Health Care
Tax Policy
Tax Code
Amendment 3 (2026)
local governments
By
Erica Monet Li, MPH, CHES®
|
August 27, 2026

Property Tax Cuts Under Amendment 3 Would Lead to Reductions in Services for Some Florida Hospitals

Key Takeaways: Amendment 3 would put funding for Florida’s public hospitals at risk. Florida’s public hospital districts and health systems would lose an estimated $323 million over the next three years if Amendment 3 passes.

In response to Gov. Ron DeSantis’ call for a special session on property taxes, the Florida Legislature passed House Joint Resolution (HJR) 1-F — and its companion Senate Bill (SB) 4-F — which would increase the state’s homestead exemption, reduce the assessment growth cap on non-homesteaded properties, and create a pathway for the full elimination of non-school property taxes on homesteads. The proposed amendment to Florida’s constitution will be in front of voters in the upcoming November 2026 general election.

If Amendment 3 passes in November, some public hospital districts in Florida will lose over half their revenue, resulting in less access to care, increased wait times, less staff availability, and decreased funding for community care and programs that serve Floridians with low income. Table 1 and Figure 1 below highlight the estimated losses for Florida’s public hospitals.[1]

The proposed amendment contains no plans to replace hospital revenue that would be lost as a result of cutting homestead property taxes. Currently, 28 hospital or health care taxing districts in Florida have the ability to levy property taxes. This ad valorem revenue is used to fund care for the underinsured and uninsured, also known as indigent care. Although every special taxing district does not currently utilize property taxes, they have the ability to raise millage rates, if needed, in order to provide for the functioning of the district’s hospitals, clinics, or other special health care programs. In some cases, special hospital districts do not directly operate hospitals and clinics, but contract with other community facilities to provide the needed care.  Each hospital taxing district is unique in terms of facilities, community served, and programs funded.

If Amendment 3 passes in November, some public hospital districts in Florida will lose over half their revenue, resulting in less access to care, increased wait times, less staff availability, and decreased funding for community care and programs that serve Floridians with low income

Baker County Hospital Authority

Estimated Loss: $1,048,799

The Baker County Hospital Authority is contracted to fund Baker County Medical Services, which is responsible for the operations and management of the Ed Fraser Memorial Hospital, Frank Wells Nursing Homes and its related facilities in order to provide health care to people in Baker County.[2] Approximately 96 percent of Baker County Medical Services’ revenue comes from property taxes.[3] Seventy-five percent of those funds are allocated to the hospital for funding indigent care, while the rest is utilized for administrative duties such as auditing.

Under the proposed property tax cuts, the overall revenue for the hospital district would decrease by $414,211 in FY 2027-28 and then by $634,588 in FY 2028-29, representing a total loss of over $1 million — or roughly 76 percent of its total hospital revenue — over the next three years. This hospital district already lacks an OB-GYN, meaning individuals cannot safely give birth in Baker County. Cuts of this magnitude are unprecedented, being that the lowest budget the authority has operated with under the last 17 years has been $775,000, which was during the Great Recession in 2009. It was able to receive those dollars by raising the millage rate in the county. At this moment, there have been no solutions to replace this critical funding for Baker County families.

North Broward Hospital District

Estimated Loss: $100,359,489

The North Broward Hospital District (NBHD), also known as Broward Health, consists of 25 facilities located throughout North Broward County. Its flagship facility, the Broward Health Medical Center, is the largest medical center in the county, with over 723 beds and a Level 1 trauma center.[4] In 2024, the center had over 95,000 emergency room visits, 3,490 births, and over 35,000 hospital admissions. NBHD’s mission includes strengthening the community, which is supported by various outreach initiatives, including funding healthy start programs, supporting nursing care in the community for pregnant and newly birthing mothers, and non-parent caregivers of children in the community.

