State Sen. Don Gaetz was not entertaining any arguments against work requirements for Medicaid recipients.
Gaetz, a Republican representing Escambia and Santa Rosa counties, presented his bill, titled “Public Assistance, to the Senate Committee on Appropriations on Monday. SB 1758 would make several changes to Medicaid in Florida and would require recipients to show proof of work, unless they fall into one of several exemptions.
“If they aren't doing those things and they're able to work, then they should work. And if they do, I think it's good for them, it's good for their children, it's good for their grandchildren,” Gaetz said.
"The reason I work is that my grandfather worked, my father worked, my mother worked, and my grandmother worked. So I work, and I think that's a noble thing to do.”
The committee voted 14-4 in favor of the bill. Opponents are concerned that work requirements may cause more harm than good.
What is SB-1758
The Public Assistance Act would do a number of things, including requiring Florida to ask the federal government for approval to establish a system of checking on the work status of Medicaid recipients and denying coverage for those without a job.
Why add a work requirement?
The language to add a work requirement follows the language in a new federal law, last year’s HR 1, the Big Beautiful Bill Act, signed into law by President Donald Trump last summer. Under the law, states that expand their Medicaid programs must add work requirements for able-bodied adults.
Florida did not expand Medicaid, and is not required to create a system to check on residents’ work statuses. However, Gaetz said those requirements would help the state save money on an able-bodied population receiving benefits and not contributing to the state.
Gaetz referenced a state analysis that found about 111,000 Medicaid recipients who were able-bodied and not employed.
“(These are people) who don't take care of small children at home, who don't take care of an elderly person at home, who don't take care of a disabled person at home, but who are receiving Medicaid benefits anyway,” Gaetz said. “Under this bill, if this bill passes, they would go to work.”
Potential problems
SB 1758 has several exemptions. Recipients 65 and older would not have to show proof of work; neither would someone with a disability, those residing in a nursing home, the terminally ill or low-income parents with small children up to 13 years old.
The recipients who would have to provide proof are low-income, able-bodied adults with children between 14 and 18 years old, said Joan Alker, executive director of the Center for Children and Families at Georgetown University.
In Florida, parents can qualify for Medicaid if their income doesn’t exceed 27% of the federal poverty line. That’s an annual income of about $8,000 for a family of four. Full-time work in Florida's minimum comes to $29,000 a year.
“If these parents get a job and meet the work requirement, they're going to earn too much money to be eligible for Medicaid, and they're going to lose their Medicaid,” Alker said.
“This is performative policy making,” she said. “It just doesn't make any sense.”
An amendment was added to the bill to allow for a 12-month grace period before losing Medicaid should a parent become employed, but the amendment only applies to parents with a child 6 years old or younger.
There’s another potential problem. Creating the work requirement might be against the law, Alker said.
Alker said that, according to the statutory language of HR 1, the work reporting requirement cannot be waived. She said that means states that don’t want to add the work mandate can’t apply for a waiver – they must add the mandate.
On the other hand, states, like Florida, that don't have Medicaid expansion can't add the mandate, , Alker said. “Technically speaking, Florida should not get a waiver to do this. The Legislature should not even be considering this.”
What else would the bill do?
SB 1758 would also authorize the Agency for Healthcare Administration to investigate Medicaid overpayments for fraud, expand home and community-based care for mental illness, expand the Medicaid pharmacy program to obtain drug rebates and reduce international costs, and require the Supplemental Nutrition Assistance Program to add photo IDs to EBT cards.
The photo ID was suggested way to deter fraudulent SNAP payments. Florida has a SNAP payment error rate of 15%. The state is required by HR 1 to reduce that rate to 6%; otherwise it could face a $1 billion fine.
What opponents said about SB 1758
Sen. Carlos Guillermo Smith, D-Orlando, expressed concerns about what might happen to a Medicaid recipient who develops cancer.
“They're working substantially less, or perhaps not working at all, because they're undergoing cancer treatment. How does this bill interact with those individuals who are seeking care?” Smith asked.
Senators and members of the public also expressed concern about the financial constraints of the Department of Children and Families, which would be overseeing the work requirements. In 2023, DCF was tasked with redetermining the Medicaid status of all recipients following the end of the COVID-19 public health emergency.
At least 1.3 million recipients lost Medicaid during the unwinding period, but reports show that 58% lost Medicaid for red tape reasons, such as not being able to contact DCF.
“Creating more paperwork and red tape and opportunities for eligible people to lose coverage because they miss a form or they miss a deadline is a risk that's too great,” Smith said.
Gaetz didn’t deny errors made by DCF in the past.
“But just because they may have problems in some of those areas, and they do, and we all know it, doesn't mean we should not do something when it's something is the right thing to do,” Gaetz said.
Should the bill become law, multiple state agencies would be tasked with creating a business plan on the feasibility of implementing the requirements. The plan would have to be turned in by the end of the year for review by the Legislature.
