‍The state budget for fiscal year (FY) 2024-25 totals $116.5 billion after accounting for $949.6 million in vetoes, a decrease of over $2 million compared to prior-year funding. Concerning funding sources, the budget incorporates $48.6 billion in General Revenue Fund dollars, $30 billion from state trust funds, and $37.9 billion in federal funds.

Below, Florida Policy Institute summarizes the health and human services section of the budget, which includes appropriations for KidCare, Medicaid, WIC, TANF, and more.

Current Landscape

Florida ranks near the bottom on health coverage for children and adults.^[1] The state is also among the lowest on multiple rankings of health and wellness.^[2] Lawmakers have not expanded Medicaid to 570,000 uninsured residents with low income; consequently, one in five Floridians live in the “coverage gap,” meaning they make too much money to receive Medicaid and too little money to qualify for Marketplace insurance.^[3] This contributes to the growing racial health gap, exacerbating health disparities in communities of color.^[4],[5] This is especially significant as Florida has come to the end of a period known as the “Medicaid unwind,” which was required by the federal government. It refers to the ending of continuous insurance coverage that required states to allow individuals on Medicaid to keep their health insurance during the pandemic without having their eligibility checked.^[6]

During the Medicaid unwind, Florida disenrolled 1.4 million individuals from the program, which includes over 542,000 children.^[7] Because Florida does not offer a seamless transition to other forms of health insurance, it is unclear whether or not those who lost coverage during this time were transitioned to the marketplace, or if they now fall into the coverage gap. Enrollment in Florida’s Children’s Health Insurance Program (CHIP), known as KidCare, has not kept up with the number of disenrollments over the last year.^[8]

Although Florida has not expanded Medicaid or KidCare at this time, the Legislature took steps this year to bolster Florida’s health sector workforce as a means to access care by passing the “Live Healthy” legislation. This is the largest health care package passed in Florida’s recent history. While investing in the health care workforce is important, it should also come with opportunities to provide direct health care access to people with low income who do not have health insurance.

Florida lags far behind other states in investments for mental health and substance use disorder (SUD) treatment. In early February 2023, 32.3 percent of adults in Florida reported symptoms of anxiety and/or depressive disorder, and trends from 2022 suggest that among individuals who report these symptoms or disorders, 24 percent have unmet needs for counseling and therapy.^[9] Adding to the pressure on Florida's already-strained community mental health system is the state's very high rate of uninsured people with a mental illness. Mental Health America estimates there are 393,000 uninsured Florida adults with mental illness — the 11th-highest percentage in the country. Additionally, 12 Floridians die each day due to opioid overdoses.^[10] The most recent Medical Examiners Commission Annual Drug Report shows that in 2022, 44 percent of the deaths that were investigated by Florida’s medical examiners involved drug use.^[11] Florida’s state-run mental health facilities are currently understaffed, according to the Department of Children and Families’ latest budget request.^[12] In effect, individuals in Florida who are awaiting care are waiting for up to 15 days to receive the help they need for their SUD, and they are not receiving that help on time.

Although Florida has not expanded Medicaid or KidCare at this time, the Legislature took steps this year to bolster Florida’s health sector workforce as a means to access care by passing the “Live Healthy” legislation.

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 Floridians and residents with a disability 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.^[13] Furthermore, by 2030, Florida’s Department of Elder Affairs anticipates that over 30 percent of Floridians will be aged 60 or older, increasing the demand for these health care services.^[14] However, enormous HCBS waitlists in the tens of thousands grow substantially year after 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 safety net program for providing families with children the means to meet basic needs, does an inadequate job of reaching and assisting families struggling to make ends meet. 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, TANF benefit payments in Florida are only 14.6 percent of the federal poverty level (FPL), which puts Florida’s benefit payments in the bottom 10 among all states in the country. Since 1996, fewer families receive TANF cash assistance and, when adjusted for inflation, Florida’s TANF benefit levels have dropped 46 percent.^[15]

