Saying he believes a distinction should be drawn between those who can work and those who can’t, a top Senate Republican wants to implement work requirements for Florida’s $38 billion Medicaid program.
To that end, former Senate President Sen. Don Gaetz has sponsored SB 1758, a 38-page bill that he says would require about 147,000 low-income, able-bodied, childless adults who rely on Medicaid for their health care to work 80 hours a month or be enrolled in a work training program.
If not, they would lose access to their health coverage.
“It seems to me as responsible stewards we need to look at ways to ensure that those people who really need Medicaid services get them at a time when tough choices have to be made,” Gaetz said during a Monday night committee meeting.
“And if able-bodied people who don’t have small children at home, who aren’t caring for an elderly person or a disabled person, I see no reason why we should turn to the taxpayers and say, ‘You have responsibility for paying for their health care services when they choose not to work.'”
Gaetz said he finds “value” in creating a “work culture” instead of a “dependency culture.”
“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,” he said.
Florida operates a $38 billion Medicaid program and, latest available data show, more than 3.95 million people were enrolled in it as of Dec. 31.
Placing work requirements on those recipients, Senate Democratic Leader and Health Policy Committee member Lori Berman argued, would establish a no-win scenario for the beneficiary.
“If you work 80 hours, even just 80 hours a month at minimum wage, that’s $12,000. You will no longer qualify for Medicaid,” Berman said.
Most minimum wage jobs don’t offer access to health insurance, which means they will be without health care coverage, she continued.
“So, if you do a requirement, we set up a Catch-22, where they are no longer going to have health insurance once you go to work,” Berman said. She added: “And if you don’t go to work, you’re going to lose coverage as a punishment.”
SB 1758 cleared the Senate Health Policy Committee by an 8-3 vote with Sens. Rosalind Osgood, D-Tamarac, and Tracie Davis, D-Jacksonville, joining Berman in voting against the measure.
In an effort to assuage some concerns, Gaetz said his legislation would require the Agency for Health Care Administration, which oversees Medicaid, to work with other state agencies to develop a plan to implement the work mandate. The legislation would require AHCA to submit that plan to the governor and Legislature by Dec. 1.
Ultimately, Gaetz said, the plan would require legislative approval before taking effect.
SB 1758, described as a “public assistance” bill, is in part a reaction to the One Big Beautiful Bill Act, which changed how Medicaid is financed and administered.
The the law requires Medicaid work requirements for states that expanded Medicaid to low-income, childless adults as allowable under the federal Affordable Care Act, often referred to as Obamacare.
Florida did not expand Medicaid, though, so the work requirements aren’t required under federal law.
The federal law did, however, expand the work requirements for residents who tap Supplemental Nutrition Assistance Program, or SNAP, benefits, and the bill requires states to match the federal requirements. Specifically, SB 1758 requires individuals aged 18 through 64 who do not have a child under the age of 14 to work or take education training courses.
Existing Florida law has work requirements for SNAP beneficiaries up to age 59 and who do not have a child under the age of 18.
The Department of Children and Families, which administers SNAP, would issue electronic benefit transfer (EBT) cards bearing photographic images of the recipients. Proponents say requiring a photo on the card could go a long way to prevent EBT “trafficking,” or selling food benefits for cash.
DCF, which had a 15.1% SNAP error rate in the most recent year with full data — a performance that, under the Big Beautiful law, would have required Florida to pay up to $1 billion toward the costs of the food benefit if not brought down. Error rates reflect administrative mistakes the result in either the underpayment or overpayment of benefits.
To avoid those increased costs, the Senate bill would require DCF to implement a statewide SNAP payment accuracy plan designed to reduce the state’s payment error rate to below 6%. The plan would be submitted to the Legislature and governor by July 15.
DCF also would be required for the next two years to submit quarterly reports to the governor and Legislature detailing the SNAP payment error rate, error trends, and corrective actions.
Not identicalThe House has included similar SNAP language, from work requirements to the mandate that DCF reduce the SNAP error rate to below 6%, in HB 693, which cleared the House Health Care Facilities & Systems Subcommittee last week.
The House bill is not identical to the Senate measure, though. For instance, it does not include work requirements for Medicaid enrollees.
The House bill would amend Florida’s Medicaid statutes to prevent payment to any “prohibited entity” in federal law, such as abortion providers like Planned Parenthood, for one year.
The Senate bill doesn’t contain that language.
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