NBHD is poised to lose $35.7 million in FY 2027-28 and $64.7 million in FY 2028-29, for a total loss of $100.4 million over three years. This is roughly 40 percent of its total property tax revenue, and 5 percent of the hospital district’s total revenue. The NBHD has decreased the millage rate over the past three years due to increased patient revenue and overall growth — resulting in a $17-million property-tax revenue decrease in FY 2026. Due to its nature of being located in a large, fiscally diverse community, NBHD will have more options to absorb the costs of Amendment 3. However, the $100.4 million loss due to Amendment 3 is still significant — and is over five times the amount of the $17 million property tax revenue decrease resulting from the millage rate reductions.

South Broward Hospital District

Estimated Loss: $2,205,296

The South Broward Hospital District (SBHD), also known as Memorial Healthcare System, is home to Memorial Regional Hospital, its flagship facility and one of the largest hospitals in Florida. It includes Memorial Cardiac and Vascular Institute, Memorial Cancer Institute, which treats more inpatients than any other in Broward County, and Memorial Neuroscience Institute.[5] Ad valorem revenue collected by this hospital district primarily goes to covering the costs of its governmental obligations, including the county’s mandatory Medicaid match, community redevelopment assessments, and the tax collector’s fee.[6] Like the NBHD, SBHD’s Board of Commissioners recently voted to reduce the millage rate, stating that the financial strength of the hospital resulting from patient charges and growth offsets some of the needed tax revenue.

SBHD will lose $783,505 in FY 2026-27 and then $1.4 million in FY 2028-29, leading to a total revenue loss of roughly $2.2 million over the next three years.

Indian River County Hospital District

Estimated Loss: $8,868,244

The Indian River County Hospital District (IRHD) is contracted to fund over 21 programs and facilities, each with specific needs that require their own allocations of ad valorem dollars. For example, the IRHD funds four programs at the Cleveland Clinic Indian River Hospital (CCIRH) Behavioral Health Center Intensive Outpatient Program, Behavioral Health Integration in the Emergency Room, Partners in Women's Health (PIWH) and the 12-month Month Maternity Sustainability Project.[7] A portion of its budget also covers the required county contribution to the federal Medicaid program, a requirement of every county in Florida. Currently, IRCHD receives 98.3 percent of its revenue from ad valorem taxes, 55 to 60 percent of which comes from homesteaded property taxes.[8],[9]

The passage of Amendment 3 would result in a loss of $3.2 million in FY 2027–28 and $5.7 million in FY 2028-29, a total loss of $8.9 million over the next three years. The direct result would be cuts to the many programs that serve the county of 170,000 residents for over 200,000 facility and program encounters each fiscal year. Aside from the CCIRH, critical programs that mitigate or help drug use, behavioral and mental health programs, violence prevention, and maternal and fetal health programs risk losing funding. Other challenges in this specific hospital district include the fact that there is only one Medicaid dental provider who might also not be sustained with budget cuts.

North Lake County Hospital District

Estimated Loss: $8,150,096

The North Lake County Hospital District (NLCHD) funds three hospitals including Advent Health Waterman, UF Health Leesburg, and Lifestream Behavioral Health. Other major operations funded by the hospital district include six clinics ranging from primary care to general community health. Over 90 percent of the funds from the NLCHD come from ad valorem revenue.[10]

NLCHD is poised to lose $2.9 million in FY 2027-28 and $5.2 million FY 2028-29, which is $8.1 million, or 88 percent of the hospital district’s total revenue. In turn, NLCHD would not have funds to invest in care for people who are underinsured on insured. UF Health Leesburg is currently in the process of creating a stroke center; however, it may not be able to continue investing in this project if the funds for the indigent care costs for the hospital are not offset by the NLCHD.[11] This hospital district’s main goals include providing care for people who are uninsured or underinsured, improving the long-term health of the community, and accommodating the growth of the county. Without these funds, the care of people in North Lake County will be adversely affected by the decrease in quality and timeliness of care, and there will be decreased room for growth.

