Month: November 2024

Historical Context of Medicaid Funding in Florida Nursing Homes

Medicaid has long been the backbone of financing long-term care for seniors in Florida. Since the 1970s, Florida’s Medicaid program has covered nursing home care for low-income elderly who exhaust their savings. Over time, rising healthcare costs and demographic pressures have strained this funding. In 2009, for example, Florida implemented a nursing home “Quality Assessment” (provider fee) to draw additional federal funds and avert a massive budget shortfall. This move prevented a $231 million Medicaid funding gap that would have caused “significant financial instability, staff layoffs and the elimination of services” in nursing homes (FHCA Member Update | Florida Health Care Association). Throughout the 2010s, Florida also transitioned to a statewide Medicaid managed care system for long-term care, aiming to control costs while maintaining access. The state did not expand Medicaid eligibility under the ACA, focusing Medicaid resources on traditional groups (poor children, disabled, and elderly) (Florida FY 2024-25 Budget Summary: Health and Human Services). As a result, nursing home funding largely depended on state budgets and federal matching funds, without the extra boost some states received from expansion.

Key historical points:

• Reliance on Medicaid: Florida nursing homes have depended on Medicaid for decades. By the mid-2010s, Medicaid was paying for over half of all nursing home residents in the state (Facts About Long Term Care In Florida | Florida Health Care Association). (In FY2015 Florida’s Medicaid nursing home expenditures were about $3.47 billion (Medicaid’s Role in Nursing Home Care).) This entrenched Medicaid as the primary payer for elder care.
• 2008–2009 Fiscal Crisis: State revenue shortfalls threatened deep cuts to nursing home reimbursements. Lawmakers enacted a provider assessment in 2009 to generate matching federal dollars, avoiding a $231 million funding cut that would have hit facilities hard (FHCA Member Update | Florida Health Care Association). This helped stabilize funding during the Great Recession.
• 2017–2018 Payment Reforms: Florida’s legislature approved a new Prospective Payment System for nursing homes, changing how Medicaid funds are distributed among facilities. To ease the transition, the FY2019–2020 budget included a $23.5 million Medicaid rate increase (about $1.47 more per patient day) (Florida’s New Medicaid Math Creates Nursing Home Winners, Losers). This slight boost was meant to offset any facilities losing funds under the new formula.
• COVID-19 Era (2020–2021): The pandemic brought new challenges. Nursing homes faced higher costs for staffing and PPE, while occupancy dropped. Federal relief (e.g. enhanced Medicaid match rates and stimulus funds) helped Florida maintain nursing home funding despite economic strain. In 2021, Florida’s House initially proposed Medicaid cuts to nursing homes (given budget uncertainty), but the final budget avoided those cuts (Budget deal avoids health cuts, includes postpartum Medicaid extension) (Budget deal avoids health cuts, includes postpartum Medicaid extension). Instead, payments were kept intact thanks to recovering revenues and federal aid.

Overall, Florida’s history shows a pattern of Medicaid being critically important for elder care, with periodic state interventions to shore up funds rather than allow dramatic cuts that could destabilize nursing homes. Medicaid’s role grew as Florida’s senior population expanded and private long-term care insurance remained limited.

Current Medicaid Funding Levels and Recent/Proposed Cuts

Current funding: Florida has increased Medicaid funding for nursing homes in recent budgets, recognizing the needs of its aging population. The state’s FY2024–2025 budget included an 8% increase (about $247.8 million) in Medicaid payments for nursing centers (Breaking Down the Florida Medicaid Rate Increase). This hike – roughly $470,000 more per facility on average – is the largest ever in Florida and took effect in October 2024. It brought Florida’s total Medicaid nursing home budget to roughly $3.3 billion annually, supporting care for tens of thousands of residents. This investment aims to improve staff salaries, cover rising care costs, and prepare for growing demand (Breaking Down the Florida Medicaid Rate Increase) (Breaking Down the Florida Medicaid Rate Increase).