Supplemental Nutrition Assistance Program (SNAP) benefits are a critical safety net for the 13 percent of Floridians who participate in the program, often after experiencing hardships such as loss of income, divorce, or a medical crisis.^[16] Yet, policymakers are taking only a few steps to address food insecurity statewide, provide public assistance 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 

The total Health and Human Services (HHS) budget is $46.5 billion, a decrease of $759 million from the FY 2023-24 budget. (See Table 1.) Within HHS, Florida’s Medicaid program, which is administered by the Agency for Health Care Administration (AHCA), accounts for roughly $33.4 billion (72 percent) of the entire HHS budget — roughly 7 out of every 10 dollars in the HHS budget end up going to ACHA for Medicaid-related expenditures.^[17] AHCA uses most of these Medicaid funds, about $25.4 billion, for the Statewide Medicaid Managed Care program,^[18] which is responsible for providing care to over 4.3 million beneficiaries.^[19]  Finally, approximately 68 percent of the Medicaid budget is financed through federal funding. 

After years of decreases in federal government support due to the phasing out of enhanced FMAP to support higher caseloads during COVID-19, Florida has seen a leveling out of funds for Florida’s Medicaid program. (See Figure 1.)

Broadly, Florida’s Social Services Estimating conference expects a 4.9 percent decrease in spending on total Medicaid services in FY 2024-25 compared to FY 2023-24, from approximately $35 billion to $33.2 billion.^[20] Of those funds, the federal share decreases by 9.2 percent from $20.3 billion to $18.4 billion, while state spending would increase by 1 percent from $14.7 billion to $14.8 billion. Furthermore, the number of people enrolled in the Medicaid program is expected to decrease by 8 percent in FY 2024-25, from 4.8 million people to 4.4 million people.^[21]

KIDCARE 

The budget fully funds caseloads in the KidCare programs (Florida Healthy Kids, MediKids, and Children's Medical Services) at $787 million.^[22] This is a major increase from last year’s KidCare budget of $563 million.^[23] This is due to the Legislature’s decision to raise the income eligibility levels for the program, increasing the number of children who can be served. This increase in funds reflects the December 2023 estimating conference’s forecast for expenditures.^[24] These funds were allocated for FY 2023-24. However, because the implementation of the expansion has been delayed, the most recent projections for the KidCare program do not mirror those from the previous fiscal year. The latest Social Services Estimating Conference from July 2024 projects that $668 million will be spent on the KidCare program in FY 2024-25, without considerations for the expansion of the program.^[25] Broadly, this means that spending for the program will historically remain the same, while more children who could be served by the program wait for health care coverage.

MEDICAID

Medicaid spending in Florida is a combination of general revenue funds and federal money provided for the program. The federal share for most Medicaid service costs is determined by the federal medical assistance percentage (FMAP).^[26] During the COVID-19 pandemic, Florida’s Medicaid program received a higher FMAP because of rules that were put in place to keep individuals enrolled in Medicaid. The Consolidated Appropriations Act, put in place by the Biden administration in 2023, began to phase out the higher percentage of federal funds for the program.^[27]  (See Figure 1.) This phase out is reflected in the budget. The proposed Medicaid budget for FY 2024-25 is approximately $33.4 billion, $1.1 billion less (approximately 3 percent) than the previous year because of the offset of enhanced federal funds.^[28],[29] This matches the historical spending of the program.

MEDICAID EXPANSION

Florida is one of 10 states that has not provided health care access through Medicaid to adults with low income aged 19 to 64 who do not have minor children or a disability. Because Florida has a strict eligibility requirement that only covers parents up to 28 percent of the Federal Poverty Level,^[30] adults who do have children must currently make less than $7,230 annually to qualify for a three-person family.^[31] 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.^[32] FPI estimates that expanding Medicaid would save the state about $200 million annually,^[33] and would benefit more than 570,000 uninsured adult Floridians.^[34] If the state expands Medicaid, it would also receive $2.8 billion in incentive funding from the American Rescue Plan Act over the first two years.^[35] Although there are no proposals to expand Medicaid this year, there is a statewide ballot initiative that is set for 2026.^[36]