Health Care District of Palm Beach County

Estimated Loss: $66,484,769

The Healthcare District of Palm Beach County (HCDPBC) funds a network of Community Health Centers; a Skilled Nursing Center; School Health team members that are staged in more than 170 public schools; a rural, acute care teaching hospital; two Trauma Hawk air ambulances; two ground ambulances for Health Care District patients; and quality control for the county’s trauma system.[12] In FY 2025-26, 70 percent of the district’s funding came from ad valorem taxes, which is the health care district’s largest revenue source. This covers up to 81 percent of the district’s total expenses.  These expenses include trauma care, school health services, behavioral health care, pharmacy services, primary care clinic operations, and more.

Under Amendment 3, HCDPBC would lose $23.2 million in FY 2027-28 and $43.3 million in FY 2028-29, a total loss of $66.5 million over the next three years. This loss equals 22 percent of the health care district’s total revenue.  Similar to other taxing districts, HCDPBC would have to grapple with large losses that would impact the services it is able to provide. The district maintains its commitment to serving the community and is actively monitoring legislative developments and evaluating their potential long-term financial impact. While any reduction in ad valorem revenue warrants careful planning, the district reports remaining financially stable and well-positioned to navigate potential changes responsibly.[13]

Halifax Hospital Taxing District

Estimated Loss: $9,970,036

Halifax Hospital Taxing District (HHTD) is the leading health care provider for Volusia and Flager counties. Its range of services is offered through a network that includes a tertiary hospital, two community hospitals, an urgent care network, psychiatric services, and a specialized cancer treatment center with multiple outreach locations. It is the area’s only provider of a Level Two Trauma Center, Center for Transplant Services, and a Pediatric Emergency Department that is staffed 24/7 by board certified pediatricians. It has collaborated with UF Health to bring over 14 specialties to the area.[14] Like other hospital taxing districts, the ad valorem funds collected by HHTD offset costs of indigent care — funding care for people serviced by the Halifax Health System who are under or uninsured. HHTD also provides a range of community benefit programs that include outreach programs to improve the public health needs of the community. In FY 2026, HHTD collected $22.2 million worth of ad valorem funds.[15]

Halifax Health is poised to lose $3.7 million in FY 2026-27 and $6.3 million in FY 2027-28, totaling nearly $10 million over the next three years.

Southeast Volusia Hospital Authority

Estimated Loss: $2,642,862

The Southeast Volusia Hospital Authority (SVHA) originally operated the Bert Fish Medical Center, levying taxes for the operations of this hospital. In 2014, The SVHA Board of Commissioners selected Adventist Health Systems’ proposal to acquire the Bert Fish Medical Center and has since provided roughly $3 million per year from an endowment created by the sale of the hospital.[16]  Bert Fish Hospital now operates as Advent Health New Smyrna Beach and has undergone several projects that include enhancement of the emergency room, surgical services, advancing IT, and privatizing patient rooms. The SVHA currently collects ad valorem taxes to offset indigent care costs, community programming, and legal fees.

SVHA has made an effort to reduce millage rates and still provide this funding. It is set to lose $976,073 in FY 2026-27 and $1.7 million in FY 2028-29, resulting in a total loss of approximately $2.6 million.

West Volusia Hospital Authority

Estimated Loss: $11,246,440

The West Volusia Hospital Authority (WVHA) funds a network of agencies and community programs to support low-income residents in the Hospital District. Funding includes operating expenses for Halifax Hospital and Advent Health, Primary and Emergency Room Care, the Florida Department of Health Dental Servies, and more. Funded agencies include Community Legal Services of Mid Florida, Life-Spire Community Services, Hispanic Health Initiative, Rising Against all Odds, and more.[17] Broadly, services range from supportive community health care, HIV/AIDS outreach, behavioral and mental health services, early autism diagnostic services, and more. Additionally, WVHA provides coverage through its primary care clinics for WVHA Health Card members, who are eligible if they have income up to 150 percent the Federal Poverty Level ($40,980 for a family of three).[18] In a memo to the WVHA Board of Directors, Chairman Rakeem Ford stated that based on estimates provided by the Volusia County Tax Collector's Office, the authority currently generates approximately $21 million annually through its 0.9897 millage rate.