Despite the recent funding boost, Florida’s nursing homes remain wary because proposed cuts at the federal level could reverse these gains. Federal proposals: In 2023–2024, federal lawmakers have floated massive Medicaid reductions as part of budget negotiations. For example, a U.S. House budget resolution passed in 2025 calls for $880 billion in Medicaid cuts over a decade (House Passes Budget Resolution Cutting Billions From Medicaid Funding). Such cuts – amounting to ~25% of projected federal Medicaid spending – would dramatically shrink the funds flowing to states. Another leaked federal budget plan outlined up to $2.3 trillion in Medicaid cuts over 10 years (Groups Express Major Concerns With Leaked ‘Menu’ of $2.3 Trillion in Medicaid Cuts). If enacted, these proposals would force states like Florida to either fill the gap with their own dollars or scale back coverage and payments. Florida analysts warn that a per-capita cap or block grant approach (as discussed in these plans) would “limit the amount of money Florida could receive for its Medicaid program” by capping federal contributions (Groups Express Major Concerns With Leaked ‘Menu’ of $2.3 Trillion in Medicaid Cuts). The result would be intense pressure on Florida’s budget and likely cuts to provider payments or eligibility. As Joan Alker of Georgetown University noted, “There is simply no way that a state could manage their way out of these kinds of cuts… vulnerable people, including children and people in nursing homes, would be put at grave risk.” (Groups Express Major Concerns With Leaked ‘Menu’ of $2.3 Trillion in Medicaid Cuts)

State-level actions: At the state level, Florida’s recent trend has been to maintain or increase Medicaid nursing home funding, but proposals to cut have surfaced during tight budgets. In early 2021, both chambers of the Florida Legislature considered reducing nursing home reimbursements to save money (alongside hospital cuts), given concerns of a pandemic-driven revenue shortfall (Budget deal avoids health cuts, includes postpartum Medicaid extension). However, by session’s end these cuts were averted – the final budget kept nursing home Medicaid rates intact (Budget deal avoids health cuts, includes postpartum Medicaid extension). Legislators tapped into federal relief funds (e.g. American Rescue Plan dollars) and an improving economy to avoid slashing elder care funding (Budget deal avoids health cuts, includes postpartum Medicaid extension). Florida’s governor and legislature have generally prioritized protecting seniors’ services, so no major state Medicaid cut for nursing homes has been enacted in recent years. That said, future state budgets could come under strain if the economy falters or federal support decreases. Any significant cut in Florida’s Medicaid nursing home line-item would instantly affect virtually all facilities (as Medicaid is a payer in nearly all of them) and could lead to closures or service reductions. Thus far, Florida has chosen to invest more (as in 2024’s 8% increase) rather than cut, but advocacy groups remain on guard each budget cycle (Budget deal avoids health cuts, includes postpartum Medicaid extension).

Federal vs State funding dynamic: It’s important to note that Medicaid is a federal-state partnership – Florida’s spending is partially matched by federal dollars. Florida’s federal medical assistance percentage (FMAP) is roughly 58% for Medicaid (EXHIBIT 6. Federal Medical Assistance Percentages and Enhanced Federal Medical Assistance Percentages by State, FYs 2022–2025). This means for every $1 Florida spends, the federal government contributes about $1.38. Conversely, if Florida or the feds cut Medicaid funding, the state loses that matching money. For instance, a $100 million state cut could forego roughly $138 million in federal funds, reducing overall healthcare funding by ~$238 million. This matching structure amplifies the impact of cuts. It also means Florida has a strong incentive to maximize federal dollars (as seen in the 2009 provider assessment program). Proposed federal caps or funding reductions are especially concerning – Florida could lose billions in federal funds, forcing the state to either massively increase its own spending or make painful cuts in who/what is covered. In short, current funding levels are temporarily bolstered, but looming proposals threaten to shrink the Medicaid pie that Florida’s elderly depend on.

Medicaid Dependence Among Florida’s Nursing Home Residents

Medicaid is absolutely critical for Florida’s nursing home residents. As of the latest data, over half of all nursing home residents in Florida rely on Medicaid to pay for their care (Facts About Long Term Care In Florida | Florida Health Care Association). In 2015, approximately 57% of Florida’s 73,000 nursing facility residents were covered by Medicaid (Medicaid’s Role in Nursing Home Care). This percentage has likely remained above 50% through the late 2010s and 2020s, given demographic trends. In practical terms, that means roughly 40,000+ seniors in Florida’s nursing homes have Medicaid as their primary payer at any given time. The remaining residents are financed by Medicare (for short-term rehabilitation stays) or private pay (out-of-pocket or long-term care insurance). Medicare, which only covers limited post-acute nursing home care, accounts for about 19% of long-term care spending (Facts About Long Term Care In Florida | Florida Health Care Association), and those patients typically stay just weeks for rehab. Private-pay residents make up the rest, but many middle-class seniors deplete their assets quickly due to nursing home costs averaging $89,000–$100,000 per year in Florida (Facts About Long Term Care In Florida | Florida Health Care Association). Once they spend down their savings, they must turn to Medicaid.