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.^[37] This funding is directed to their safety net program serving uninsured or underinsured people. A substantial portion of funding supporting 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 $1.3 billion budget for community mental health and SUD services is less than the FY 2023-24 budget by $190 million. This is not a significant difference and still reflects the increases from the 2023 session when the state adopted a new triennial plan for the delivery of mental health substance abuse services.^[38] The plan emphasizes that there is a growing need to improve access to and delivery of these services in Florida. This year’s budget does not include the non-recurring block grant funding of $67.7 million that was available last fiscal year for community mental health services and SUD services.^[39] That allocation was provided through federal COVID-19 relief, and it was designed to support a wide range of behavioral health treatment and recovery support services to reduce crime, overdoses, suicides, and unemployment and help break the cycle of hospitalization, homelessness, and incarceration among the most vulnerable Floridians.

The budget also contains “special categories” that include grants and aid for specific mental health and substance use projects. Notably, the enacted budget includes $41.6 million in general revenue for Children’s Action Teams (CAT) that provide community-based services to children aged 11 to 21 with a mental health or co-occurring substance abuse diagnosis.^[40] This funding matches last year’s after the state planned to increase 30 new CAT teams between 2023 and and 2026.^[41]

Moreover, the budget includes a $481.6 million appropriation to community substance abuse services.^[42] This is $52 million less than the previous fiscal year.^[43] However, the budget still reflects the increase in spending seen in FY 2023-24 that 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.^[44] As a result of this lawsuit, Florida will receive more than $3.1 billion until[1]  2040  to “abate or remedy the opioid epidemic.” 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 2024-2025, there is $22.5 million in non-recurring funds from the Opioid Settlement Trust Fund allocated for projects in Community Substance Abuse Services.^[45] 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. More non-recurring funds in this category include $18 million to fund a media campaign highlighting the dangers of substance misuse. Additionally, there are over 75 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.^[46] 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 

In addition to funding in the General Appropriations Act, the “Live Healthy” legislative package includes $1.1 billion in supplemental funding for health care services during FY 2024-25. These appropriations are included in four measures outlined below: SB 7016 (Chap. No. 2024-15, Laws of Fla.),^[47] SB 7018 (Chap. No. 2024-16, Laws of Fla.),^[48] SB 330 (Chap. No. 2024-12, Laws of Fla.),^[49] and SB 1758 (Chap. No 2024-14, Laws of Fla.).^[50]

SB 7016- Health Care ($717 million) 

Most of the appropriated funds are for Medicaid provider reimbursement rate increases. This includes 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)
• behavioral analysis services ($13 million)

Significant appropriations are also directed to multiple state agencies to bolster Florida’s health care workforce. This includes:

• Florida Reimbursement Assistance for Medicaid Education program ($30 million to DOH)
• Dental School Loan Repayment Program ($8 million to DOH)
• Training, Education and Clinical in Health (TEACH) funding program ($25 million to AHCA)
• Linking Industry to Nursing Education (LINE) Fund ($5 million to DOE)
• Slots for Doctors program funding 500 new physician residency slots ($50 million to AHCA)

There are additional appropriations to invest in direct health care services. This includes:‍

• Mobile response teams ($11.5 million to DCF)
• The Cinotti Health Care Screening and Services Grant program ($10 million to DOH)
• Telehealth Minority Maternity Care Program ($23.4 million to DOH)

Appropriations are also made to AHCA ($5.5 million) and DOH ($4.6 million) to increase staff needed to assist with implementation of the new law.

SB 7018  -  Florida Health Care Innovation ($51.2 million)

Funds are appropriated to DOH for support of the newly created Health Care Innovation Council ($250,000 for FY 2023-2024 and $1 million for FY 2024-25) and for a new revolving loan program to implement innovations in technology, workforce, and health care. Rural hospitals or non-profits that accept Medicaid patients in rural areas will be given priority consideration for these loans ($50 million annually to DOH from FY 2024-25 through FY 2034-2035).

SB 330 – Behavioral Health Teaching Hospitals ($313 million)

This legislation appropriates:

• $300 million in nonrecurring funds for a competitive grant program for behavioral health teaching hospitals, for use in $100 million increments over the next three fiscal years.

