Central Florida advocates uplift effort to expand Medicaid in Florida

Hundreds of thousands of Floridians today without health insurance are caught in what’s known as a Medicaid coverage gap: Their incomes are too high for them to qualify for Medicaid, but not enough to qualify for federal subsidies to help them afford private insurance.

This is because Florida is one of just nine states — all Republican-controlled — that haven’t expanded Medicaid, a public health insurance program, under the Affordable Care Act. Doing so would expand coverage eligibility to adults 18 to 64 whose incomes are at or below 138 percent of the federal poverty level. In 2024, that is just $20,782.

Currently, if you earn more than $19,392 as a single adult in a one-person household, you make too much to qualify for Medicaid in Florida. For a family of three, the cutoff is $33,064. The program also serves elderly adults, individuals with disabilities, children, and people who are pregnant.

A statewide effort is underway to close the gap. Advocates in Central Florida gathered Thursday afternoon outside of the Agency for Health Care Administration building in Orlando to uplift the need for Medicaid expansion — not only as a net good for the working-class adults and families it would directly benefit, but for the state’s rural hospitals and communities as a whole.

“Medicaid expansion would save our state upwards of $200 million a year, create hundreds of thousands of jobs,” said Acadia Jacob, MPH, advocacy director for the nonprofit Florida Voices for Health.

“But the reality is, Medicaid expansion is a literal lifeline to the hundreds of thousands, millions of Floridians who are already without access to care or at risk of losing it, as well as the critical health systems that serve them.”

Since 2020, five rural hospitals in Florida have closed, according to Jacob. Just 22 rural hospitals in the state remain. Of those that are left, 86% have closed their labor and delivery wards due to cost, she said — at a time when maternal and infant mortality rates are already high, and access to abortion care is being further restricted.

“The median drive time is 50 minutes for a pregnant person to get to a hospital in rural areas,” said Jacob.

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photo by McKenna Schueler

Dr. Jenna Ferreira, a clinical pharmacist, speaks in support of Medicaid expansion (April 3, 2024)

“It is not ethical nor patriotic, nor even smart business, to make healthcare inaccessible to the point where patients must choose between medicine and food.”

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Dr. Jenna Ferreira, a clinical pharmacist for a local hospital, explained the toll of unaffordable health care on the most vulnerable residents of local communities.

As an example, she shared the story of a 64-year-old woman she encountered recently in an emergency room, who presented with stroke-like symptoms and who was in a hyperintensive crisis, with a blood pressure almost twice that of a normal value.

The woman was homeless, said Ferreira, having been priced out of her longtime apartment due to a rent hike and evicted. She couldn’t afford her prescribed medication for diabetes, high cholesterol and high blood pressure, so she didn’t take it.

According to Ferreira, this put the woman’s body “into quite literal crisis.”

“Sadly, this story is not an isolated case, but rather a disturbing new norm,” said Ferreira, who has similarly advocated for Orange County’s push to cancel local residents’ medical debt, using leftover federal pandemic relief funds.

“I want to make it abundantly clear that it is not ethical nor patriotic, nor even smart business, to make healthcare inaccessible to the point where patients must choose between medicine and food, leaving their chronic conditions untreated,” said Ferreira.

Leaving chronic conditions untreated, she added, clears the way for problems to manifest into debilitating diseases and medical crises — issues that can be preventable with the proper medical care ahead of time.

Matthew Grocholske, a student activist at Rollins College and organizer with the local chapter of the Sunrise Movement, said he’s seen this in the area of mental health. In high school, he said, he saw many of his friends involuntarily committed to intensive psychiatric settings for mental health struggles that had reached a crisis point.

Under Florida’s Baker Act, children and adults can be committed to a psychiatric ward — without their consent — if they are at immediate risk for harming themselves or others.

That decades-old law saw some reforms from lawmakers this year, at least in part as a response to scathing reports highlighting the use of the law on young, often non-white children, with law enforcement officers sometimes literally dragging children from their elementary or middle school classrooms.

