Constitutional amendment campaign for Medicaid expansion officially kicks off

Buoyed by the success of proposed constitutional amendments on recreational marijuana and abortion, Florida Decides Healthcare is re-upping its efforts to put Medicaid expansion on the ballot in November 2026.

“Today is the first day of the signature collection for the ballot initiative. We need to gather roughly 1 million signatures,” Florida Decides Healthcare Campaign Manager Jake Flaherty said.

Flaherty said he expects the effort to cost between $12 million and $18 million, but said the recent success of proposed constitutional amendments to protect access to abortion and to make recreational marijuana legal for adults has assuaged previous fundraising concerns.

To date, the campaign has raised $1 million for the efforts and has $200,000 on hand. Those figures, though, include funds raised in 2018 and 2019 during a previous effort to put the issue before voters. That push was thwarted by a combination of the COVID-19 pandemic and legislative changes designed to make it more difficult for citizen-led initiatives to appear on the ballot.

“We’ve got a good amount of fundraising to do but I think that we’ve got a lot of wind behind our sails here,” Flaherty said.

Florida is one of 10 states that has not expanded Medicaid coverage to low-income childless adults with earnings at or below 138% of the federal poverty level as allowed under the Affordable Care Act, the federal health care law often referred to as Obamacare.

Under the Affordable Care Act, the federal government pays 90% of the costs of expanding Medicaid to childless low-income adults; the states are responsible for the remaining 10%. The Florida Policy Institute (FPI) estimates that by agreeing to expand Medicaid, the state would save $200 million annually because of the increased federal funds, said FPI Chief Strategy and Development Officer Holly Bullard.

The $200 million figure, though, does not include the additional federal matching funds included in the American Rescue Plan Act passed in 2021. Congress agreed to bump the federal matching rate for Obamacare expansion by 5 percentage points for the first two years following a Medicaid expansion. Bullard said a Centers on Budget and Policy Priorities report shows that a 5-point enhancement would bring in an additional $2.8 billion over five years.

“It’s sort of like a signing bonus,” Bullard said. “This makes so much financial sense for states, which is why you’re seeing broad bipartisan support in other states engaging in this.”

House and Senate Democrats have supported the idea of an expansion. Rep. Joel Rudman, a Republican and physician from Navarre, has also come out in favor of expanding Medicaid.

But legislative leadership has been steadfast in its opposition to Medicaid expansion since an effort was made in 2016 to do so.

Senate President Kathleen Passidomo has made improving access to health care her top priority for the 2024 Session and has proposed what she calls “Live Healthy” legislation. The bill (SB 7016) focuses on fortifying the workforce through increased graduate medical education opportunities and contains hundreds of millions of dollars to increase the Medicaid rates paid to health care providers who treat the poor, elderly and disabled.

In her 2024 Session Opening Day remarks, Passidomo made clear the Senate would not include a Medicaid expansion in the bill, calling an expansion “nothing more than a false government promise” because the state’s workforce wouldn’t be able to handle the influx of patients.

“We’ve had the debate several times over the last decade. Medicaid expansion is not going to happen in Florida. It is not a quick fix. It is not a panacea. In fact, if you cannot actually schedule an appointment with a health care provider, Medicaid expansion is nothing more than a false government promise,” Passidomo said in her Opening Day remarks.