• $6 million in recurring funds for 10 newly created residencies through the Slots for Doctors Program at $150,000 per each newly created residency position, for the first four designated behavioral health teaching hospitals.

• $2 million in recurring funds for workforce development programs through the TEACH Funding Program, for the first four designated behavioral health teaching hospitals.

• $5 million in recurring funds to operate the Florida Center for Behavioral Workforce and the Louis de la Parte Florida Mental Health Institute. 

SB 1758- Individuals with Disabilities ($38.8 million) 

This legislation appropriates $38.8 million to APD to enroll more people with developmental disabilities in the home- and community-based Medicaid waiver program. Combined with the budget appropriation for FY 2024-25 there is a total of $120.5 million in additional funding to serve more individuals in this waiver program.

HOME- AND COMMUNITY-BASED SERVICES

Massive waitlists and slight annual increases for 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 down 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/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).

Massive waitlists and slight annual increases for HCBS have left thousands of Floridians languishing without care for years.

Funding allocations for FY 2024-25 will only marginally reduce the number of people on these waitlists. The budget includes:

• ‍$64.8 million to serve approximately 921 individuals on the Community Based Services Waiver waitlist (APD).^[51] There are 23,372 individuals on the waitlist. ^[52] APD 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.  

• $4 million in newly recurring and $2 million in nonrecurring funding to take approximately 412 people off the Alzheimer’s Disease Initiative (ADI) waitlist.^[53] The ADI waitlist stands at 17,174 Floridians.^[54]  ADI is a Department of Elder Affairs (DOEA) program that provides respite and support services to family caregivers of individuals living with Alzheimer’s disease and similar cognitive disorders. The waitlist has grown since last year by 1,022 people.‍

• $6 million in recurring funding to serve approximately 900 people on the Community Care for the Elderly (CCE) Program waitlist.^[55] This represents a significant permanent increase over current funding — triple the nonrecurring $2 million currently allocated. Still, neither proposal meets DOEA’s request of $10 million in recurring funds. There are 82,174 Floridians on the CCE waitlist, ^[56] and this would serve just 1.1 percent.‍

• $5 million to take approximately 1,349 people off the Home Care for the Elderly (HCE) waitlist. ^[57] HCE is a DOEA program that provides subsidies to individuals caring for seniors in a private home setting. There are currently 20,290 seniors on this waitlist, which has grown since the last fiscal year.^[58] This funding would only serve 6.6 percent of people on the list.^[59]

PUBLIC HEALTH FUNDING

The FY 2024-25 budget funds the Florida Department of Health at $4.1 billion,^[60] up from the FY 2023-24 appropriation of $3.9 billion.^[61] This includes $1.2 billion for county health departments,^[62] which is not a significant difference from the prior fiscal year’s $1.1 billion allocation.^[63]

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 to pregnant, breastfeeding, and non-breastfeeding postpartum mothers with low income, along with infants and children under the age of five at nutritional risk.

The WIC program is associated with better overall health outcomes for infants and children nutritionally at risk. In addition, the program is also associated with reducing low-birth-weight rates and improving fetal and cognitive development.^[64] In addition to giving children in families with low income access to a more nutritious diet, WIC plays a role in improving school performance.^[65]

The FY 2024-25 budget appropriates roughly $423 million for WIC,^[66] the same amount as was appropriated for the program in FY 2023-24.^[67] This funding comes exclusively from the federal government. Although Florida’s WIC program only serves about 69 percent of eligible people,^[68] it is expected that data will show a decline of over 16,000 people for March 2023 through March 2024, due, in part, to the end of COVID-era flexibility in program administration.^[69]

If the decline in participation of eligible families continues, the benefits of the WIC program will not be fully realized. Ensuring that WIC participation of eligible Floridians increases requires funding of collaborative strategic planning by lawmakers, state agencies, and health professionals, alongside eligible families, to explore impediments to participation and effective workable solutions.^[70] Because 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 2024-25 General Appropriations Act, lawmakers authorize DOH to submit a budget amendment to access increased funds provided by Congress for WIC in the March 2024 Consolidated Appropriations Act.^[71],[72] This increase in federal funding will allow Florida to offer WIC benefits to more Floridians.

