Fact-checking Nikki Fried’s claim about Florida’s Medicaid funding

Florida Agriculture Commissioner Nikki Fried, a Democratic candidate for governor, criticized the state’s Medicaid policies at a recent virtual town hall meeting.

Asked about the state’s Medicaid budget for developmental disabilities, Fried said that the program’s undersized funding says a lot about Florida’s legislative priorities. 

"It is disgusting that we are 49th in the nation when it comes to funding," Fried said about 20 minutes into the Feb. 21 event, which was hosted by the advocacy group Florida Voices for Health. "The fact that we are not doing it is such a disgrace to our state and shows where the priorities are not right now in a Republican Legislature."

Medicaid is a joint state and federal program to provide health insurance to the very poor. The program has long been a point of contention among Florida’s politicians. 

One of the state’s largest disputes related to the program is Medicaid expansion, which, if enacted, would extend the program’s eligibility to those with incomes up to 138% of the federal poverty level. 

To date, Florida is one of 12 states that has not expanded its Medicaid eligibility.

While the efficacy of Florida’s Medicaid program has been debated since the state adopted it in 1970, we wondered whether Fried’s characterization of the program’s funding for people with disabilities really fit the bill.

Data shows she’s right. 

One way to gauge the accuracy of Fried’s statement is to examine the latest data available for each states’ overall Medicaid spending. 

At first glance, Florida ranked fifth in the nation for overall Medicaid spending, at about $24 billion a year, according to the U.S. Centers for Medicare and Medicaid Services. When looking at the spending per capita, Florida ranks 10th.

Though these rankings seem notable, they do not present a full picture of the program’s funding. The sizable spending figure can mostly be attributed to Florida’s dense population, the third largest in the U.S.

To fairly compare Florida’s Medicaid spending with other states, experts said we should look at the state’s spending per enrollee. 

Only three states — Nevada, Georgia and South Carolina — spent less than Florida per enrollee in fiscal year 2019, per the Kaiser Family Foundation, or KFF.

While some states’ Medicaid budgets are funded 50/50 with state and federal dollars, Florida contributes less — its budget is 60% dependent on federal funding.

"Florida does okay by some of the people it considers most deserving," Scott Darius, executive director of Florida Voices for Health, told PolitiFact. "But we keep state funding to a minimum." 

Still, Fried’s broader point was specifically related to Florida’s Medicaid spending on services for people with disabilities. The person who asked her the question at the town hall also referenced the statistic as he described his experience being wait-listed for services through Medicaid.

Florida ranked 49th out of 50 states in per-capita Medicaid spending for intellectual and developmental disabilities, according to a 2019 report by the Florida Developmental Disabilities Council, a nonprofit research organization that drew from 2017 data. 

The Florida Policy Institute, a progressive-leaning research organization, cited this statistic in its 2020-2021 budget report and noted that the ranking has remained consistent for years now.

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The KFF also ranked Florida 49th out of 50 states and the District of Columbia in Medicaid spending for intellectual and developmental disabilities, at about $12,000 per enrollee in fiscal year 2019.

The funding for Florida’s iBudget Medicaid Waiver, a program designed to provide "medically necessary supports and services" to those with developmental disabilities, has decreased by about 10% annually since 2007.

More than 20,000 people with intellectual and developmental disability services are on a waitlist for Medicaid services, the Tampa Bay Times reported. Many have been on the list for several years. 

Though Florida has recently approved more funding for the iBudget waiver, experts contend that the state needs to do more to ensure that Floridians with developmental disabilities receive the assistance they need.

"It’s way overdue for Florida leaders to step up and make a significant investment to eliminate the waitlist for these essential services," said Anne Swerlick, senior policy analyst at Florida Policy Institute.

Florida’s legislature approved a $112.1 billion state budget on Monday, March 14, for the 2022-23 fiscal year. The final budget includes a $41.9 million appropriation to take about 789 individuals with intellectual and developmental disabilities off the waitlist, Darius told PolitiFact. "Other than that, the funding seems to have stayed steady."

Darius said Florida’s ranking on this measure was unlikely to change at this level of funding.

In response to a question about services to people with disabilities, Fried said Florida ranked "49th in the nation when it comes to (Medicaid) funding."

While the latest data ranks Florida fifth in the nation for overall Medicaid spending, the context of Fried’s statement was related to the state’s funding for intellectual and developmental disability services. 

Though Florida is spending a significant amount of money on its Medicaid program, the state is 49th in the U.S. regarding per-capita spending on services for people with disabilities. Since 2007, Florida’s fiscal effort for such services has decreased 10% annually.

We rate this claim True.