Grocholske, who has himself been Baker Acted, called the state’s mental health care system in Florida a “shame.”

For the young people who are unable to access mental health care to prevent a crisis, “that is something that is dysfunctional,” said Grocholske.

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photo by McKenna Schueler

Matthew Grocholske, a student activist at Rollins College and organizer with the local chapter of the Sunrise Movement, speaks in support of Medicaid expansion (April 3, 2024)

Central Florida Jobs with Justice — a coalition of local labor, faith and social advocacy organizations — organized the rally on Thursday to uplift an effort to get Medicaid expansion on the statewide ballot in 2026. The group also organized the push for medical debt relief in Orange County.

The Medicaid expansion effort, spearheaded by the political committee Florida Decides Healthcare, was officially launched in February.

According to the ballot summary of the initiative, the proposal aims to “provide Medicaid coverage to individuals over age 18 and under age 65 whose incomes are at or below 138 percent of the federal poverty level and meet other nonfinancial eligibility requirements, with no greater burdens placed on eligibility, enrollment, or benefits for these newly eligible individuals compared to other Medicaid beneficiaries.”

Florida Decides Healthcare, a campaign that’s years in the making, launched this effort two years ahead of time because advocates still need to get signatures from a minimum of 891,523 Floridians in support to place the initiative on the ballot.

The language of the ballot summary also needs to be approved by the Florida Supreme Court, which must determine that the summary is clear, unambiguous, and only pertains to a single subject so as not to confuse voters. If placed on the ballot, it would need to have support from at least 60% of voters to pass.

Advocates say opting into Medicaid expansion could help more than 1.5 million low-income Floridians who are uninsured. And because of how Medicaid expansion works under the Affordable Care Act, opting into the program would qualify Florida for federal aid that the state currently doesn’t receive.

That federal aid would cover 90% of the cost of expansion, while Florida would be responsible for the remaining 10%. Opting into Medicaid expansion, however, would also qualify Florida for an additional $2.8 billion over two years in federal Medicaid funding from the American Rescue Plan Act of 2021, according to the Florida Policy Institute, which has backed the Florida Decides Healthcare campaign.

Overall, the FPI — a progressive nonprofit — estimates that expanding Medicaid in Florida could altogether result in annual savings of roughly $200 million per year by, for instance, freeing up state revenue funds and reducing states for uncompensated health care.

Some advocates in support of Medicaid expansion see it as a basic first step towards recognizing healthcare as a human right. “Medicare expansion is simply a scratch on the surface,” said Ferreira, the pharmacist. “There will be no justice, no practice of medicine until we as a state and ultimately as a nation can recognize healthcare for the human right that it is.”

Others in attendance at the rally included representatives of the local labor unions Unite Here Local 737 and the Communications Workers of America Local 3108 — which represents staff of Central Florida Jobs With Justice — as well as Medicare for All Florida, faith leader Bishop David Maldonado, and groups like PoderLatinx that advocate for the needs of Hispanic and Latinx communities.

Local state Democrats in support of the initiative — Sen. Victor Torres and Rep. Anna Eskamani — also made appearances.

State Democrats have unsuccessfully tried to expand Medicaid through the state Legislature in the past, but as the minority party, even some bipartisan support for the idea hasn’t been enough to get it across the finish line, or even close to it.

At the start of the 2024 legislative session, state Senate President Kathleen Passidomo for her part said that Medicaid expansion won’t be coming to Florida if she has anything to say about it.

Advocates in other states have similarly faced challenges with their state lawmakers. In over a half-dozen states, — including Idaho, Maine, Missouri, Nebraska, Oklahoma, South Dakota and Utah — advocates have successfully taken the issue to the ballot box and won.

That’s what advocates in Florida hope to see here. “Whether by the ballot box or through the legislature, Florida will close the coverage gap,” said Jacob of Florida Voices for Health.

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