program will historically remain the same, while more children who could be served by the program wait for health care coverage.

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MEDICAID

Medicaid spending in Florida is a combination of state general revenue funds and federal funds provided for the program. Currently, Florida receives $1.34 in federal funding for every dollar the state spends on Medicaid.[35] The federal share for most Medicaid service costs is determined by the federal medical assistance percentage (FMAP).[36] Florida’s current FMAP is 57.2 percent. Florida’s current Medicaid spending reflects an increase of 5 percent from last fiscal year ($33.4 billion) to this fiscal year ($35 billion).

Caseloads within Florida’s Medicaid program continue to decline after the end of the continuous coverage provision that was put into place at the start of the COVID-19 pandemic. This provision allowed individuals to remain enrolled in Medicaid through the end of the public health emergency (PHE), in exchange for enhanced federal funding. In December 2022, Congress passed the Consolidated Appropriations Act, which ended the continuous enrollment provision in March of 2023.[37] The latest SSEC projects  a 1.6 percent decrease in Floridians enrolled in Medicaid in FY 2025–26. It also projects that after this fiscal year, the program will remain steady in growth and enrollment, remaining largely around 4.2 million Floridians.[38] Other projections state that program expenditures will increase by 7.9 percent in FY 2025–26, creating a need for an additional $962.8 million. At this time, the Medicaid budget does not account for federal reductions to the program due to the most recent passage of H.R.1, which guts nearly $1 trillion from healthcare spending.[39]These changes may potentially lower payments to hospitals and providers that serve a large proportion of people utilizing Medicaid. As more Floridians face increasing costs for their health care premiums under the Affordable Care Act Marketplace and Medicaid cuts, an additional 1.4 to 1.9 million Floridians will lose coverage, while uncompensated care costs rise to over $4 billion over the next 10 years. [40]

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MEDICAID EXPANSION

Florida is one of 10 states that has not provided health care access through Medicaid to adults aged 19 to 64 with low income and who are without minor children or disabilities. Since Florida has a strict eligibility requirement that only covers parents at up to 28 percent of the Federal Poverty Level,[41] For a family of three, adults with children must currently make less than $7,462 annually to qualify  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.[42] FPI estimates that expanding Medicaid would save the state about $200 million annually,[43] and would benefit more than 570,000 uninsured adult Floridians.[44] Although there are no proposals to expand Medicaid this year, there is a statewide ballot initiative set for 2026.[45]

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COMMUNITY MENTAL HEALTH AND SUBSTANCE USE DISORDER SERVICES

The Department of Children and Families administers funding for community mental health and substance use disorder (SUD) services (collectively referred to as behavioral health services) through seven not-for-profit regional managing entities.[46] This funding is directed to their safety net program, which serves uninsured or underinsured people. A substantial portion of funding for this safety net program comes from two federal block grants: the Community Mental Health Block Grant and the Community Substance Abuse Block Grant.

This year, the total  budget for behavioral health services is $1.4 billion, an increase of $72.2 million as compared to FY 2024–25 .[47] While not a significant difference, this still reflects the increases from the 2023 session when the state adopted a new triennial plan for the delivery of behavioral health services.[48] The plan emphasizes that there is a growing need to improve access to and delivery of these services in Florida.

Florida’s budget contains “special categories” which include grants and aid for specific mental health and SUD projects. Notably, the enacted budget includes $41.6 million in general revenue for Children’s Action Teams (CAT) which provide community-based services to youth aged 11 to 21 with a mental health disorder or comorbid substance abuse diagnosis.[49] This funding matches last year’s, after the state planned to increase 30 new CATs between 2023 and 2026.[50]

Moreover, the budget includes a $505.8 million appropriation to community substance abuse services.[51] This is a $24.1 million increase in comparison to  the previous fiscal year.[52] The budget still reflects the increase in spending seen in FY 2023–24, which was partially attributed to new dollars that the state received as part of a high-profile lawsuit against pharmaceutical companies for wrongful conduct that contributed to the opioid crisis in Florida.[53] As a result of this lawsuit, Florida will receive more than $3.1 billion until 2040 to “abate or remedy the opioid epidemic.” These funds include $5 million in recurring funds to the Department of Children and Families to purchase emergency opioid antagonists—medications used to treat opioid overdoses—for emergency responders. Additional funds in this category include a $10 million recurring appropriation in general revenue for pregnant women who need residential treatment, outpatient treatment with housing support, outreach, detoxification, child care, and postpartum case management. The budget also authorizes $13 million in general revenue to support the Family Intensive Treatment (FIT) team model, designed to help families with parental substance abuse.

Although some of these funds for mental health and substance abuse services are recurring and receive funding each year, policymakers continue to rely on substantial non-recurring funds for recurring needs. In FY 2025–26, there are $24.2 million in non-recurring funds from the Opioid Settlement Trust Fund allocated for projects in Community Substance Abuse Services.[54] These projects include funding for nonprofits to conduct research studies on peer support, provide apprenticeship opportunities, and create resources to help find treatment in Florida. Another non-recurring fund in this category includes $22.5 million to fund a media campaign highlighting the dangers of substance misuse. Additionally, there are over 60 contracted projects in Florida that are currently funded to provide a wide range of mental health and substance abuse services throughout the state in local communities, and all are funded on a year-to-year basis.[55] When the non-recurring dollars are exhausted, it will create a funding and treatment “cliff” unless policymakers appropriate state funds to continue the increased service capacity. This creates uncertainty for providers on their capacity to keep delivering services and uncertainty for consumers as to whether they will have access to ongoing treatment.

LIVE HEALTHY UPDATES

Supplemental Health Care Appropriations in the “Live Healthy” Legislative Package

In 2024, the Florida Legislature passed one of the largest health packages in the history of the state. The “Live Healthy” legislative package included $1.1 billion in supplemental funding for health care services during FY 2024–25 and included funds to be spent over the following 10 years. These appropriations were included in four pieces of legislation: SB 7016, SB 7018, SB 330, and SB 1758.[56],[57],[58],[59]  

Most of the appropriated funds in SB 7016 were for Medicaid provider reimbursement rate increases. This included recurring appropriations to AHCA to increase rates for:

  • home and community-based services for persons with disabilities ($196 million);
  • private duty nursing services ($29 million);
  • therapy services ($34.2 million);
  • preventive care dental services ($34.9 million), and
  • behavioral analysis services ($13 million).

These recurring funds were set with the intention to retain and increase the number of Medicaid providers in the state by raising the amount of money they receive when providing these services. As of FY 2025–26, it is yet to be seen if these increases have, in fact, increased the number of providers available in the state. With additional Federal cuts to Medicaid this year, it will be important to follow this legislation over the long-term.

Significant appropriations were also directed to multiple state agencies to bolster Florida’s health care workforce, including $11.5 million in recurring funds to the Department of Children and Families, to enhance mobile response teams (MRTs) throughout the state. The goal of MRTs is to respond to those experiencing severe mental health crises, de-escalate the immediate cause, and provide families with community support.[60] In Florda, MRT services are provided by a team of licensed professionals, master’s level professionals, and paraprofessionals trained in crisis intervention skills. Currently, there are 53 mobile response teams that serve Florida’s 67 counties. Some entities, such as the Life Management Center of NW Florida, serve more than one county and have multiple teams. Bay, Calhoun, Gulf, Homes, Jackson, and Washington counties are all served by the same Mobile Response Team. Given this increase in funding, it will be necessary to track the success of these teams to prioritize bolstering care in the counties that need it the most.