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 2024-25 budget includes an appropriation of roughly $113 million for TANF cash assistance payments,^[73] a decrease of about $10 million from the FY 2023-24 budget.^[74] Although the decrease is due to an anticipated decline in the TANF caseload,^[75] 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 wide-scale disasters during the 2024 hurricane season.

Florida lawmakers have kept TANF payments at the same level for over three decades. As an 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. (Table 2). Inflation has eroded the payment value by at least 45 percent.^[76] The maximum TANF benefit for families in Florida ($303/month for a family of three) is 14 percent of the federal poverty level,^[77] which is not enough for families to make ends meet.^[78]

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 cared for in their own homes.  In 2022, the Legislature, using TANF money,^[79] increased payments to people caring for children who have been removed from their parents under court order. However, neither the 2023 nor 2024 Legislatures increased monthly TANF cash benefits to parents who need help to keep their families together.^[80]

Although increasing the money available to care for children who need help the most is a good investment, laws that only provide for better care of children after they are removed from their parents 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 the temporary help they need in hard times to keep their children out of foster care. 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 or build skills for stable employment. In the TANF program, most recipients who do not have a disability must participate in the TANF Employment and Training (E&T) program as a condition of eligibility unless they have a good reason to be excused. 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 or lack of child care and transportation, keep them from being able to attend the program.^[81] The program should provide robust work supports 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.

VETERANS AND THE MILITARY

The FY 2024-25 budget increases funding for the Department of Veterans Affairs (DVA) from $201 million to $218.6 million. The department assists veterans in accessing benefits and operates long-term care facilities for veterans in Florida.^[82]

However, the budget includes a 12.6 percent decrease in funding for the Department of Military Affairs (DMA). Specifically, for FY 2024-25, lawmakers appropriated $169.5 million for DMA,^[83] which is $24.5 million less than the previous fiscal year appropriation of $194 million.^[84] The Florida State Guard, which was appropriated $109.1 million in FY 2023-24,^[85] is only allotted $19.9 million for FY 2024-2025, ^[86] although the budget specifically allows for certain unexpended funds appropriated for DMA in FY 2023-2024 to be carried over to FY 2024-2025.^[87]  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.”^[88]

As part of DMA’s appropriation, the Legislature funds the National Guard Tuition Assistance Program at just over $5 million,^[89] the same as the previous fiscal year’s funding level. The program assists National Guard members who are seeking undergraduate or certain postgraduate degrees.

‍

Notes

^[1] 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.

^[2] Commonwealth Fund, “2023 Scorecard on State Health System Performance” https://www.commonwealthfund.org/publications/scorecard/2023/jun/2023-scorecard-state-health-system-performance June 22, 2023; Kaiser Family Foundation, State Health Facts, https://www.kff.org/statedata/.

^[3] Kaiser Family Foundation, “How Many Uninsured Are in the Coverage Gap and How Many Could be Eligible if All States Adopted the Medicaid Expansion? March 31, 2023, 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/.

^[4] Gideon Lukens and Breanna Sharer, “Closing the Medicaid Coverage Gap Would Help Diverse Groups and Narrow Racial Disparities,” Center on Budget and Policy Priorities, June 14, 2021, https://www.cbpp.org/research/health/closing-medicaid-coverage-gap-would-help-diverse-group-and-narrow-racial.

^[5] 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.

^[6] Erica Monet Li, “End of Continuous Coverage and What That Means for Medicaid in Florida,” February 16, 2023, https://www.floridapolicy.org/posts/end-of-continuous-coverage-and-what-that-means-for-medicaid-in-florida.

^[7] Georgetown Center for Families and Children, “What is the Impact of Unwinding on Medicaid Enrollment?” https://ccf.georgetown.edu/unwinding-enrollment-data/.

^[8] Erica Monet Li, “Map of Children’s Medicaid Coverage Loss in Florida,” Florida Policy Institute, May 15, 2024  https://www.floridapolicy.org/posts/map-of-childrens-medicaid-coverage-loss-in-florida.