Table 1 below summarizes Florida’s nursing home landscape and Medicaid’s role:

Table 1: Florida nursing home statistics and Medicaid reliance. Over half of Florida’s ~71k nursing home residents depend on Medicaid, which covers about 40% of all nursing-home spending (Facts About Long Term Care In Florida | Florida Health Care Association). (Data sources: Florida Health Care Association and Kaiser Family Foundation)

As shown above, Medicaid’s payments are a lifeline for a majority of nursing center residents. These are typically individuals who have outlived their financial resources or who were lower-income to begin with. Many Florida seniors “spend down” their assets on care until they qualify for Medicaid. Without Medicaid, most of these individuals would simply be unable to afford nursing home care, given the extremely high costs (nearly 3X the annual income of a typical senior) (Medicaid’s Role in Nursing Home Care) (Medicaid’s Role in Nursing Home Care). In fact, nationally “Medicaid covers 6 in 10 nursing home residents” (Medicaid’s Role in Nursing Home Care), and Florida is no exception to that heavy dependence.

It’s also worth noting that virtually all Florida nursing homes participate in Medicaid. Out of ~700 facilities statewide, only a handful (if any) forego Medicaid funding. Thus, any cut to Medicaid affects the entire nursing home sector in Florida, not just a subset. Medicaid is truly the safety net for long-term care: it picks up costs that neither Medicare nor private insurance cover for chronic nursing home stays. Florida’s Medicaid program for the elderly (sometimes called the Institutional Care Program) ensures that seniors who need 24/7 care can get it, even after their savings run out. Therefore, proposals to reduce Medicaid funding raise alarm in Florida because they directly threaten the care of tens of thousands of frail elders who have no other way to pay for nursing home services.

Nursing Homes at Risk: Facilities Affected and Closures

Florida has just under 700 nursing homes serving its elderly population (Facts About Long Term Care In Florida | Florida Health Care Association). Every one of these facilities would feel the impact of Medicaid cuts, since Medicaid residents are spread across virtually all homes. Currently 100% of Florida counties have at least one nursing home, and many communities rely on their local nursing center as a critical healthcare provider and employer. In the past, when Medicaid funding tightened, nursing homes faced serious financial stress. Florida’s nursing home industry historically operates on thin margins because Medicaid reimbursement rates have often been below the actual cost of care. For years, Medicaid payments in Florida covered only about 80% (or even less) of what it actually costs to take care of a nursing home resident ([

COVID-19 Pandemic Continues To Exacerbate Medicaid Underfunding In Nursing Homes

](https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/COVID-19-Pandemic-Continues-To-Exacerbate-Medicaid-Underfunding-In-Nursing-Homes.aspx#:~:text=Shortfalls%20in%20Medicaid%20funding%20are,miniscule%20budgets%20and%20net%20losses)). Providers made up the difference by using funds from private-pay residents or other efficiencies, but sustained underpayment is not viable long-term.

Risk of closures: If Medicaid cuts were deep enough, some Florida nursing homes could be forced to close their doors. Nationwide, hundreds of nursing homes have closed in recent years due to financial pressures. Between 2015 and 2019, 550 nursing homes closed across the U.S. ([

COVID-19 Pandemic Continues To Exacerbate Medicaid Underfunding In Nursing Homes

](https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/COVID-19-Pandemic-Continues-To-Exacerbate-Medicaid-Underfunding-In-Nursing-Homes.aspx#:~:text=There%20have%20been%20550%20nursing,away%20from%20their%20loved%20ones)), with closures accelerating to nearly 200 in a single year (2019) ([