Funds are appropriated this fiscal year to the Department of Health (DOH) to continue the revolving loan program established in SB 7018 of Live Healthy ($50 million annually to DOH from FY 2024–25 through FY 2034–35).[61] The purpose of this is to implement innovations in technology, workforce, and health care. Rural hospitals or non-profits that accept Medicaid patients in rural areas are given priority consideration for these loans. To date, no loans have been issued under the program.

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HOME- AND COMMUNITY-BASED SERVICES WAITLISTS

Massive waitlists and slight annual increases for Home- and Community-Based Services (HCBS) have left thousands of Floridians languishing without care for years. Since the COVID-19 pandemic hit, the demand for HCBS has increased substantially, especially among older, homebound adults. Investing more in these programs now can help offset taxpayer costs in the long-term. Usually, as older adults wait to receive services, they spend what little savings they have, gradually becoming eligible for Medicare. At this stage of life, health care is the most expensive. Investing in preventative HCBS programs can reduce the need for other more costly services, such as institutional care.

Current waitlists include all seniors and people with disabilities who have been screened and determined to need services by the appropriate Aging and Disabilities Resource Center or the Agency for Persons with Disabilities(APD).

Funding allocations for FY 2025–26 will only marginally reduce the number of people on these waitlists.

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Unspent Funds for the iBudget Agency for APD Waitlist

The iBudget APD waiver provides a wide array of medical, social, behavioral, and residential services to individuals whose daily lives are severely hindered by a developmental disability present before adulthood. The program currently serves over 35,000 people, and as of August 2025, there are 20,769 individuals on this waitlist (also known as the pre-enrollment list).[62] This year, the Legislature appropriated no additional funds to move people off the waitlist. A comprehensive bill analysis for HB 1103, which passed in 2025, includes data showing that in recent years, APD has not been spending appropriations made by the Legislature for pulling people off from the waitlist and enrolling them in the iBudget program.[63] From FY 2019–20 through FY 2023–24, a total of $431.5 million reverted to the state. In 2024, the Legislature directed APD to move 400 people from the waitlist and appropriated an additional $38.8 million for this purpose. As of February 2025, only 56 of these people had been enrolled. It is projected that APD will revert $32.7 million in general revenue of its FY 2024–25 appropriation.

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AHCA Medicaid HCBS budget (IDD Pilot Program)

The IDD Pilot Program is a Medicaid Managed Care HCBS waiver program administered by AHCA. Prior to this year, it was only available to participants in certain counties in South Florida. Current enrollment is capped at 600 participants. With the passage of HB 1103, enrollment is now authorized statewide.[64] The FY 2025–26 budget provides an increase of $44.2 million in recurring funds ($18.9 million in state general revenue and $22.2 million in federal funds) to cover the cost of increased enrollment. The average annual capitation payment per enrollee—the sum AHCA will pay to the private managed care plan vendor for each enrollee—is $55,000. It is projected that this amount will fund approximately 806 additional enrollees in the pilot program.[65]

Other prominent waitlists and budgets include the following:

  • ‍$3 million in non-recurring funding to take approximately 206 people off of the Alzheimer’s Disease Initiative (ADI) waitlist.[66] This is half of the $6 million requested in the Department of Elder Affairs (DOEA) Legislative Budget Request (LBR). The ADI waitlist stands at 17,081 Floridians.[67] The ADI provides respite and support services to family caregivers of individuals living with Alzheimer’s disease and similar cognitive disorders. This funding will serve 1.2 percent of people on the waitlist. ‍
  • $4 million in recurring funding and $3 million in non-recurring funding to serve approximately 1,079 people on the Community Care for the Elderly (CCE) Program waitlist.[68] This is less than the $8 million requested in the DOEA’s LBR. There are 74,341 Floridians on the CCE waitlist, [69] and this will serve 1.5 percent of people on the waitlist.‍
  • $3.5 million to take approximately 910 people off of the Home Care for the Elderly (HCE) waitlist. [70] HCE is a DOEA program that provides subsidies to individuals caring for seniors in a private home setting. This is less than the requested $7 million in DOEA’s LBR. There are currently 21,755 seniors on this waitlist, which has grown since the last fiscal year.[71] This funding will serve 4.2 percent of people on the waitlist.

Proviso under the CCE and HCE waitlists states that $2 million allocated under each funding category will be prioritized for elders at “risk level five.” This determination is based on a statewide calculation that measures the likelihood of institutionalization due to physical health difficulties, daily living challenges, and caregiver availability.[72] The priority score calculation is based on a flowchart that asks questions about the caregiver, the client’s need for assistance, and the daily activities of the client.[73] A risk level five indicates that the client scored 46 points or higher on the screening tool, which then allows the individual to be moved to the proper care channels. If a client is found to be ineligible (scoring 29 or less on the scale), they may re-submit an application, but they are required to wait for a year to do so.

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PUBLIC HEALTH FUNDING

The FY 2025–26 budget funds the Florida Department of Health (DOH) at $4.1 billion,[74] a slight increase of $15 million compared to FY 2024–25.[75] This includes $1.2 billion for county health departments,[76] which is not a significant difference from the prior fiscal year’s $1.2 billion allocation.[77]

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SPECIAL SUPPLEMENTAL NUTRITION PROGRAM FOR WOMEN, INFANTS, AND CHILDREN (WIC)

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a federally funded program that provides healthy food and one-on-one nutrition counseling for pregnant, breastfeeding, and non-breastfeeding postpartum mothers with low income, along with infants and children under the age of five who are at nutritional risk.

The WIC program is associated with better overall health outcomes for infants and children who are nutritionally at risk. In addition, the program is also associated with reducing low-birth-weight rates and improving fetal and cognitive development.[78] In addition to giving children in families with low-income access to a more nutritious diet, WIC plays a role in improving school performance.[79]

The FY 2025–26 budget is roughly $423 million for WIC,[80] the same amount that was appropriated to the program in FY 2024–25. This funding comes exclusively from the federal government. Florida fails to serve over one-quarter of the people who are eligible for WIC,[81] and does not provide any state funds to expand access to the program.

Without more robust participation of eligible families in the program, the benefits of WIC will not be fully realized.  Ensuring the increase of WIC participation of eligible Floridians requires collaboration and strategic planning between lawmakers, state agencies, and health professionals alongside eligible families to explore impediments to participation and effective workable solutions.[82] Since many otherwise eligible families are still not being served, despite a modest increase in participation, Florida policymakers should be investing general revenue funds to explore specific reforms and analyze barriers that keep eligible families from participating in the program.

Fortunately, in the implementing bill to the FY 2025–26 budget, lawmakers authorize DOH to submit a budget amendment to access any increase in funds provided by Congress for WIC.[83]  

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TEMPORARY ASSISTANCE FOR NEEDY FAMILIES (TANF)

The TANF program helps families with very low income make ends meet by providing them cash assistance to pay for subsistence needs like toothpaste, diapers, rent, and utilities.