^[9] Kaiser Family Foundation, “Mental Health in Florida,” 2023, https://www.kff.org/statedata/mental-health-and-substance-use-state-fact-sheets/florida/#:~:text=As%20shown%20in%20the%20figure,of%20adults%20in%20the%20U.S.

^[10] Florida Behavioral Health Association, “Our Guiding Principles,” n.d., https://www.floridabha.org/.

^[11] Florida Department of Law Enforcement, Medical Examiners Commission, “Drugs Identified in Deceased Persons: 2022 Annual Report,” January 2024 https://www.fdle.state.fl.us/MEC/Publications-and-Forms/Documents/Drugs-in-Deceased-Persons/2022-Annual-Drug-Report-FINAL-(1).aspx.

^[12] Florida Department of Children and Families, FY 24-25 Legislative Budget Request, pp. 288-290, http://floridafiscalportal.state.fl.us/Document.aspx?ID=26122&DocType=PDF.

^[13] Centers for Disease Control and Prevention “Disability and Health U.S State Profile Data for Florida (Adults 18+ years of age)” May, 13 2023, https://www.cdc.gov/ncbddd/disabilityandhealth/impacts/florida.html.

^[14] Department of Elder Affairs, “Florida State Plan on Aging 2022-2025,” August 5, 2021 https://elderaffairs.org/wp-content/uploads/FINAL-Florida-State-Plan-on-Aging-2022-2025-10182021.pdf.

^[15] 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, May 29, 2024, https://www.cbpp.org/research/income-security/continued-increases-in-tanf-benefit-levels-are-critical-to-helping.

^[16] Approximately 2.9 million of the 22 million people living in Florida participate in SNAP. United States Department of Agriculture, “Latest Available Month - May 2023, State Level Participation & Benefits: Persons,” August 9, 2023, https://fns-prod.azureedge.us/sites/default/files/resource-files/snap-persons-8.pdf; Census Reporter, Florida Profile, https://censusreporter.org/profiles/04000US12-florida/.

^[17] Chapter 2024-231, General Appropriations Act, Laws of Florida, line items 202-229, https://laws.flrules.org/node/9627.

^[18] Chapter 2024-231, General Appropriations Act, Laws of Florida, line items 202-220.

^[19]Agency for Healthcare Administration, “Florida Medicaid: Fast Facts for July 2024,” 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.

^[20] 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.

^[21] Social Services Estimating Conference, “July 2024 Forecast Medicaid Caseload Summary,” http://edr.state.fl.us/content/conferences/medicaid/medcases_summary.pdf.

^[22] Chapter 2024-231, General Appropriations Act, Laws of Florida, line items 181-186.

^[23] GAA FY 23-24 Line Items 176-181 https://www.flsenate.gov/Session/Bill/2023/2500/BillText/er/PDF.

^[24] Social Services Estimating Conference, “Florida KidCare Program December 4 and 21, 2023 Executive Summary," December 2023 http://edr.state.fl.us/Content/conferences/kidcare/archives/231221kidcareexecsummary.pdf.

^[25] Social Services Estimating Conference, “Florida KidCare Program July 10 and 24, 2024 Executive Summary,” July 2024, http://edr.state.fl.us/Content/conferences/kidcare/kidcareexec.pdf.

^[26] Medicaid and CHIP Payment and Access Commission, “Medicaid 101:Financing” https://www.macpac.gov/medicaid-101/financing/.

^[27] Georgetown Center for Children and Families, “Consolidated Appropriations Act, 2023: Medicaid and CHIP Provisions Explained”, January 5th, 2023 https://ccf.georgetown.edu/2023/01/05/consolidated-appropriations-act-2023-medicaid-and-chip-provisions-explained/#:~:text=Section%205131%20of%20the%20Consolidated,eliminated%20after%20December%2031%2C%202023.

^[28] Chapter 2024-231, General Appropriations Act, Laws of Florida, line items 202-299.