COVID-19 Pandemic Continues To Exacerbate Medicaid Underfunding In Nursing Homes

](https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/COVID-19-Pandemic-Continues-To-Exacerbate-Medicaid-Underfunding-In-Nursing-Homes.aspx#:~:text=There%20have%20been%20550%20nursing,away%20from%20their%20loved%20ones)). Low Medicaid reimbursement was cited as a major factor – “Medicaid reimbursements only cover 70 to 80 percent of the actual cost of care”, leading to chronic losses ([

COVID-19 Pandemic Continues To Exacerbate Medicaid Underfunding In Nursing Homes

](https://www.ahcancal.org/News-and-Communications/Press-Releases/Pages/COVID-19-Pandemic-Continues-To-Exacerbate-Medicaid-Underfunding-In-Nursing-Homes.aspx#:~:text=Shortfalls%20in%20Medicaid%20funding%20are,miniscule%20budgets%20and%20net%20losses)). Florida, fortunately, has not yet seen a large wave of closures, but there have been some individual facility shutdowns and many near-misses. In 2017, one South Florida nursing home (at Hollywood Hills) closed after a hurricane disaster, though that was due to a crisis event and regulatory issues, not funding. Financially, Florida’s providers have so far managed to stay afloat, aided by measures like the 2009 assessment and recent funding increases. An industry representative noted in 2023 that “We have 700 nursing homes in Florida, and not one of those homes have closed in the past five years because of property insurance costs.” (Florida’s Long-Term Care Facilities Pressured by Skyrocketing …) This statement underscores that external pressures (like skyrocketing insurance premiums and COVID-19 costs) have not yet caused outright closures in Florida – and continued support from Medicaid has been key to that stability.

However, stakeholders warn that the situation could change quickly if Medicaid funding is cut. When budgets are strained, nursing homes may respond by freezing admissions of Medicaid patients, reducing staff levels, or halting capital improvements. If cuts are severe, some facilities – especially those with high Medicaid census – could slide into insolvency. Rural and inner-city nursing homes would be most vulnerable, as they have the highest proportion of Medicaid residents and fewer private-pay clients to offset losses. Closure of a nursing home can be devastating: residents must be transferred elsewhere (often far from their families), and local hospitals suddenly have nowhere to discharge some patients. Florida officials have long tried to avoid this outcome. This is why, for instance, the Florida legislature backfilled funding in lean years and why the recent 8% rate increase was celebrated as a lifeline for struggling facilities (Breaking Down the Florida Medicaid Rate Increase) (Breaking Down the Florida Medicaid Rate Increase).

If Medicaid were cut significantly, all ~691 Florida nursing homes would be affected, with many potentially at risk of shutting down. Even a modest cut can hurt: Florida Health Care Association (FHCA) has estimated that a 1% reduction in Medicaid rates equates to millions of dollars less per year, which could push marginal facilities into deficit. During past budget debates, FHCA warned that proposed cuts of a few hundred million could “result in significant financial instability” for nursing homes, imperiling care quality (FHCA Member Update | Florida Health Care Association). In summary, while Florida has thus far avoided a cascade of nursing home closures, Medicaid cuts would put facilities in jeopardy. Continuous adequate funding is critical to keep these centers open and capable of serving the growing elder population. The closure of even a handful of nursing homes due to Medicaid shortfalls would signal a serious crisis for Florida’s long-term care system.

Healthcare Job Losses Associated with Medicaid Cuts

Medicaid cuts don’t only threaten facilities and residents – they also put Florida’s healthcare workforce at risk. Nursing homes are labor-intensive operations, relying on nurses, certified nursing assistants (CNAs), therapists, kitchen and housekeeping staff, and more. Labor typically accounts for the majority of a nursing home’s expenses. When Medicaid funding is reduced, facilities have limited options: they must either find other revenue (unlikely), cut back services, or reduce staffing costs. The most immediate fallout of Medicaid cuts is often staff layoffs or hour reductions. The FHCA noted that a major shortfall in 2009 would have led to widespread “staff layoffs” in Florida nursing homes (FHCA Member Update | Florida Health Care Association). Similarly, national experts caution that “lower reimbursement rates can lead to reductions in staffing”, harming care quality (Medicaid’s Role in Nursing Home Care).