The FY 2025–26 budget appropriates roughly $85.5 million for TANF cash assistance payments,[84] a decrease of about $27 million from the FY 2024–2025 budget. Although the decrease is due to an anticipated decline in the TANF caseload,[85] state lawmakers have not addressed the urgent need for an increase in monthly benefits for individual families, as well as the possibility that need will increase if the state experiences a recession or wide-scale disasters during the 2025 hurricane season.

Florida lawmakers have kept TANF payments at the same level for over three decades. For example, since 2009, TANF payment levels have remained stagnant while the Federal Poverty Level has increased, making it harder for families to make ends meet. (Figure 2). Inflation has eroded the payment value by over 46 percent.[86] The maximum TANF benefit for families in Florida ($303/month for a family of three)[87] is under 14 percent of the federal poverty level, which is not a sufficient livelihood for families .[88]

Compared to the assistance that Florida provides to children for out-of-home care, lawmakers have done little to improve the financial assistance that Florida provides to children  for in-home care. In 2022, the Legislature—using TANF money[89]—increased payments to people caring for children who have been removed from their parents’ homes under a court order. However, none of the 2023, 2024 and 2025 Legislatures have increased monthly TANF cash benefits to parents who need help keeping[90]

Although increasing the money available to care for children who need help is a good investment, laws that only provide for better care of children until after they are no longer under their parents’ guardianship are the antithesis of family-friendly policies. Unless Florida lawmakers act, TANF benefits for families will only continue to fall further below the poverty line—to the detriment of children whose most basic needs go unmet.

Due to stagnant cash assistance levels, Florida’s TANF program is not fulfilling its intended purpose of promoting economic self-sufficiency and providing families with the necessary assistance required to keep their children out of foster care during personal hardships. Increasing TANF payment levels would help meet children's basic needs in families with low income.

The budget does not include adequate investment in meaningful support for TANF recipients to improve their education nor does it build the skills needed for stable employment. In the TANF program, most recipients who do not have a disability must participate in TANF employment and training (E&T) activities as a condition of eligibility, unless they have a good reason to be excused.[91] Nonetheless, many Floridians in TANF E&T either do not get the targeted education and training necessary to boost their employability, or they lose their assistance when significant obstacles—such as health problems, lack of child care, and inaccessible transportation—keep them from being able to attend the program.[92] The program should provide robust work support targeted to the needs of the individual family, instead of terminating cash assistance when barriers are insurmountable or subjecting participants to cookie-cutter E&T assignments.

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VETERANS AND THE MILITARY

The FY 2025–26 budget increases funding for the Department of Veterans Affairs (DVA) from $218.6 million in FY 2024–25[93] to $237 million after vetoes.[94] The department assists veterans in accessing benefits and operates long-term care facilities for veterans in Florida.

However, the budget includes a 22.8 percent decrease in funding for the Department of Military Affairs (DMA). Specifically, for FY 2025–26, lawmakers appropriated about $131 million for DMA,[95] which is $38.9 million less than the previous fiscal year’s appropriation of $169.5 million. Still, the Florida State Guard (FSG), which was appropriated $19.9 million for FY 2024–2025, is allotted $36.5 million,[96] with much of the increase in funding designated to contracted services.[97] Among other things, these contracted services are for supporting ongoing training and recruitment, maintenance, and the FSG’s Maritime.[98],[99][100]

As part of DMA’s appropriation, the Legislature funds the National Guard Tuition Assistance Program at just over $5 million,[101] the same as the previous fiscal year’s funding level.[102] The program assists National Guard members who are seeking undergraduate or certain postgraduate degrees.

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Notes

[1] Congressional Budget Office “Estimated Budgetary Effects of Public Law 119-21, to Provide for Reconciliation Pursuant to Title II of H. Con. Res. 14, Relative to CBO’s January 2025 Baseline,” July 4, 2025 https://www.cbo.gov/publication/61570

[2] Alice Burns, Jared Ortaliza, Justin Lo, Matthew Rae, Cynthia Cox, “How will the 2025 Reconciliation Bill Affect the Uninsured Rate in Each State? Allocating CBO’s Estimates of Coverage Loss” June 6, 2025 https://www.kff.org/affordable-care-act/issue-brief/how-will-the-2025-reconciliation-bill-affect-the-uninsured-rate-in-each-state-allocating-cbos-estimates-of-coverage-loss/

[3] H.R. 1 — 119th Congress, July 7, 2025, https://www.congress.gov/bill/119th-congress/house-bill/1. See also

Food Research and Action Center, U.S. Department of Agriculture, “Comparison of Senate & House Budget Reconciliation Proposals 2025,” https://frac.org/comparison-senate-house-budget-reconciliation-2025

[4] Katie Bergh and Dottie Rosenbaum, “House Agriculture Committee Proposal Would Worsen Hunger, Hit State Budgets Hard,” Center on Budget and Policy Priorities, May 13, 2025, https://www.cbpp.org/research/food-assistance/house-agriculture-committee-proposal-would-worsen-hunger-hit-state-budgets.

6 Under the reconciliation bill passed by Congress, states with extremely high error rates may have a reprieve until as late as 2030 before cost sharing of grocery benefits kicks in. See H.R. 1 — 119th Congress, July 7, 2025, https://www.congress.gov/bill/119th-congress/house-bill/1. Error rates are usually published annually in June for the previous fiscal year.  Food and Nutrition Service, U.S. Department of Agriculture, “SNAP Payment Error Rates,” https://www.fns.usda.gov/snap/qc/per

[6] Katie Bergh, Dottie Rosenbaum and Wesley Tharpe, “House Reconciliation Bill Proposes Deepest SNAP Cut in History, Would Take Food Assistance Away from Millions of Low-Income Families,” Center on Budget and Policy Priories, Ma 28, 2025, https://www.cbpp.org/research/food-assistance/house-reconciliation-bill-proposes-deepest-snap-cut-in-history-would-take

[7] Gina Plata-Nino, Food Research & Action Center, “House Republicans Advance Deep Cuts to SNAP, Shifting Costs to States While Hunger and Economic Pressures Mount,” Table, May 16, 2025, https://frac.org/blog/house-republicans-advance-deep-cuts-to-snap-shifting-costs-to-states-while-hunger-and-economic-pressures-mount#:~:text=States%20would%20begin%20paying%20at,obscure%20the%20long%2Dterm%20consequences

[8] Joseph Llobrera, Dottie Rosenbaum, and Catlin Nchako, “Senate Agriculture Committee’s Revised Work Requirement Would Risk Taking Away Food Assistance from More Than 5 Million People: State Estimates,” Center on Budget and Policy Priorities, June 27, 2025, https://www.cbpp.org/research/food-assistance/senate-agriculture-committees-revised-work-requirement-would-risk-taking

[9] Erica Monet Li, “US House Reconciliation Bill Would Strip Away Access to Health Care Coverage and Food Assistance for Many Florida Immigrants,” Florida Policy Institute, June 12, 2025, https://www.floridapolicy.org/posts/us-house-reconciliation-bill-would-strip-away-access-to-health-care-coverage-and-food-assistance-for-many-florida-immigrants