^[29] Chapter 2023-239, General Appropriations Act, Laws of Florida, line items 197-223, https://laws.flrules.org/2023/239.

^[30] Kaiser Family Foundation,”Medicaid Income Eligibility Levels for Parents 2022-2024,” 2024, 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.

^[31] U.S Department of Health and Human Services, ASPE ,”Poverty Guidelines” 2024 https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines.

^[32] 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.

^[33] 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.

^[34] 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/.

^[35] 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.

^[36] Florida Decides Healthcare, https://floridadecideshealthcare.org/petition.

^[37] Florida Department of Children & Families, Managing Entities, https://www.myflfamilies.com/service-programs/samh/managing-entities/.

^[38] 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.

^[39] Chapter 2023-239, General Appropriations Act, Laws of Florida, line item 383.

^[40] Chapter 2024-231, General Appropriations Act, Laws of Florida, line item 371.

^[41] 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.

^[42] Chapter 2024-231, General Appropriations Act, Laws of Florida, line item 374.

^[43] Chapter 2023-239, General Appropriations Act, Laws of Florida, line item 375.

^[44] 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.

^[45] Chapter 2024-231, General Appropriations Act, Laws of Florida, line item 374.

^[46] Chapter 2024-231, General Appropriations Act, Laws of Florida, line item 377.

^[47] Senate Bill 7016 Health Care, 2024, https://www.flsenate.gov/Session/Bill/2024/7016.

^[48] Senate Bill 7018 Health Care Innovation, 2024, https://www.flsenate.gov/Session/Bill/2024/7018/?Tab=Analyses.

^[49] Senate Bill 330 Behavioral Health Teaching Hospitals, 2024, https://www.flsenate.gov/Session/Bill/2024/7018/?Tab=Analyses.

^[50] Senate Bill 1758 Individuals with Disabilities, 2024, https://www.flsenate.gov/Session/Bill/2024/1758.

^[51] Chapter 2024-231, General Appropriations Act, Laws of Florida, line item 241. Based on Calculation from the Agency for Person with Disabilities Legislative Budget Request of $70,338 per individual in the program, http://floridafiscalportal.state.fl.us/Document.aspx?ID=26107&DocType=PDF.

^[52] Florida Center for Inclusive Communities at USF, “Floridians on the DD Waitlist,” January 2023, http://ddwaitlist.cbcs.usf.edu/.

^[53] Chapter 2024-231, General Appropriations Act, Laws of Florida, line item 398. 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=26152&DocType=PDF.

^[54] Florida Department of Elder Affairs, “Wait List/Priority List for Services," November 21, 2023, https://fcoa.starchapter.com/images/waitlistreport_11212023.pdf.

^[55] Chapter 2024-231, General Appropriations Act, Laws of Florida, line item 399. Based on calculations from the Department of Elder Affairs Legislative Budget Request of $6,680 per person, http://floridafiscalportal.state.fl.us/Document.aspx?ID=26152&DocType=PDF.

^[56] Florida Department of Elder Affairs, “Wait List/Priority List for Services, “November 21, 2023,” https://fcoa.starchapter.com/images/waitlistreport_11212023.pdf.

^[57] Chapter 2024-231, General Appropriations Act, Laws of Florida, line item 399. Based on calculations from the Department of Elder Affairs Legislative Budget Request of $3,706 per person, http://floridafiscalportal.state.fl.us/Document.aspx?ID=26152&DocType=PDF.

^[58] Florida Department of Elder Affairs, “Wait List/Priority List for Services," November 21, 2023, https://fcoa.starchapter.com/images/waitlistreport_11212023.pdf.

^[59] In Chapter 2023-239, General Appropriations Act, Laws of Florida, line item 402, policymakers appropriated $3 million in recurring funds from the General Revenue Fund (GRF) to serve elders on the Home Care for the Elderly (HCE) Program waitlist. The following fiscal year, in Chapter 2024-231, General Appropriations Act, Laws of Florida, line item 399, policymakers appropriated $5 million in recurring funds from the GRF to serve elders on the HCE Program waitlist. Together, the recurring appropriation for the HCE Program is set to be $9 million annually, which matches the allocation made in Chapter 2022-156, General Appropriations Act, Laws of Florida, line item 396, https://laws.flrules.org/node/8669.

