Florida bill would force some on Medicaid to work but at what cost?

TAMPA, Fla. — Only the lowest paid Floridians qualify for Medicaid in the Sunshine State, the result of eligibility rules that are among the strictest in the nation.

A single mom with two children can only enroll her kids if her yearly salary is less than $38,000, roughly half of Florida’s average household income. She would be excluded from Medicaid herself, as is any parent who earns above $8,000 per year, or roughly one quarter of the federal poverty level.

And adults with no children? They’re ineligible no matter how little they earn unless they’re disabled.

The result is that the vast majority of the almost 4 million Floridians enrolled in the federal health benefit program are children, disabled individuals and adults who stay home to care for young children or the elderly.

Despite that, Florida may be about to adopt a work requirement program that critics say could violate federal law. It will likely cost millions of dollars to implement and enforce, though they say it would apply only to a tiny fraction of Medicaid recipients.

A bill that would require able-bodied adults on Medicaid to complete at least 80 hours of work or job training was passed by a Florida Senate health committee last month.

Sponsored by Florida Sen. Don Gaetz, the law is intended to take advantage of a provision in the Trump administration’s One Big Beautiful Bill Act, which requires states to mandate work requirements for Medicaid recipients.

It will help to establish a “work culture as opposed to a dependency culture,” Gaetz said during the meeting on Feb. 2.

“There’s got to be a distinction drawn between those who can’t get up off the couch and those who won’t get up off the couch,” Gaetz said.

Under the proposal, able-bodied adults who fail to meet the work requirement would be kicked off Medicaid. But critics say that makes no sense, since those who comply and take on extra work would then be at risk of losing their health coverage because they now earn too much.

“Such a policy would mean that very low-income parents and young adults are damned if you do and damned if you don’t,” said Joan Alker, executive director and research professor at the Georgetown Center for Children and Families.

The catch-22 scenario is because the work requirement provision of the Trump bill was designed for states that took advantage of additional federal funding via the Affordable Care Act. That money goes to states that expand Medicaid to adults who earn up to 138% of the federal poverty level — or $45,000 for a household of four.

Florida is one of 10 states that have not done so.

Under Gaetz’s bill, work requirements would apply to able-bodied adults under 64 who are not caregivers or whose children are 14 and up.

He said that would be around 147,000 adults, a figure his office said was provided by the Florida Department of Children and Families.

An estimate by the Florida Agency for Health Care Administration puts that number even lower, according to the bill analysis: about 112,000 recipients — less than 3% of all those on Medicaid.

Georgia implemented a Medicaid work requirement program in 2023.

Although it has not fully expanded Medicaid, Georgia allows adults who earn up to the federal poverty level to enroll provided they do at least 80 hours of work or job training per month.

The program, which had enrolled 8,000 people as of June, cost the state more than $100 million, according to a KFF Health News analysis of state reports.

Two-thirds of that cost was chalked up to administrative and operation costs, an analysis by the Georgia Budget and Policy Institute found.

“It’s falling flat on its face and failing,” said Leo Cuello, a research professor at the Center for Children and Families at Georgetown University.

Gaetz’s bill requires that several state agencies, including the Florida Agency for Health Care Administration, produce a joint business plan for Florida’s program by the end of this year.

The proposal needs legislative approval, a safety measure to ensure that it is an effective use of tax dollars, Gaetz said.

“We don’t want to do what Georgia did,“ he said.

Cuello has doubts that work requirement rules would be legal in a state that has not expanded Medicaid.

The One Big Beautiful Bill Act bars work requirements for individuals in traditional Medicaid categories, including parents who meet the low-income thresholds.

Florida’s plan would have to be submitted to the Center for Medicaid and Medicare Services as a waiver application. Cuello expects it would be denied.

“Florida doesn’t have a Medicaid expansion, so there’s no populations Florida can target,” he said.

A spokesperson for the Center for Medicaid and Medicare Services said the federal bill would allow all states to adopt a work requirement program.

Several health advocacy groups, including the American Cancer Society and Florida Voices for Health, have expressed concerns about vulnerable people suddenly losing health care coverage.

A daughter of a survivor of domestic violence, Acadia Jacob, an advocacy director with Florida Voices for Health, said women often flee from abusive relationships without a phone or a computer. They would struggle to provide the paperwork needed to prove they are working.

“Ultimately, if one pay stub is lost, one form submitted late, one supervisor who can’t be reached, she and her kids risk losing access to their care,” she said. “I just want to encourage you all to be really careful about adding barriers, especially for those who are the most vulnerable, so that they don’t fall through the cracks.”