[10] Margot Dankner et al., “House Republican Reconciliation Bill Takes Away Health Coverage, Food Assistance, Tax Credits from Millions of Immigrants and Their Families,” Center on Budget and Policy Priorities, June 6, 2025, https://www.cbpp.org/research/immigration/house-republican-reconciliation-bill-takes-away-health-coverage-food

[11] Kaiser Family Foundation “State Health Facts: Health Insurance Coverage of the Total Population” https://www.kff.org/other/state-indicator/total-population/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Uninsured%22,%22sort%22:%22desc%22%7D

[12] Commonwealth Fund,”2025 Scorecard on State Health System Performance: Fragile Progress, Continuing Disparities” June 18, 2025 https://www.commonwealthfund.org/publications/scorecard/2025/jun/2025-scorecard-state-health-system-performance

[13] Kaiser Family Foundation, “How Many Uninsured Are in the Coverage Gap and How Many Could be Eligible if All States Adopted the Medicaid Expansion? February 25, 2025, https://www.kff.org/medicaid/issue-brief/how-many-uninsured-are-in-the-coverage-gap-and-how-many-could-be-eligible-if-all-states-adopted-the-medicaid-expansion/

[14] Latoya Hill, Nambi Ndugga, Samantha Artiga, Anthony Damico “Health Coverage by Race and Ethnicity, 2010-2023,”KFF , February 13, 2025 , https://www.kff.org/racial-equity-and-health-policy/issue-brief/health-coverage-by-race-and-ethnicity/

[15] Anne Swerlick, “If Florida Leaders Are Serious About Reducing Health Disparities They Must Expand Medicaid Now,” Florida Policy Institute, March 17, 2021, https://www.floridapolicy.org/posts/if-florida-leaders-are-serious-about-reducing-health-disparities-they-must-expand-medicaid-now

[16] Kaiser Family Foundation, “Mental Health and Substance Use State Fact Sheet,” 2023, https://www.kff.org/interactive/mental-health-and-substance-use-state-fact-sheets/  

[17] Mental Health America, Data and Rankings: Adults with AMI Who Are Uninsured 2024 https://mhanational.org/the-state-of-mental-health-in-america/data-rankings/access-to-care/

[18] Florida Behavioral Health Association, “Our Guiding Principles,” n.d., https://www.floridabha.org/.

[19] Florida Department of Law Enforcement, Medical Examiners Commission, “Drugs Identified in Deceased Persons: 2023 Annual Report,” pg. 2 January 2025 https://www.fdle.state.fl.us/MEC/Publications-and-Forms/Documents/Drugs-in-Deceased-Persons/2023-Annual-Drug-Report-FINAL.aspx .

[20] Florida Department of Children and Families, FY 25-26 Legislative Budget Request, pg. 177-179 http://floridafiscalportal.state.fl.us/Document.aspx?ID=28363&DocType=PDF

[21] Centers for Disease Control and Prevention “Disability and Health U.S State Profile Data for Florida (Adults 18+ years of age)” April 3 2025, https://www.cdc.gov/dhds/impacts/index.html .

[22] Department of Elder Affairs, “Florida State Plan on Aging 2026-2029,” Pending Draft 2025 pg. 5  https://elderaffairs.org/wp-content/uploads/DRAFT_FL_State_Plan_on_Aging_2025.pdf

[23] The Federal Poverty Level (FPL) for a household of three is $26,650.00 annually while the maximum annual TANF benefit for a household of three in Florida is $3,636—or 13.6 percent of the FPL. Compare Office of the Assistant Secretary for Planning and Evaluation,” Poverty Guidelines,” U.S. Department of Health and Human Services, https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines with   Fla. Stat.  414.095 (10), 2024, https://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0400-0499/0414/0414.html

[24] Approximately 2,936,427 of the estimated 23 million people living in Florida participate in SNAP. United States Department of Agriculture,” Supplemental Nutrition Assistance Program: Number of Persons Participating,” August 8, 2025, https://fns-prod.azureedge.us/sites/default/files/resource-files/snap-persons-8.pdf

[25] Chapter 2025-231, General Appropriations Act, Laws of Florida, line items 197-225, https://laws.flrules.org/files/Ch_2025-198.pdf

[26] Chapter 2025-231, General Appropriations Act, Laws of Florida, line items 197-216

[27]Agency for Healthcare Administration, “Florida Medicaid: Fast Facts for May 2025” https://bi.ahca.myflorida.com/t/FLMedicaid/views/MedicaidEnrollmentDashboardExternal/EnrollmentFastFacts?%3Adisplay_count=n&%3Aembed=y&%3AisGuestRedirectFromVizportal=y&%3Aorigin=viz_share_link&%3AshowAppBanner=false&%3AshowVizHome=n.

[28] Social Services Estimating Conference,”Medicaid Services Expenditures (In millions) State and Federal Share Calculations,” July 25th, 2024. http://edr.state.fl.us/content/conferences/medicaid/medexp_StateFederalShareWorksheet.pdf.

[29] Social Services Estimating Conference, “February 2025 Forecast Medicaid Caseload Summary,” http://edr.state.fl.us/content/conferences/medicaid/medcases_summary.pdf.

[30] Chapter 2025-231, General Appropriations Act, Laws of Florida, line items 179-184

[31] Chapter 2024–231, General Appropriations Act, Laws of Florida, line Items 181-186, https://laws.flrules.org/files/Ch_2024-231.pdf

[32] Social Services Estimating Conference, “Florida KidCare Program July 16 and 24, 2025 Executive Summary”, https://edr.state.fl.us/content/conferences/kidcare/kidcareexec.pdf  

[33] Social Services Estimating Conference, “Florida KidCare Program February 12 and 24, 2025 Executive Summary”, https://edr.state.fl.us/content/conferences/kidcare/archives/250224kidcareexecsummary.pdf

[34] Social Services Estimating Conference, “Florida KidCare Program December 10 and 17, 2025 Executive Summary,” https://edr.state.fl.us/content/conferences/kidcare/archives/241217kidcareexecsummary.pdf

[35] Kaiser Family Foundation, “Federal Medical Assistance Percentage (FMAP) for Medicaid and Multiplier, Timefame FY 2026 https://www.kff.org/medicaid/state-indicator/federal-matching-rate-and-multiplier/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D

[36] Medicaid and CHIP Payment and Access Commission, “Medicaid 101:Financing” https://www.macpac.gov/medicaid-101/financing/.

[37] H.R.2617 Consolidated Appropriations Act, 2023 U.S Congress https://www.congress.gov/bill/117th-congress/house-bill/2617/text

[38] Social Services Estimating Conference , “Medicaid Caseloads and Expenditures February 12, 25, and 25, 2025 Executive Summary” https://edr.state.fl.us/content/conferences/medicaid/execsummary.pdf

[39] Congressional Budget Office “Estimated Budgetary Effects of Public Law 119-21, to Provide for Reconciliation Pursuant to Title II of H. Con. Res. 14, Relative to CBO’s January 2025 Baseline,” July 4, 2025 https://www.cbo.gov/publication/61570

[40] Center for American Progress “The Big, ‘Beautiful’ Bill’s Health Care Cuts Would Drive Up Uncompensated Care and Threaten Vulnerable Hospitals” May 23, 2025 https://www.americanprogress.org/article/the-big-beautiful-bills-health-care-cuts-would-drive-up-uncompensated-care-and-threaten-vulnerable-hospitals/

[41] Kaiser Family Foundation,”Medicaid Income Eligibility Levels for Parents 2002-2025,”, 2025 https://www.kff.org/medicaid/state-indicator/medicaid-income-eligibility-limits-for-parents/?activeTab=map&currentTimeframe=0&selectedDistributions=january-2023&selectedRows=%7B%22states%22:%7B%22florida%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.