^[60] Chapter 2024-231, General Appropriations Act, Laws of Florida, line items 427-578.

^[61] Chapter 2023-239, General Appropriations Act, Laws of Florida, line items 427-578.

^[62] Chapter 2024-231, General Appropriations Act, Laws of Florida, line items 493-509.

^[63] Chapter 2023-239, General Appropriations Act, Laws of Florida, line items 499-511.

^[64] 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.

^[65] Steven Carlson and Zoë Neuberger.

^[66] Chapter 2024-231, General Appropriations Act, Laws of Florida, line item 460.

^[67] Chapter 2023-239, General Appropriations Act, Laws of Florida, line item 471.

^[68] FLHealthCHARTS, Women, Infants and Children (WIC) Eligibles Served (2023), Percentage of WIC Eligibles, Single Year, Florida Department of Health, https://www.flhealthcharts.gov/ChartsDashboards/rdPage.aspx?rdReport=NonVitalIndNoGrp.Dataviewer&cid=65.

^[69] United States Department of Agriculture, Food and Nutrition Services, “WIC Data Tables, Annual State Level Data, Total Participation,” June 14, 2024, https://fns-prod.azureedge.us/sites/default/files/resource-files/27wilatest-6.pdf.

^[70] 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.

^[71] Chapter 2024-228, Implementing the 2024-2025 General Appropriations Act, Laws of Florida, Section 21, https://laws.flrules.org/files/Ch_2024-228.pdf.

^[72] Consolidated Appropriations Act, 2024, Public Law No: 118-42 (03/08/2024), https://www.congress.gov/bill/118th-congress/house-bill/4366/text.

^[73] Chapter 2024-231, General Appropriations Act, Laws of Florida, line item 362.

^[74] Chapter 2023-239, General Appropriations Act, Laws of Florida, line item 361.

^[75] Florida Office of Economic and Demographic Research, Social Services Estimating Conference Temporary Assistance for Needy Families, July 9, 2024, http://edr.state.fl.us/content/conferences/tanf/tanfforecast.pdf.

^[76] Gina Azito Thompson, Diana Azevedo-McCaffrey, and Da’Shon Carr, “Increases in TANF Cash Benefit Levels Are Critical to Help Families Meet Rising Costs,” Center on Budget and Policy Priorities, February 3, 2023, Appendix Table 1, https://www.cbpp.org/sites/default/files/atoms/files/10-30-14tanf.pdf.

^[77] Section 414.095 (10), Fla. Stat. (2022).

^[78] Compare the Federal Poverty Level (FPL) for a family of 3 ($25,830 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 2024, https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines.

^[79] 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.  Azevedo-McCaffrey and Safawi, 2022. While these programs are laudable, Florida now spends only about 19 percent of its federal and state TANF funds on cash assistance to TANF families. Center on Budget and Policy Priorities, Florida TANF Spending, 2021, https://www.cbpp.org/sites/default/files/atoms/files/tanf_spending_fl.pdf.

^[80] 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.

^[81] 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.

^[82] Chapter 2024-231, General Appropriations Act, Laws of Florida, line items 579-607.

^[83] Chapter 2024-231, General Appropriations Act, Laws of Florida, line items 3045-3097A.

^[84] Chapter 2023-239, General Appropriations Act, Laws of Florida, line item 3057-3108.

^[85] Chapter 2023-239, General Appropriations Act, Laws of Florida, line items 3095-3108.

^[86] Chapter 2024-231, General Appropriations Act, Laws of Florida, line items 3089-3097A.

^[87] Chapter 2024-231, General Appropriations Act, Laws of Florida, Section 244.

^[88] Chapter 2022-157, Implementing the 2022-2023 General Appropriations Act, Laws of Florida, Section 80, https://laws.flrules.org/files/Ch_2022-157.pdf.

^[89] Chapter 2024-231, General Appropriations Act, Laws of Florida, line item 3055.