If the homestead exemption is increased to $150,000, the authority is projected to lose approximately $4.2 million in annual revenue. To put that into perspective, that is roughly equivalent to the amount budgeted ($4.5 million) for specialty care services during the authority's 2025–2026 fiscal year. Under Amendment 3, the homestead exemption would increase again to $250,000 in the second year, resulting in an estimated annual revenue reduction of approximately $7.1 million. That amount is nearly equal to the authority's combined FY 2025–26 funding for specialty care services, Halifax Hospital services, and emergency room care, which total approximately $8.7 million. Because property tax revenue is the authority's primary source of funding, reductions of this magnitude could significantly impact the authority’s ability to support health care programs and services that benefit residents across the district.[19]

Hendry County Hospital Authority

Estimated Loss: $5,506,417

Hendry County Hospital Authority (HCHA) operates the Hendry Regional Medical Center located in Clewiston, Florida.  Although a majority of revenue for HCHA comes from patient charges, it collected over $16 million in ad valorem revenue in FY 2026, which helped to offset costs of charity care.[20] Hendry Regional Medical Center provides general medical and surgical care for inpatient, outpatient, and emergency room patients. It also participates in the Medicaid and Medicare program.

HCHA will lose $2.1 million in FY 2027-28 and then $3.4 million in FY 2028-29, totaling roughly $5.5 million towards its overall budget over the next three years.

Sarasota County Public Hospital District (Sarasota Memorial Hospital System)

Estimated Loss: $43,441,943

Sarasota Memorial Hospital System (SMHS) is one of the largest public health systems in America, consisting of 21 facilities, over 11,000 employees, and 2,500 physicians and advanced practice providers, and it sees approximately 2 million patients per year.[21] In FY 2026, SMH received nearly $109 million in ad valorem revenue that helped to offset more than $350 million in costs of mission-driven services and community programs.[22] As the region’s safety-net hospital, Sarasota Memorial Hospital carries a larger responsibility to provide essential and specialized care that other hospitals in the region do not. The flagship Sarasota campus is the only hospital in Sarasota County with a trauma center, and the only one that delivers babies and provides inpatient obstetrical care. It is also the only one with a neonatal intensive care unit, inpatient pediatric unit, and behavioral health hospital that serves people of all ages.

SMH is projected to lose $15.3 million in FY 2027-28 and then $ 28.1 million in FY 2028-29, a total loss of around $43.4 million over the next three years. Although tax revenue makes up less than 5 percent of SMH's $2 billion in operating revenue, it plays a critical role in supporting financial stability, community services, and capital investments. SMH reinvests all of its earnings into programs, services, and facilities that enhance and expand community access to high-quality care. SMH’s potential loss of $43.4 million would impact the hospital’s ability to improve operations.

The Special Case of Lake Shore Hospital Authority

The Lake Shore Hospital Authority (LSHA) is located in Columbia County and has not had an operational hospital since 2020. Although the authority formerly worked with an operator, Community Health Systems, to run the Shands Lake Shore Medical Center, the authority agreed to terminate the contract due to large financial losses.[23] As a result, the LSHA commissioners decided to lower the millage rate and remain functioning in case the opportunity does arise to open a public hospital in the county.  In FY 2019, before the closure of Shands Lake Shore Medical Center, the LSHA collected over $2 million in ad valorem revenue, which was spent on indigent care.[24] Should the LSHA find a contractor to operate another public hospital, these funds would help offset costs of indigent care in Columbia County.