[42] Laura Guerra-Cardus, Gideon Lukens “Last 11 States Should Expand Medicaid to Maximize Coverage and Protect Against Funding Drop as Continuous Coverage Ends”, January 24, 2023 https://www.cbpp.org/research/health/last-11-states-should-expand-medicaid-to-maximize-coverage-and-protect-against#reduction-in-people-uninsured-and-cbpp-anchor.

[43] Florida Policy Institute, “Potential Budget Savings and Revenue Gains from Medicaid Expansion in Florida” June 24, 2019 https://www.floridapolicy.org/posts/potential-budget-savings-and-revenue-gains-from-medicaid-expansion-in-florida.

[44] Patrick Drake, Jennifer Tolbert, Robin Rudowitz, and Anthony Damico, “How Many Uninsured Are in the Coverage Gap and How Many Could be Eligible if All States Adopted the Medicaid Expansion?” February 26, 2024 https://www.kff.org/medicaid/issue-brief/how-many-uninsured-are-in-the-coverage-gap-and-how-many-could-be-eligible-if-all-states-adopted-the-medicaid-expansion/.

[45] Florida Decides Healthcare, 2025  https://floridadecideshealthcare.org/

[46] Florida Department of Children & Families, Managing Entities, https://www.myflfamilies.com/services/samh/providers/managing-entities

[47] Chapter 2025-231, General Appropriations Act, Laws of Florida, line items 352-370

[48] Florida Department of Children and Families, “Triennial Plan for the Delivery of Mental Health and Substance Abuse Services State Fiscal Years 2023-2024 and 2025-2026,” 2023, https://www.myflfamilies.com/sites/default/files/2023-06/Substance%20Abuse%20%26%20Mental%20Health%20Services%20Triennial%20State%20and%20Regional%20Master%20Plan%20%202023-2025.pdf.

[49] Chapter 2025-231, General Appropriations Act, Laws of Florida, line item 356.

[50] Florida Department of Children and Families, ”Triennial Plan for the Delivery of Mental Health and Substance Abuse Services State Fiscal Years 2023-2024 and 2025-2026”, 2023 https://www.myflfamilies.com/sites/default/files/2023-06/Substance%20Abuse%20%26%20Mental%20Health%20Services%20Triennial%20State%20and%20Regional%20Master%20Plan%20%202023-2025.pdf.

[51] Chapter 2025-231, General Appropriations Act, Laws of Florida, line item 359.

[52] Chapter 2024-231, General Appropriations Act, Laws of Florida, line item 374.

[53] John Guard, Chief Deputy Attorney General, “Opioid Settlements: Presentation to the Florida Senate Appropriations Committee on Health and Human Services” February 22, 2023 https://flsenate.gov/Committees/Show/AHS/MeetingPacket/5688/10137_MeetingPacket_5688_2.pdf.

[54] Chapter 2025-231, General Appropriations Act, Laws of Florida, line item 359.

[55] Chapter 2025-231, General Appropriations Act, Laws of Florida, line item 363.

[56] Chapter 2024-015, Health Care, Laws of Florida, https://laws.flrules.org/2024/15

[57] Chapter 2024-016, Health Care Innovation, Laws of Florida, https://laws.flrules.org/2024/16

[58] Chapter 2024-12, Behavioral Health Teaching Hospitals, Laws of Florida https://laws.flrules.org/2024/12

[59] Chapter 2024-014 Individuals with Disabilities, Laws of Florida https://laws.flrules.org/2024/14

[60] Florida Department of Children and Families, ”Mobile Response Teams” (MRTs), 2025 https://www.myflfamilies.com/services/samh/mobile-response-teams#:~:text=Mobile%20Response%20Teams%20(MRTs)%20are,school%2C%20or%20wherever%20they%20are.

[61] Chapter 2025-231, General Appropriations Act, Laws of Florida, line item 525A

[62] Agency for Persons with Disabilities, “Pre-Enrolment Numbers by Priority Category and County: As of 8/05/2025” https://apd.myflorida.com/publications/reports/docs/Preenrollment%20Website%20Reporting%2020250805.pdf

[63] Florida House of Representatives, “Final Bill Analysis CS/CS/HB1103: Services for Individuals with Disabilities” 2025 https://www.flhouse.gov/Sections/Documents/loaddoc.aspx?FileName=h1103z.HSS.DOCX&DocumentType=Analysis&BillNumber=1103&Session=2025

[64] Chapter 2025-130, CS/Cs/HB1103: Services for Individuals with Developmental Disabilities https://flsenate.gov/Session/Bill/2025/1103/BillText/er/PDF

[65] Florida House of Representatives, “Final Bill Analysis CS/CS/HB1103: Services for Individuals with Disabilities” 2025 https://www.flhouse.gov/Sections/Documents/loaddoc.aspx?FileName=h1103z.HSS.DOCX&DocumentType=Analysis&BillNumber=1103&Session=2025

[66] Chapter 2025-231, General Appropriations Act, Laws of Florida, line item 383. Based on calculations from the Department of Elder Affairs Legislative Budget Request of $14,563 per person, http://floridafiscalportal.state.fl.us/Document.aspx?ID=28393&DocType=PDF

[67] Florida Department of Elder Affairs, “Wait List/Priority List for Services, “February 25, 2025” https://fcoa.starchapter.com/images/waitlistreport_02252025__002_.pdf

[68] Chapter 2025-231, General Appropriations Act, Laws of Florida, line item 384. Based on calculations from the Department of Elder Affairs Legislative Budget Request of $6,488 per person, http://floridafiscalportal.state.fl.us/Document.aspx?ID=28393&DocType=PDF

[69] Florida Department of Elder Affairs, “Wait List/Priority List for Services, “February 25, 2025” https://fcoa.starchapter.com/images/waitlistreport_02252025__002_.pdf

[70] Chapter 2025-231, General Appropriations Act, Laws of Florida, line item 384. Based on calculations from the Department of Elder Affairs Legislative Budget Request of $3,846 per person, https://fcoa.starchapter.com/images/waitlistreport_02252025__002_.pdf

[71] Florida Department of Elder Affairs, “Wait List/Priority List for Services, “September 24, 2024” https://fcoa.starchapter.com/images/waitlistreport_09252024__002_.pdf

[72] Agency For Healthcare Administration, ”59G-4.193 Statewide Medicaid Managed Care Long-term Care Waiver Program Prioritization and Enrollment” https://ahca.myflorida.com/content/download/5953/file/59G-4.193_SMMC-LTC-Waiver_Prioritization_Enrollment.pdf

[73] Department of Elder Affairs, ”DOEA Priority Score Calculation” https://flrules.org/Gateway/reference.asp?No=Ref-07525

[74] Chapter 2025-231, General Appropriations Act, Laws of Florida, line items 409-556A.

