A top Senate Republican say passing Medicaid work requirements will be an uphill battle.
Former Senate President Don Gaetz has been working with the administration of Gov. Ron DeSantis on making changes to Florida’s Supplemental Nutrition Assistance Program laws to bring the state in compliance with President Donald Trump’s signature One Big Beautiful Bill Act.
Those changes would exclude legally residing immigrants from participating in the food security program and require most people between the ages of 18 and 64 who don’t have a child under age 14 to work or take education training courses to continue to qualify for food assistance.
But Gaetz’s bill, SB 1758, goes beyond the federal law by including work and training requirements for certain Medicaid enrollees, a move decried by community groups and health care advocates.
According to a Senate staff analysis, the work requirements would affect about 111,000 Medicaid enrollees. They couldn’t be implemented without federal approval and additional approval from the Florida Legislature.
The House hasn’t included the work requirements in its companion legislation, HB 693.
Sen. Don Gaetz (via Florida Senate) Gaetz was less than optimistic Tuesday when asked whether he thought the work requirements would pass.
“It’s an uphill battle,” he told the Florida Phoenix.
When asked why, Gatez said: “Because we would have to negotiate with the House.” Republican leaders in both chambers have been at odds regarding each other’s priorities this legislative session.nThe Medicaid work requirements is one of those many differences.
HB 693 was passed by the House on March 3 by a 79-30 vote. The Senate bill cleared its last committee date this week and could be considered by the full Senate on Friday.
Scope of practice
Unlike the Senate bill, the House measure contains a number of “scope of practice” changes. That refers to statutory and regulatory duties and responsibilities of health care providers.
The House bill would expand the scope of practice for advanced practice registered nurses, including certified registered nurse anesthetists, and dental hygienists. Because of those provisions, the bill is opposed by organized medicine, including the Florida Medical Association and the Florida Dental Association.
The Florida Senate traditionally has killed scope of practice bills.
For example, the Senate Rules Committee this week essentially killed priority legislation — HB 363 — for House Speaker Daniel Perez when it delayed a vote on the bill on March 3. The bill would have created a new health care provider called dental therapists.
Because the Rules Committee is not slated to meet again, the bill died in the committee.
The House bill also would prohibit the state from making Medicaid payments to Planned Parenthood, as allowable under the federal law.
The Senate bill doesn’t contain the Planned Parenthood funding ban.
Meanwhile, the Senate bill proposes additional changes not included in the House measure, not the least of which is a section that, if passed, would blunt the impact of a pair of appellate court rulings that blocked the state from recouping Medicaid payments from hospitals that provided state pre-authorized emergency health care to undocumented immigrants.
The Senate bill also directs the state Agency for Health Care Administration to:
- Submit a waiver to the federal government requesting approval for a new home- and community-based behavioral health services program for adults with serious mental illness who are high users of services in institutional settings.
- Require its Medicaid Pharmaceutical and Therapeutics Committee to develop a preferred physician-administered drug list, preferred product list, and high-cost drug list.
- Hire a vendor to study use of the federal 340B Discount Drug Purchase program in Florida. Specifically, the bill directs the study to examine drug purchasing reimbursement, billing, coding, dispensing, and reimbursement and rebate interplay with the Medicaid program. The report must be submitted to the Legislature and governor by June 30, 2027. To ensure the analysis can be conducted, the bill directs AHCA to send out data requests to various stakeholders and gives the agency enforcement powers to obtain data.
Similarities
Both bills would expand SNAP work requirements to people up to age 64 and reduce the parental exemption to those with children under the age of 14. Existing Florida law has work requirements for SNAP beneficiaries up to age 59 and who do not have a child under age 18.
The Department of Children and Families, which administers the SNAP program, is directed under both bills to reduce Florida’s SNAP error rates, which include under- and over-payments.
Under the federal law, states with error payments greater than 6% will be on a hook for a portion of the food benefit costs. Florida’s error rate was more than 15% in 2024 and the state is on track for a 13% error rate. If not reduced, the state would be responsible or 100% of the food benefit costs, or about $1 billion.
Florida Phoenix is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Florida Phoenix maintains editorial independence. Contact Editor Michael Moline for questions: info@floridaphoenix.com.