Florida’s nursing homes employ tens of thousands of direct care workers. To give a sense, Florida requires a minimum of 3.6 hours of direct care per resident per day (one of the highest staffing standards in the U.S.) (Facts About Long Term Care In Florida | Florida Health Care Association). With ~71,000 residents, that translates to roughly 256,000 staff-hours of care needed per day. Providing that care involves a large workforce of nurses and aides. If Medicaid funding can’t support those hours, facilities may violate staffing requirements or be forced to reduce their census. In either case, workers lose jobs or get fewer shifts. A national advocacy group, PHI, points out that “Medicaid cuts will further magnify challenges to the quality of direct care jobs, and worsen recruitment and retention challenges” (Shortsighted Medicaid Cuts Will Endanger the Lives and Jobs of Millions – PHI). Providers may cut workers’ hours, impose hiring freezes, or even shut down, “alongside other essential supports”, leaving many caregivers unemployed (Shortsighted Medicaid Cuts Will Endanger the Lives and Jobs of Millions – PHI). In Florida, which already faces a caregiving workforce shortage, Medicaid cuts would exacerbate the problem.

Potential job impact highlights:

• Direct layoffs: Facilities facing immediate budget shortfalls might lay off staff to save money. This could include nurses, CNAs, activities staff, and support personnel. Florida’s FHCA warned that a $231 million cut would have led to exactly this outcome – significant staff reductions, directly impacting care (FHCA Member Update | Florida Health Care Association).
• Unfilled Positions: Homes may institute hiring freezes, leaving vacancies open. Many Florida nursing homes already struggle to fill nursing assistant jobs; cuts would make it even harder to offer competitive wages to attract workers.
• Wage/Benefit Cuts: To avoid outright layoffs, some facilities might cut employee benefits, defer pay raises, or reduce hours (converting some full-time staff to part-time). This effectively is a loss of income for healthcare workers.
• Training and Quality Suffer: Tight budgets often mean cutting ancillary roles (like staff educators or quality improvement nurses). That, in turn, can lower the quality of care environment and contribute to burnout among remaining staff.

The healthcare job losses wouldn’t be isolated to nursing homes either. Medicaid cuts can ripple through the entire eldercare continuum. For instance, if nursing facilities scale back, hospitals could see backups of patients who need nursing home placement, which strains hospital staff. Home health agencies and assisted living that depend on Medicaid waivers might also experience funding squeezes, impacting home-care aides’ jobs. However, nursing homes would feel the brunt because they rely so heavily on Medicaid for operating revenue (around 40–60% of their income).

Florida’s economy could lose a substantial number of jobs if Medicaid is slashed. Medicaid spending actually creates jobs – the dollars go toward salaries of nurses, aides, dietitians, social workers, etc. According to PHI, more than 5 million direct care workers nationally are supported by long-term care programs, and Medicaid is the largest payer of these services (Shortsighted Medicaid Cuts Will Endanger the Lives and Jobs of Millions – PHI) (Shortsighted Medicaid Cuts Will Endanger the Lives and Jobs of Millions – PHI). In Florida, thousands of these jobs are in nursing homes. Should funding drop, many of these workers would be at risk of unemployment. This is not just a human services issue but a broader economic one: unemployed healthcare workers mean less consumer spending, less tax revenue, and more strain on social assistance programs. Moreover, many direct care workers themselves have low incomes – nearly 37% live near poverty and about 31% rely on Medicaid for their own health coverage (Shortsighted Medicaid Cuts Will Endanger the Lives and Jobs of Millions – PHI). Ironically, cutting Medicaid could strip these workers of both their jobs and their healthcare.

In summary, Medicaid cuts in Florida are likely to cost healthcare jobs, particularly in nursing homes. Layoffs and attrition would reduce the workforce available to care for seniors just as the need for care is rising. This outcome would undermine Florida’s recent efforts to bolster staffing and could set back the state’s eldercare system for years. It’s a vicious cycle: funding cuts lead to staffing cuts, which lower care quality and deter families from using facilities, which then causes further financial stress on facilities.