[75] Chapter 2024-231, General Appropriations Act, Laws of Florida, line items 427-578.

[76] Chapter 2025-231, General Appropriations Act, Laws of Florida, line items 470-484.

[77] Chapter 2024-231, General Appropriations Act, Laws of Florida, line items 493-509.

[78] Steven Carlson and Zoë Neuberger, “WIC Works: Addressing the Nutrition and Health Needs of Low-Income Families for More Than Four Decades,” Center on Budget and Policy Priorities, January 27, 2021, https://www.cbpp.org/research/food-assistance/wic-works-addressing-the-nutrition-and-health-needs-of-low-income-families

[79] Steven Carlson and Zoë Neuberger.

[80] Chapter 2025-198, General Appropriations Act, Laws of Florida, Line Item 441

[81] FLHealthCHARTS, Women, Infants and Children (WIC) Eligibles Served (2023-2024), Percentage of WIC Eligibles, Single Year, Florida Department of Health, https://www.flhealthcharts.gov/ChartsDashboards/rdPage.aspx?rdReport=NonVitalIndNoGrp.Dataviewer&cid=65.

[82] Cindy Huddleston, “Declining Participation in Florida’s WIC Program: Strategic Planning Needed to Reverse the Downward Spiral,” Florida Policy Institute, May 19, 2020, https://www.floridapolicy.org/posts/declining-participation-in-floridas-wic-program-strategic-planning-needed-to-reverse-the-downward-spiral.

[83] Chapter 2025-199. An Act Implementing the 2025-2026 General Appropriations Act, Laws of Florida, Section 35, https://www.flsenate.gov/Session/Bill/2025/2502/BillText/er/PDF

[84] Chapter 2025-198, General Appropriations Act, Laws of Florida, Line Item 347

[85] Florida Office of Economic and Demographic Research, Social Services Estimating Conference Temporary Assistance for Needy Families, February 4, 2025, https://edr.state.fl.us/Content/conferences/tanf/tanfexec.pdf

[86] . Diana Azevedo-McCaffrey and Tonanziht Aguas, ”Continued Increases in TANF Benefit Levels Are Critical to Helping Families Meet Their Needs and Thrive,” Center on Budget and Policy Priorities, Updated Februaryu 26, 2025, https://www.cbpp.org/research/income-security/continued-increases-in-tanf-benefit-levels-are-critical-to-helping

[87] Section 414.095 (10), Fla. Stat. (2024).

[88] Compare the Federal Poverty Level (FPL) for a family of 3 ($26,650.00 annually) with Florida’s payment level for a family of 3 ($3,636 annually). Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation, HHS Poverty Guidelines for 2025, https://aspe.hhs.gov/sites/default/files/documents/dd73d4f00d8a819d10b2fdb70d254f7b/detailed-guidelines-2025.pdf

[89] Because of TANF’s block grant structure, Florida is allowed to redirect money that otherwise could be spent on income support for families to a broad range of other activities, such as child welfare and pre-K. Aditi Shrivastava and Maria Manansala, “To Strengthen Economic Security and Advance Equity, States Should Invest More TANF Dollars in Basic Assistance,” September 23, 2024, Center on Budget and Policy Priorities, https://www.cbpp.org/research/income-security/to-strengthen-economic-security-and-advance-equity-states-should-invest-0. While these programs are laudable, Florida now spends only about 16 percent of its federal and state TANF funds on cash assistance to TANF families.  Office of Family Assistance,” TANF and MOE Spending and Transfers by Activity, FY 2023: Florida,” November 7, 2024, https://acf.gov/sites/default/files/documents/ofa/fy2023_tanf_and_moe_financial_pie_charts_final.pdf

[90] Chapter 2022-069, Child Welfare, Laws of Florida,  https://laws.flrules.org/2022/68. Due to the 2022 increase, many households with children in out-of-home care can now receive as much as $621.77 per child per month, depending on the child’s age. And, unlike parents who are doing their best to care for their children themselves, benefits of many of the children in out-of-home care are automatically subject to annual cost of living increases.

[91] Department of Children and Families, Temporary Assistance for Needy Families Sate Plan Renewal: October 1, 2023 – October 30, 2026, December 28, 2023, https://www.myflfamilies.com/sites/default/files/2025-06/2023-2026%20Temporary%20Assistance%20for%20Needy%20Families%20%28TANF%29%20State%20Plan%20Renewal.pdf

[92] Florida Legislature, Office of Program Policy Analysis & Government Accountability “Mandatory Work Requirements for Recipients of the Food Assistance and Cash Assistance Programs,” January 8, 2018, https://bit.ly/2018OPPAGA.

[93] Chapter 2024-231, General Appropriations Act, Laws of Florida, line items 579-607.

[94] Chapter 2025-198, General Appropriations Act, Laws of Florida, line items 557-583

[95] Chapter 2025-198, General Appropriations Act, Laws of Florida, line items 2749-2798A

[96] Chapter 2025-198, General Appropriations Act, Laws of Florida, line items 2791 –2798A

[97] Chapter 2025-198, General Appropriations Act, Laws of Florida, line item 2797

[98] The Florida State Guard was created to “preserve the public peace, execute the laws of the state, enhance domestic security, respond to terrorist threats… respond to an emergency … or respond to any need for emergency aid to civil authorities. See Sec. 251.001(8), Fla. Stat. (2024), http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0200-0299/0251/0251.html

[99] The Florida State Guard was created to “preserve the public peace, execute the laws of the state, enhance domestic security, respond to terrorist threats… respond to an emergency … or respond to any need for emergency aid to civil authorities. See Sec. 251.001(8), Fla. Stat. (2024), http://www.leg.state.fl.us/Statutes/index.cfm?App_mode=Display_Statute&URL=0200-0299/0251/0251.html

[100] Department of Military Affairs, ”2025-26 Budget Issues, Appropriation Category: Special Categories  ~  Contracted Services,” http://www.transparencyflorida.gov/Info/BudgetIssues.aspx?FY=26&BE=62050600&AC=100777&Fund=1000&FundType=&LI=2797&SC=F&OB=Y

[101] Chapter 2025-198, General Appropriations Act, Laws of Florida, line item 2760

[102] Chapter 2024-231, General Appropriations Act, Laws of Florida, line item 3055

Re-employment Assistance (RA)

American Rescue Plan Act Changes. The American Rescue Plan Act of 2021 extended PEUC and PUA benefits through the week ending September 6, 2021. It also increased the maximum duration of PEUC benefits ($300 a week) to 53 weeks and the maximum duration of PUA to 79 weeks. Although PEUC and PUA did not end until September 6, 2021, Florida withdrew from the Federal Pandemic Unemployment Compensation Program (FPUC) effective June 26, 2021. FPUC provided persons who were out of work due to COVID-19 with an additional $300 a week in unemployment insurance.

Reemployment Assistance weeks reverted to 12 effective January 1, 2022. DEO determines the maximum number of weeks available to RA claimants based on a statutory formula that looks at the average unemployment rate for the most recent third calendar year quarter (i.e., July, August, and September). Based on the downturn in unemployment, the maximum number of weeks for RA reverted to 12 effective January 1, 2022.