The Special Case of Jackson Health System

Estimated Loss: $63,900,000

Jackson Health System (JHS) is an integrated health care delivery system serving hundreds of thousands of patients in Miami-Dade County. It differs from the average hospital taxing district because its Public Health Trust, which is a team of volunteers acting on behalf of the Miami-Dade Board of County Commissioners, do not levy taxes independently through millage imposed through property taxes, but receives funding determined by the county itself.[25] JMHS is composed of Jackson Memorial Hospital, Jackson South Medical Center, Jackson North Medical Center, Jackson West Medical Center, Holtz Children’s Hospital/The Women’s Hospital at Jackson Memorial, a network of UHealth Jackson urgent care centers, Jackson Behavioral Health Hospital, multiple primary care and specialty care centers, two long-term care nursing facilities, a team of corrections health services personnel, and the Christine E. Lynn Rehabilitation Center for The Miami Project to Cure Paralysis at UHealth/Jackson Memorial.[26] Under the terms of the operating agreement between the county and the trust, the county funded the trust at $325,338,000 and $296,092,000 during the years ending on Sept. 30, 2025, and Sept. 30, 2024, respectively, from ad valorem and non-ad valorem taxes to defray the costs of its general operations.[27]  These funds offset salaries, which in turn allow JHS to focus on other programs. For example, JHS as the county’s public hospital provides all inmate care in the county, which has annual costs of up to $92 million. Furthermore, JHS funds behavioral health services at approximately $24 million a year.[28] Due to the nature of providing indigent care, it would be difficult for other private health systems to serve the populations that the JHS invests in.  Based on Amendment 3’s measures, JHS would lose $34.7 million in the first year and $29 million in the second year, for a combined total of $63.9 million annually going forward.[29]

 

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Notes

[1] To estimate the impact on public hospitals, FPI used the Revenue Estimating Conference's (REC) July 10th, 2026, county-by-county analysis of House Joint Resolution 1F (Amendment 3). The REC's methodology can be found here. According to the REC, "for all parcels, the taxable value under the joint resolution scenario minus the taxable value under the baseline scenario are identified by taxing authority code ... and then multiplied by the respective non-school millage rates of the taxing authorities relevant to that taxing authority code (TAC) to produce the impact" (p. 683) As the conference adds, "the use of TACs allows the impact to be aggregated up to county, municipal, and special district specific impacts" (p. 683). Although the conference's results do not show the impact on public hospitals (a type of special district), as taxing authorities, these hospitals levy millage rates that are presumably included in the overall impact. As such, FPI used 2025 taxing authority codes and millage rates provided by the Department of Revenue to ascertain the millage rates associated with public hospitals across pertinent counties. With the understanding that the REC's impact employs taxing authority millage rates, FPI divided the conference's total impact for a county by the total millage across taxing authorities in that county to derive an impact-per-millage and multiplied that by a public hospital's millage rate. Therefore, the estimate represents the ratio of impact attributable to hospitals based on their millage rates. A key assumption and limitation is that all jurisdictions in a county have similar taxable value and therefore generate similar revenue for a county or public hospital. Therefore, estimates provided in this report may slightly differ from county calculations that have access to geocoded parcel data for special districts. To mitigate some of the bias, FPI cross-referenced self-reported revenue loss by hospitals and compared them to the estimates. Overall, FPI’s estimates offer a general baseline for hospital impacts.

[2] Lyons and Lyons Certified Public Accountants, “Baker County Hospital Authority Financial Statements and Independent Auditor’s Report, September 30, 2024,” https://bakercountyflhospitalauth.com/resources/audits/fy2023-2024-audit_bcha.pdf.

[3] Baker County Hospital Authority “Tentative Budget Summary FY 25-26,” https://bakercountyflhospitalauth.com/resources/budgets/budget-2025-2026_.8557--roll-back.pdf.

[4] Broward Health, Annual Statistics and Reports, “Broward Health Medical Center,” https://www.browardhealth.org/about-broward-health/community/annual-statistics-and-reports.

[5] Memorial Healthcare System, “About Us,” https://www.mhs.net/about.

[6] South Broward Hospital District, “Memorial Healthcare System Financial Report April 30,2026,” https://www.mhs.net/-/media/mhs/files/about-us/finances/2026/south-broward-hospital-district-dba-memorial-healthcare-system_26-fs_final.pdf.