Economic Consequences for Florida (Tax Burdens and Cost Shifts)

Beyond the human impact, Medicaid cuts carry significant economic consequences for Florida. Medicaid is one of the largest programs in the state budget and a major conduit of federal funds into Florida’s economy. Changes to Medicaid funding can shift costs in ways that affect taxpayers, healthcare providers, and families. Here are key economic considerations:

• Loss of Federal Dollars: As noted, Florida’s Medicaid is ~58% federally funded (EXHIBIT 6. Federal Medical Assistance Percentages and Enhanced Federal Medical Assistance Percentages by State, FYs 2022–2025). If Medicaid is cut, Florida not only saves its state dollars but also loses the federal match. This represents a net loss of money circulating in the state economy. For example, a $500 million reduction in Medicaid spending might include roughly $290 million less from Washington. That’s $290 million fewer dollars paying salaries at Florida hospitals, nursing homes, pharmacies, and so on. The Florida Policy Institute emphasizes that Medicaid funding promotes economic security and stability for communities (Groups Express Major Concerns With Leaked ‘Menu’ of $2.3 Trillion in Medicaid Cuts). Reducing it would have a multiplier effect in the negative direction – less income for healthcare workers, suppliers, and local businesses. Rural areas in Florida, where healthcare facilities are big employers, would be especially hard-hit by any withdrawal of Medicaid dollars.
  
• Shifts to Local Government: Florida historically requires counties to pay a small share of Medicaid long-term care costs. Counties currently contribute on a per-resident basis to nursing home care (in the past this was a fixed ~$55 per resident per month, and proposals have suggested raising it to ~$98) (Special Review: Legislative Options for County Share of Medicaid Nursing Home Costs) (Special Review: Legislative Options for County Share of Medicaid Nursing Home Costs). If Medicaid funding is slashed or capped, the state might seek greater contributions from counties or hospital taxing districts to fill gaps. This could mean higher local taxes or special assessments to support indigent elderly care. Alternatively, if nursing homes close or cut beds, more frail seniors might end up in county-funded safety net programs or require care through local health departments. Either scenario increases strain on local governments. Essentially, one way or another, taxpayers may bear costs that Medicaid no longer covers – whether through higher county taxes to support healthcare or through subsidizing family caregivers (for instance, via tax credits or state programs for home care).
  
• Higher Out-of-Pocket Burdens: Economic costs don’t vanish; they often shift to families. If Medicaid covers fewer nursing home residents, those residents still need care. Families would have to pay privately for nursing home care or find alternatives. The annual cost of ~$90,000 is far beyond what most Florida families can afford (Facts About Long Term Care In Florida | Florida Health Care Association). Some families might resort to taking out loans or mortgages, selling property, or spending retirement savings to pay for a loved one’s nursing home. This depletes personal wealth and can lead to more seniors ultimately qualifying for Medicaid anyway (after becoming impoverished). Others might try to care for the elder at home to avoid nursing home costs, but that comes with its own economic price: often an adult child (commonly a daughter) must quit their job or reduce work hours to become a full-time caregiver. That means lost income and productivity. Research indicates that when formal long-term care is not available, family caregivers (mostly women) leave the workforce, which hurts the economy by reducing labor participation (Shortsighted Medicaid Cuts Will Endanger the Lives and Jobs of Millions – PHI). In Florida, which has a large working-age population balancing jobs and eldercare, this could translate into thousands leaving employment to care for aging relatives if Medicaid can’t support nursing home placement.
  
• Healthcare System Strain (Cost Shifting to Hospitals and Medicare): If nursing homes have fewer resources or capacity due to Medicaid cuts, more elderly patients could end up in hospitals longer or cycle through emergency rooms. Hospitals are more expensive settings, and extended hospital stays for patients who can’t be discharged to a nursing facility drive up Medicare costs (Medicare often ends up paying for these avoidable hospital days). Those costs ultimately fall on federal taxpayers. Moreover, hospitals may seek higher reimbursement rates or local tax support (through public hospital districts) to cover the uncompensated care of patients who in the past would have moved to a Medicaid-paid nursing home. In Florida, where many hospitals are already dealing with uncompensated care burdens, this shift could undermine hospital finances. It’s essentially moving the cost from one part of the healthcare system to another, often a less efficient one.
  