RA work-search and work registration requirements reinstated on May 30, 2021. Persons filing an application for RA benefits beginning March 15, 2020, are not required to complete work registration in Employ Florida through May 29, 2021. In addition, work search requirements for individuals requesting benefits for the weeks beginning March 15, 2020, were also reinstated on May 30, 2021.

RA biweekly reporting requirements reinstated. Although previously waived, biweekly reporting was reinstated effective May 10, 2020. DEO’s guide to claiming weeks is here.

Mobile app deployed. DEO has deployed a mobile app for RA applications.

‍DEO announces extended benefits. DEO announced implementation of Extended Benefits (EB).

Resources and guidance. For a list of resources and guidance from the United States Department of Labor on unemployment insurance and COVID-19, go here.

For DEO’s “Reemployment Assistance Frequently Asked Questions and Additional Resources,” updated 12/30/2020, go here.

For DEO’s latest claims data, go here.

‍

Department of Children and Families (DCF) Multi-Program Policies

DCF opens offices. DCF has reopened its brick-and-mortar storefronts, which were previously closed  due to coronavirus.

DCF adds call center numbers. DCF has added a call center number for Monday through Friday, from 7 a.m. to 6 p.m. Call center numbers now include 850-300-4323, 866-762-2237, or TTY 1-800-955-8771.

Certification periods extended by 6 months only through August 2020. Certification periods for cash, food and medical assistance were extended by 6 months for individuals and families scheduled to recertify in April through August  2020. FNS’ approval of the SNAP extension for August is here.  However, effective September 1, 2020, SNAP, TANF and Medicaid recertifications have been reinstated, although DCF says that no one will lose Medicaid due to recertification.

‍DCF allows phone interviews. Phone interviews are now being used for TANF cash and SNAP food assistance.

Mandatory work requirements suspended only through May 2021. Under a directive from Governor DeSantis to waive work requirements for safety net programs, DCF  waived work requirements for individuals participating in the Supplemental Nutrition Assistance Program (SNAP) and Temporary Assistance for Needy Families (TANF) through May 2021. To do this, DCF explains that it partnered with the Department of Economic Opportunity to apply “good cause” statewide for TANF and SNAP recipients who would otherwise be subject to participation in mandatory work requirements as a condition of receiving those benefits. Through May 2021, persons who were sanctioned in the past due to work requirements will be able to reapply and participate in SNAP or TANF again.
‍

Work requirements were reinstated effective June 1, 2021.

Supplemental Nutrition Assistance Program (SNAP)

Emergency allotments (EA) ended. DCF automatically supplemented SNAP allotments of current recipients up to the maximum for a household’s size for July 2021. However, EA was discontinued beginning August 1, 2021.

The SNAP benefits increase by 15 percent ended in October 2021. Floridians who participate in SNAP to put food on the table will receive a temporary 15 percent supplement to SNAP under COVID relief passed by Congress and extended by the American Rescue Plan Act through September 2021.

FNS permanently increases SNAP through revamp of the Thrifty Food Plan. Effective October 2021, FNS has mandated a permanent increase to SNAP through a revamp of the Thrifty Food Plan. DCF says that the increase amounts to about 6% for Floridians.

Time limits suspended. SNAP time limits are suspended during the COVID-19 public health emergency. No one in Florida should be barred from SNAP due to time limits, even if they exhausted their time limit in the past.

Florida granted waiver to allow families to purchase groceries online. DCF has been granted a federal waiver to permit the State of Florida to launch a pilot project statewide effective April 21, 2020, that allows families to purchase groceries online with their Electronic Benefit Transfer (EBT) card instead of going into stores.

  • At present, participating retailers are Walmart, Amazon, Aldi, BJ’s Wholesale Club, and Publix. DCF cautions, however, that EBT cards cannot be used for delivery fees.

‍

Medicaid

No Medicaid terminations from March 2020 through the end of the federal public health emergency. The national public health emergency has existed since January 27, 2020 and has been renewed by the Secretary of the U.S. Department of Health & Human Services in 90-day increments since that time. The most recent renewal is effective January 16, 2022.

On March 31, 2020, AHCA alerted providers and DCF posted on the ACCESS website that:

  • No Medicaid recipient will lose Medicaid eligibility during the COVID-19 public health emergency (unless the individual is no longer a state resident or request voluntary termination); under the newly enacted Families First Coronavirus Response Act, a state is prohibited from ending coverage for recipients enrolled as of March 18th for the duration of the public health emergency if the state opts to obtain an enhanced federal Medicaid match.
  • AHCA is working to notify recipients who may have received a termination notice in the month of March that their benefits will be reinstated.
  • An FAQ released by federal CMS provides some examples of Medicaid eligibility groups  protected under these "no termination" requirements including: former foster care youth aging out when they turn 26; youth aging out of children's eligibility when they turn 19; individuals who become ineligible for SSI; individuals no longer qualifying for Qualified Medicare Benefits (QMB). In a May 5, 2020 update, CMS states that this “no termination” requirement also applies to medically needy individuals determined eligible during the public health emergency even if they do not continue to meet their monthly share of cost in subsequent months. This protection extends through the last day of the month the public health emergency ends.  
  • On October 28, 2020, federal CMS issued a new interim final rule weakening the continuous coverage, “no termination” requirement. In states like Florida that have opted to cover full benefits for lawfully residing children in the first 5 years after entry into the United States, once they turn 18, states are now required to limit their coverage to emergency services.  In addition, states are now permitted to reduce optional benefits such as dental coverage or increase cost-sharing such as requiring nursing home residents to contribute more to their costs of care. But in Florida this type of change would require the Legislature to amend state Medicaid law.  

Redetermination/recertification times are reinstated. As of October 1, 2020 AHCA's website is alerting recipients that the Department of Children and Families is now mailing letters for case reviews to check if a household is still eligible for Medicaid and/or Medically Needy. AHCA is urging people receiving these letters to take steps now to re-apply. But note, Medicaid coverage will not end during the COVID-19 Public Health Emergency. In January 2021 DCF conducted one-year “automated renewals” for people whose sole income is social security and SSI and are enrolled in an SSI-related Medicaid program (e.g., MEDS/AD,  Medically Needy and Medicare Savings Programs). People getting VA income were not included in the automated renewal.

Extended application time. Effective with applications filed in February 2020, the time for submitting documentation required to process an application is extended for 120 days from the date of the application and eligibility will still be effective the first day of the month the application was received. Effective July 1, 2021, this policy has been rescinded. Medicaid applications submitted on or after July 1, 2021 may be denied on the 30th day after application or the day after verification information is due. Applications filed prior to July 1, will be allowed 120 days to provide requested verification to establish Medicaid eligibility.

‍Exclusion of additional unemployment payments in determining eligibility. The $600/week of additional unemployment insurance payments under the CARES Act will not be counted as income in determining Medicaid eligibility. (However, these payments will be counted as income in determining marketplace subsidy calculations.)

