Florida Hasn’t Expanded Medicaid. Lawmakers Want To Add Work Requirements Anyway.
In states that have long refused to expand Medicaid to more low-income adults, people in the program are not subject to new One Big Beautiful Bill Act rules requiring them to prove they are working in order to get and maintain coverage.
That doesn’t stop Florida lawmakers from trying to pass Medicaid work requirements anyway. It’s the only legislative body in a non-expansion state to consider it so far.
“You have to go to work if you want your friends and neighbors to pay for your health care,” said Sen. Don Gaetz, the Republican sponsor of a Medicaid work requirement proposal moving through the Legislature.
The move baffles health care advocates and Medicaid experts. Some even doubt whether it is legal under the domestic policy law signed by President Donald Trump.
“You can’t change the working conditions,” said Leo Cuello, an attorney and professor at Georgetown University’s McCourt School of Public Policy, citing guidelines issued by the Centers for Medicare & Medicaid Services. For Cuello, the answer is clear: “It’s a pretty simple no.”
Medicaid work requirements affect Washington, D.C. and the 40 states that have expanded Medicaid eligibility to all non-disabled adults ages 19 to 64 with incomes up to 138 percent of the federal poverty level, as mandated by the Affordable Care Act. This represents an income of $22,025 per year for a single person.
Starting next January, these states must require people in their expansion groups to report at least 80 hours per month of work, education, or community service to qualify for and maintain Medicaid coverage.
About 4 million people are enrolled in Florida’s program, and Gaetz estimates that about 147,000 of them are adults who “could and should work.”
They “are able-bodied, do not have young children at home and do not take care of an elderly or disabled person,” he explained. “Yet they receive Medicaid benefits.”
Those affected by the Senate bill would primarily be parents of children 14 and older, as well as some aged 19 and 20, he said. A companion bill in the Florida House would apply Medicaid work requirements to parents of children ages 6 and older.
To qualify for Medicaid in Florida, a working-age adult without a disability must generally care for a child or older or disabled family member and cannot earn more than 26 percent of the federal poverty level, or about $592 per month for a family of three.
Most adults who are not disabled and receive Medicaid already work, and many people in low-wage jobs do not receive health insurance through an employer, according to KFF, a nonprofit health news organization that includes KFF Health News. Among single adults ages 19 to 64 in Florida who earned less than $15,000 a year in 2024, about 17% received health insurance through their jobs.
Critics say Florida’s proposal would likely force some people to become uninsured, even if they meet the work requirements. Indeed, the state’s Medicaid income limit is so low that working the mandatory 80 hours per month would likely put these people above the income eligibility limit, but would also leave them earning too little to qualify for subsidized coverage in the Affordable Care Act marketplace.
Michelle Mastrototaro said she lost her Medicaid coverage in November after taking a part-time job as a teaching assistant at a Tampa elementary school last year. Mastrototaro, 47, cares for a disabled teenage son and likely would not need to meet Florida’s proposed work requirements.
But she said her biweekly paycheck from working about 17 hours a week pushed her beyond the Medicaid income limit. Since then, she has struggled to pay for her prescription medications.
“What I do is nothing,” Mastrototaro said. “I’m just digging around to make ends meet.”
The Gaetz-led proposal ignores “the harsh realities of what it takes to qualify for Medicaid in Florida,” said Scott Darius, executive director of Florida Voices for Health, a nonprofit that advocates for Medicaid expansion. “At first glance,” he said, “this makes no sense. »
Medicaid experts say the federal budget reconciliation law says non-expansion states cannot adopt work requirements.
A state that hasn’t added more low-income adults to its Medicaid program can’t impose work requirements on those who already have coverage, Cuello said. States must cover specific categories of low-income people – such as children, pregnant women, certain parents, seniors and people with disabilities – to receive federal funding for their programs.
States that have expanded Medicaid eligibility to a limited group of low-income adults, namely Georgia and Wisconsin, will be required to impose work requirements on these enrollees.
Georgia’s partial expansion program, launching in July 2023, already includes a requirement for newly eligible adults to report at least 80 hours of work or community engagement. Federal approval for the program expires at the end of December and the state has requested an extension. Wisconsin’s program will have to implement a work requirement by January 1.
South Carolina in June sought federal approval to expand Medicaid eligibility to non-disabled parents and caregivers ages 19 to 64 who earn between 67 and 100 percent of the federal poverty level. That’s about $18,300 to $27,300 per year for a family of three. The state’s application is pending with CMS and, if approved, will implement work requirements for these newly eligible adults.
Gaetz said if Florida’s legislation is approved, the state would develop a “business plan” to implement the work requirements and seek approval from CMS.
It is unclear how much this would cost, but experience in states with Medicaid work requirements suggests that implementation would be costly. States should improve their eligibility and registration systems, hire additional staff, and inform the public about the new mandate.
For its program, Georgia spent about $54.2 million on administrative changes out of $80.3 million in total spending for the program from October 2020 to March 2025, according to a report from the U.S. Government Accountability Office. Most administrative expenses — about $47.4 million, or 88% — came from the federal government.
Georgia’s experience echoes that of others, according to a 2019 GAO review of states that received authorization to implement Medicaid work requirements under the first Trump administration. That report focused on five states – Arkansas, Indiana, Kentucky, New Hampshire and Wisconsin – and the estimated costs were $408 million. They ranged from $6 million in New Hampshire to more than $270 million in Kentucky, although those numbers do not reflect all of the state’s costs.
Florida’s IT infrastructure for collecting and verifying information and determining eligibility is more than 30 years old and is being replaced. This is expected to be completed in 2028 and cost more than $180 million.
A legislative analysis of Gaetz’s bill estimated that if one in four people affected by the proposed work requirement lost Medicaid coverage, the state could save about $80 million a year.
Darius, of Florida Voices for Health, said those potential savings are hardly worth it.
“It requires the state to build this giant regulatory framework, rebuild the systems and employ a whole group of people to track down the very small number of people who would ultimately be affected by this,” he said.
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