[7] Indian River County Hospital District, “Indian River County Hospital District Budget Fiscal Year 2025-2026,” https://irchd.com/wp-content/uploads/2024/03/Final-approved-FY25-26-budget-for-posting.pdf.

[8] Indian River County Hospital District, “IRCHD Budget 2025-2026," https://irchd.com/wp-content/uploads/2024/03/Final-approved-FY25-26-budget-for-posting.pdf.

[9] IRHD Interview, Conducted by Erica Li, Florida Policy Institute, July 2026.

[10] North Lake County Hospital District 2024-2025 Approved Budget, https://www.northlakecountyhospitaldistrict.com/_files/ugd/327c8f_7c0970f2ddc9432fb09ca9cc68464759.pdf.

[11]  North Lake County Hospital District Commissioner, Interview by Erica Li, written notes, June 23, 2026.

[12] Health Care District of Palm Beach County, “Financials: Expenditures/Expenses,” https://www.hcdpbc.org/resources/financials.

[13]  Email Communications, Associate VP of Communications and External Affairs to Erica Li. July 2026.

[14] Halifax Health, “Halifax Health Named One of Becker’s Top Places to Work in Healthcare in 2026,” https://halifaxhealth.org/halifax-health-named-one-of-beckers-top-places-to-work-in-healthcare-in-2026

[15] Halifax Health District, “Fiscal Year 2026 Budget,” https://www.halifaxhealthdistrict.org/wp-content/uploads/FY2026_Budget_1st%20Public%20Hearing_9.17.25_FINAL.pdf.

[16] Advent Health, “Adventist. Health System acquires Bert Fish Medical Center, renames it Florida Hospital New Smyrna.”

[17] West Volusia Hospital Authority “About Us: Access to Healthcare Through Other Funded Agencies,” https://westvolusiahospitalauthority.org/about-us/.

[18] West Volusia Hospital Authority Health Card Program Eligibility Guidelines and Procedures Revised – June 18, 2026, https://westvolusiahospitalauthority.org/wp-content/uploads/2026/06/Guidelines-6-18-26.pdf.

[19] West Volusia Hospital Authority Chairman, Interview with Erica Li, Written Notes; Email Correspondence July 10, 2026.

[20] Hendry County Hospital Authority Budget Summary Fiscal Year 2026, https://www.hrmc.us/docs/FY2026.pdf.

[21] Sarasota Memorial Health Care System, “Community Report 2026,” https://online.flippingbook.com/view/691879064/.

[22] Sarasota County Public Hospital District, “Statement of Revenues and Expenses for the Year Ending September 30, 2026,” https://www.smh.com/Portals/0/Documents/Financial/Final_Adopted_Budget_2026.pdf?ver=DH34eEcqGLaRLZwWJSRJVQ%3d%3d.

[23] ABC 20 WCJB, “Lake Shore Hospital Authority Ends Agreement with Service Provider,” June 25, 2020, https://www.wcjb.com/2020/06/26/lake-shore-hospital-ends-agreement-with-service-provider/.

[24] Department of Financial Services, Special District- Lake Shore Hospital Authority, Annual Financial Report, 2019, https://logerx.myfloridacfo.gov/LogerX/SubmittedReports.

[25] Public Health Trust of Miami-Dade County, Florida A Department of Miami-Dade County, Florida: Financial Statements, Required Supplementary Information, and Schedules, September 30, 2025, and 2024. https://www.miamidade.gov/govaction/legistarfiles/Matters/Y2026/260403.pdf.

[26] Jackson Health System, “Who We Are,” https://jacksonhealth.org/about-us/.

[27] Public Health Trust of Miami-Dade County, Florida A Department of Miami-Dade County, Florida: Financial Statements, Required Supplementary Information, and Schedules, September 30, 2025, and 2024.

[28] Jackson Health System VP of Government Relations, Interview with Erica Li, written notes, July 13, 2026.

[29] Jackson Health System VP of Government Relations, Interview with Erica Li, written notes, July 13, 2026.

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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.

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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.
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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.

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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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