Coverage of Medicaid services during the state of emergency

  • Coverage of all medically necessary services to COVID-19 testing and treatment.
  • Waiver of limits on services that must be exceeded to maintain the health and safety of recipients diagnosed with COVID-19 or when necessary to maintain a recipient safely in their home
  • Waiver of prior authorization requirements for hospital, physician, advanced practice registered nursing, physician assistant, home health services and durable medical equipment and supplies. As of June 19, 2020, AHCA reinstated prior authorization requirements for all of these services.
  • Waiver of copayments for all services
  • Waiver of limits on early prescription refills, except for controlled substances
  • Coverage of a 90-day supply of maintenance prescriptions when available at the pharmacy
  • Reimbursement of out-of-state providers providing medically necessary services to Florida Medicaid beneficiaries. As of July 1, 2021, the availability of provider “provisional enrollment” for in-state and out-of-state providers will end.
  • Delay of fair hearings only in those instances when the recipient is continuing to receive services pending the outcome of the hearing

COVID-19 Vaccines for Medicaid Enrollees. In an executive order published March 16, 2021 Governor DeSantis revised the vaccine distribution plan, which applies to the general public including Medicaid enrollees, to lower the age requirement to 40 effective March 29, 2021 and then effective April 5, 2021 all Floridians are eligible to receive any COVID-19 vaccination approved by the Food and Drug Administration.

Medicaid enrollees eligible to receive the vaccine may visit myvaccine.fl.gov to find a location distributing the vaccine and to schedule an appointment.

On March 12, 2021, AHCA published instructions for Medicaid enrollees on how to obtain Medicaid transportation once they have scheduled an appointment for a vaccine. AHCA states: "Florida Medicaid will take you to get the COVID-19 vaccine at no cost. All you need to do is set up a time to get your vaccine. Next, let your Medicaid plan know you need a ride and they will take care of the rest. If you are not enrolled in a plan, call the Medicaid Helpline at 1-877-254-1055 to find out the name and phone number for a transportation service."

The state has also recently launched a new email system to help bring COVID-19 vaccines to homebound seniors. Seniors will be able to sign up to have the vaccine come to them by emailing a request to HomeboundVaccine@em.myflorida.com.

AHCA has posted Medicaid Alerts and FAQs providing more detail on Medicaid service changes in response to COVID-19. They address a wide range of topics including, but not limited to: telemedicine guidance for medical, behavioral health, and early intervention services providers; long-term care provider network flexibilities allowing more types of providers to deliver specified long term care services; and continuity of care for adult day care center enrollees during the time these centers are closed.

AHCA is loosening coverage restrictions for behavioral health services. Effective May 5, 2020, all prior authorization requirements for mental health or substance use disorder treatment are waived and service limitations (frequency and duration) are lifted. For behavioral analysis services, current authorizations will be extended through an "administrative approval process" which does not require providers to reassess beneficiaries currently getting services. Effective July 1, 2021 service limits will be reinstated for behavioral health services and effective July 15, 2021 Medicaid prior authorization requirements will be reinstated for behavioral health services.

Per a May 29, 2020 provider alert, during the state of emergency AHCA will be reimbursing providers for telemedicine well-child visits provided to children older than 24 months through age 20. Providers are directed to actively work to schedule follow-up in-person visits to administer immunizations and other physical components of the exam which cannot be accomplished through telemedicine.  

The public charge rule will not be applied to immigrants’ use of Medicaid benefits for COVID-19 testing and treatment.

Coverage of home and community-based waiver services (HCBS) - In response to the public emergency, Florida obtained approval from the federal government to make changes in HCBS waiver programs, including the Long Term Care and Developmental Disabilities programs. The changes are effective retroactively from January 27, 2020 to January 26, 2021. Details can be found here. They include, but are not limited to:

  • permitting virtual evaluations, assessments and care planning meetings in lieu of face to face meetings and use of electronic signatures;
  • lifting service limits in order to address health and welfare issues of enrollees;
  • adjusting service prior authorization requirements;
  • temporarily expanding the settings where services can be provided;  
  • allowing payments for support services provided to enrollees in hospital or short- term institutional settings; and
  • prohibiting visitors in certain residential settings to minimize the spread of infection.

Note on COVID-19 testing, treatment, and vaccines for the uninsured. Florida has not opted to receive 100 percent federal Medicaid funding for COVID-19 testing of people without health insurance. Under the 2021 American Rescue Plan Act this option has been expanded to cover COVID-19 treatment and vaccines for the uninsured as well. Since the state has not taken up this option Floridians must look to an uneven patchwork of free testing, treatment, and vaccine resources scattered around the state. AHCA advises that uninsured people may receive free testing from their county health department or a federally qualified health center and that “many communities provide testing for free for individuals who do not have insurance. Please [click here] to find a test site in your area. Uninsured individuals should ask before the test whether testing is free of charge." There are no state agency instructions on where uninsured people can receive free treatment. However, more information on possible sources for free treatment is available here.

Residency proof no longer required at some vaccine sites, “paving the way for migrants.” - On April 29, 2021 Surgeon General Rivkees issued a new public health advisory specifying that COVID-19 vaccines are available to “a Florida resident” or someone “who is present in Florida for the purpose of providing goods or services for the benefits of residents and visitors of the State of Florida.” This new policy applies to all state-run and federally supported vaccination sites. It rescinds an advisory issued in January that had restricted vaccinations to people who could show proof of Florida residency

2021 unemployment compensation claimants can access free or reduced cost health insurance through the ACA marketplace. The Affordable Care Act (ACA) Marketplace was re-opened in February 2021 to give people who need health insurance a new “special enrollment" opportunity to get covered. The 2021 American Rescue Plan eliminated or vastly reduced premiums for many people with low or moderate incomes.

Starting July 1, 2021, people who received or have been approved for unemployment compensation for any week beginning in 2021 can access free or reduced cost comprehensive health insurance plans through the ACA marketplace. This benefit is available regardless of someone's current income. To get this benefit, people must enroll in the marketplace no later than August 15, 2021. For help with enrollment, contact Covering Florida at 877-813-9115.

Child Nutrition Programs

School children in distance learning still eligible for free or reduced cost meals. Students in distance learning for  2020-21 can still receive school meals through the National School Lunch Program if they are eligible. The student or parent/guardian may pick up meals at the school but should contact their school for more information.

For a list of current child nutrition program waivers for Florida from USDA, go here.

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

Congress allows increased fruit and vegetable benefits. At present, WIC provides $9 for children and $11 for women monthly for fruits and vegetables. The American Rescue Plan Act makes funding available for a four-month increase in the benefit of up to $35 monthly, if a state chooses to do so.

DOH attains waiver allowing remote issuance: Department of Health (DOH) obtained a waiver of the requirement that participants pick up their EBT cards in person at recertification or during nutritional education appointments.

‍WIC participants allowed to substitute certain food. Under a waiver from USDA, WIC participants in Florida are allowed to substitute milk of any available fat content and whole wheat or whole grain bread in package sizes up to 24 oz. when 16 oz. packages are unavailable.

‍USDA waived physical presence requirements: Although the scope and logistics are unclear at this time, USDA has given DOH permission to waive the requirement that persons be physically present at each certification or recertification determination in order to determine eligibility under the program through May 31, 2020.

USDA extends certification periods through May 31, 2020, for some participants.

For a list of current WIC waivers for Florida from USDA, go here.


Temporary Assistance for Needy Families (TANF)

HHS provides guidance. HHS has issued guidance on the flexibilities in TANF to respond to COVID-19.

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