• Economic Ripple Effects: Medicaid funds healthcare jobs, and healthcare jobs in turn contribute to local economies (through spending on housing, food, etc.). Cutting Medicaid thus has a ripple effect: job losses and wage cuts in the healthcare sector mean reduced spending power in communities. Florida’s sizable eldercare industry (nursing homes, assisted living, home care) is a significant employer. A contraction in this industry due to funding cuts could be a drag on the state’s economic growth. Conversely, investments in Medicaid have a stimulative effect. The American Health Care Association notes that adequate Medicaid funding helps nursing homes keep staff employed and purchase goods and services, supporting other businesses (Breaking Down the Florida Medicaid Rate Increase) (Breaking Down the Florida Medicaid Rate Increase). Removing that funding could lead to lower state GDP and fewer total jobs. State tax revenues could also dip since healthcare workers pay income (though Florida has no state income tax) and sales taxes on their purchases.
  

In essence, cutting Medicaid might seem like a way to save government money, but it often shifts costs rather than truly eliminates them. The burden may move to families (through unpaid care or medical debt), to local governments (through increased need for local healthcare funding), or to other payers like Medicare and private insurance (through cost-shifting and higher emergency care usage). Florida taxpayers could end up paying in different ways – for example, supporting an unemployed family caregiver via public assistance, or paying higher property taxes to shore up a local nursing home if the state Medicaid falls short. These indirect costs are harder to quantify but very real.

Finally, we should consider Florida’s large retiree-driven economy. If Medicaid for the elderly is perceived as inadequate, it might deter some seniors from retiring to Florida or prompt wealthier residents to purchase expensive long-term care insurance (money that then flows into insurance premiums rather than local spending). Florida has built a reputation as a senior-friendly state partly because there’s an expectation that safety nets like Medicaid and quality nursing homes will be available if needed. Undermining that safety net could have long-term economic implications for Florida’s attractiveness to retirees. In summary, Medicaid cuts risk shifting costs to Floridians and harming the state economy, whereas maintaining robust Medicaid funding for seniors helps distribute costs more broadly and keep the healthcare sector and families stable.

Long-Term Projections of Medicaid Needs for Florida’s Aging Population

Florida’s elderly population is large and growing rapidly, portending much greater Medicaid needs in the future. Florida is already known for its sizeable senior population, but the coming decades will see an unprecedented surge in residents over 60 and 80 years old as Baby Boomers age. The Department of Elder Affairs reports that as of early 2020, Florida had over 5.5 million residents age 60 and older () – more seniors than the total populations of some states. By 2045, the 60+ population is projected to reach 8.4 million, comprising over 30% of Florida’s population (). This dramatic shift (a roughly 50% increase in the number of older Floridians from today) will significantly increase demand for long-term care services, including those funded by Medicaid.

Table 2: Florida’s Senior Population Growth (60+ age group)

Table 2: Projected growth of Florida’s older adult population. By 2030 about one in three Floridians will be 60+, and by 2045 the 60+ group will exceed 8 million (roughly 30% of the population) () (). This trend indicates a substantially larger pool of seniors who may need Medicaid-funded long-term care.

Several implications emerge from these projections:

• The absolute number of seniors who may need nursing home care will rise. Even if the rate of seniors entering nursing homes stays the same or declines (due to preferences for aging at home or in assisted living), the sheer growth in the elderly population means Florida will have more nursing home residents in the future. For instance, if 4% of seniors eventually require nursing home placement, 4% of 8.4 million in 2045 is about 336,000 people – far above the roughly 71,000 in nursing homes today (which is about 1.3% of Florida’s ~5.5 million seniors). While many factors will influence exact numbers, it’s clear the demand for institutional long-term care could double or triple over the next 20–30 years.
  
• Medicaid enrollment for long-term care will increase accordingly. Florida’s Medicaid currently covers ~41–42 thousand nursing home residents (given 57% of ~71k). In the coming decades, that could rise to tens of thousands more. If, hypothetically, Florida had 100,000 nursing home residents in 2035, at least ~60,000 might be on Medicaid (assuming similar proportions). And that’s just nursing homes; many seniors will also need Medicaid home- and community-based services (HCBS) to avoid or delay nursing home placement. Florida already has large waiting lists for Medicaid HCBS waivers for the elderly (Florida FY 2024-25 Budget Summary: Health and Human Services). The Department of Elder Affairs anticipates “continued increases in the number of older residents over the next 10 years” as boomers age in and 900 new seniors move to Florida per day through migration (). This will put pressure on both institutional care and home care programs funded by Medicaid.
  
• Budget impact: Long-term care is expensive, and with more people needing it, Florida’s Medicaid spending will have to rise significantly just to maintain current service levels. In FY2015, Florida spent $3.47 billion on nursing home care via Medicaid (Medicaid’s Role in Nursing Home Care). By FY2025, that figure is around $3.3–3.5 billion (after the recent increase). By the 2030s, it would not be surprising if Florida needs to spend well over $5–6 billion annually on nursing facility care, plus additional billions on home care, to keep up with demand. If Medicaid funding doesn’t keep pace, the gap between needs and funding will widen. Florida could see longer waiting lists for community care and stricter eligibility for nursing home coverage if budgets remain flat while the senior population swells. Conversely, to adequately fund care, Florida’s leaders will have to allocate a larger share of the state budget to Medicaid or find new revenue sources, as the elder boom accelerates.
  
• Elderly demographic shifts: The fastest-growing segment of the elderly is the 85+ group – those most likely to require intensive long-term care. Many baby boomers will be in their 80s by the 2030s and 2040s. Nationally, about 1 in 3 people who turn 65 will require nursing home care at some point (Medicaid’s Role in Nursing Home Care), and many of those will be in the 80+ age bracket when that need arises. Florida, having one of the highest life expectancies and many retirees, is poised to have a very large 85+ cohort. This suggests Florida’s Medicaid will increasingly be serving “old-old” adults with multiple chronic conditions (e.g. dementia, severe disabilities). The intensity and length of care needed could increase (e.g. someone living 5 years in a nursing home instead of 2 years). This will drive costs per enrollee higher even aside from general inflation.
  
• Policy responses: Florida may need to innovate to meet these long-term challenges. This could include investing more in home and community care (which is often cheaper than nursing homes) to delay nursing home entry. Indeed, Florida’s Medicaid Managed Long-Term Care program is designed to keep seniors at home longer. Still, at some point, frail individuals often need nursing facility care, so Florida will likely have to expand nursing home capacity or improve efficiencies. The state might consider building public-private partnerships for elder care or encouraging private long-term care insurance uptake to offset Medicaid’s burden. Regardless, Medicaid will remain the insurer of last resort for many, and its role could grow. By 2040, a very large portion of Florida’s Medicaid budget will be dedicated to seniors unless dramatic policy changes occur. In FY2015, 59% of Florida’s Medicaid long-term care spending was already for nursing homes (Medicaid’s Role in Nursing Home Care). With the aging trend, the share of Medicaid devoted to long-term care could climb even if Florida tries to emphasize home care.
  

In conclusion, Florida faces a “gray tsunami” in the coming decades. The elderly population is set to expand rapidly, and with it, the need for long-term services and supports. Medicaid will be central to financing that care for those who cannot afford it on their own. Projections clearly show that Medicaid’s role will have to expand (in absolute dollars and likely in enrollment) to avoid catastrophic gaps in care. Any cuts to Medicaid in the near term would collide with these demographic trends, potentially leaving Florida ill-prepared for the future. On the contrary, many experts argue Florida should be increasing its investment in Medicaid eldercare to prepare for the surge of aging boomers. By 2030, more than one-quarter of Floridians will be 65+ (How Florida’s Population Is Set to Change by 2030 – Newsweek), and by 2045 about one-third will be 60+ (). The long-term trajectory is clear: demand is rising. If Medicaid funding doesn’t rise in tandem, the state could face a severe crisis where tens of thousands of frail seniors have nowhere affordable to turn for necessary care. Planning ahead – through sufficient Medicaid funding, building workforce capacity, and expanding infrastructure – will be key to ensuring Florida’s elderly are protected in the decades to come.

Sources: The above analysis is based on data from the Florida Health Care Association, Florida Policy Institute, Florida Dept. of Elder Affairs, Kaiser Family Foundation, PHI National, AHCA/NCAL, and state budget documents (Facts About Long Term Care In Florida | Florida Health Care Association) (Groups Express Major Concerns With Leaked ‘Menu’ of $2.3 Trillion in Medicaid Cuts) (Breaking Down the Florida Medicaid Rate Increase) (FHCA Member Update | Florida Health Care Association) (), among others, with a focus on Florida-specific statistics and projections. All citations refer to these source materials.