Economists: Medicaid Florida budget shortfall is expected to worsen in 2026
- Ask Medicaid Florida
- Oct 18, 2025
- 6 min read
Updated: Feb 22
Legislators may have underfunded Florida’s Medicaid program in the recently approved state budget, according to projections from the state’s top economists. The shortfall is expected to worsen in fiscal year 2026–27.
The Social Services Estimating Conference projects that Medicaid spending for fiscal year 2025–26 will exceed appropriations by $510.7 million, newly released data show. “Most importantly, the current-year estimate produces a General Revenue deficit of $125.5 million relative to the appropriated level,” economists noted in their report.
A major factor behind the deficit is the rising cost of long-term care managed-care plans, which serve low-income seniors and people with disabilities. The state is projected to spend $7.8 billion on these plans by June 30, 2026—$285.4 million more than lawmakers allocated.
In contrast, spending for Medicaid managed medical assistance plans, which cover general health services, is running slightly below budget. Economists estimate total payments of $19.8 billion, about $19.5 million less than appropriated.
Overall, analysts warn that the imbalance between Medicaid funding and actual costs could deepen in the next fiscal cycle if enrollment growth and service demand continue.
Economists from the governor’s office, House, and Senate regularly meet to evaluate spending trends in state-funded programs. Their projections guide lawmakers in developing Florida’s annual budget. The Social Services Estimating Conference, which focuses on Medicaid spending and enrollment, met on June 30, with results released this week.
The group reviewed current-year spending and projected Medicaid costs for the next fiscal year beginning July 1, 2026. Without policy changes, Medicaid is expected to cost $37.1 billion, an increase of more than $2.1 billion over the current base budget. That includes $962.8 million more in general revenue than is budgeted for FY 2025–26.
The Medicaid managed-care plans—covering both long-term care and general acute care—continue to drive the spending gap, accounting for over $1.75 billion of the projected shortfall for FY 2026–27.
Economists also updated enrollment forecasts, estimating 4,149,320 Floridians will receive Medicaid coverage this year—about 67,000 fewer than lawmakers anticipated. Enrollment is projected to rise slightly to 4,186,782 participants in FY 2026–27.
People also want to know
Will Medicaid exist in 2026?
In 2026, states will begin implementing Medicaid policy changes that are estimated to increase the number of people without health insurance by 7.5 million in 2034.
What is the maximum income to qualify for Medicaid in FL?
Florida Medicaid income limits vary significantly by group, with long-term care applicants facing a 2026 limit around $2,982/month for singles, while low-income families, pregnant women, and children often qualify based on a percentage of the Federal Poverty Level (FPL) with higher thresholds, but always check the Florida Department of Children and Families (DCF) for precise figures for your situation. Excess income for long-term care can often be placed in a Qualified Income Trust (Miller Trust) to meet eligibility, notes Haimo Law and Elder Needs Law.
For Long-Term Care (Nursing Home, Home & Community-Based Services):
Single Applicant: Around $2,982/month (2026 figure).
Married Couple: Around $5,964/month combined (2026).
Key Strategy: If income is over the limit, a Qualified Income Trust (QIT) can be used, holding excess income for medical costs.
For Other Groups (Families, Pregnant Women, Children):
Limits are based on the FPL, with higher income percentages for different categories.
Example (2024): A single person might be eligible at 138% FPL, while families have higher limits.
You can find specific FPL-based limits on the KFF website and the Florida DCF for different family sizes and ages.
Where to Get Your Specific Limit:
Florida Department of Children and Families (DCF): myflfamilies.com is the official source.
Official Application Portal: Apply at ACCESS Florida to get a personalized determination.
Important Notes:
For long-term care, Florida looks at your gross income before deductions like Medicare premiums.
Separate from income, assets (like bank accounts, property) also have limits, though well spouses can keep significant assets.
Florida has not expanded Medicaid under the Affordable Care Act, so many low-income adults without children or disabilities don't qualify based on ACA rules alone.
Will Florida expand Medicaid?
The Florida Medicaid Expansion Initiative (Initiative #18-16) may appear on the ballot in Florida as an initiated constitutional amendment on November 7, 2028. The ballot initiative would require the state to expand Medicaid coverage to individuals age 18-65 with incomes at or below 138% of the federal poverty level.
What is the budget for Medicaid in Florida?
The Bureau of Medicaid Program Finance (MPF) is responsible for the fiscal planning of the $28.3 billion Florida Medicaid Services budget.
What is the 5 year rule for Medicaid in Florida?
Florida's 5-year Medicaid rule (or "look-back period") requires the state to review any asset transfers (gifts, sales below market value, etc.) made by an applicant or spouse within 60 months (5 years) before applying for long-term care Medicaid; if uncompensated transfers are found, a penalty period of ineligibility is imposed, calculated by dividing the transferred amount by the average nursing home cost, delaying benefits to prevent people from giving away assets just to qualify.
What it is:
A 5-year (60-month) look-back period for all financial transactions before a Medicaid application for long-term care.
The state checks for assets given away, sold for less than fair market value, or improperly transferred.
Purpose:
To stop individuals from giving away assets to meet Medicaid's strict financial eligibility requirements.
What triggers a penalty:
Gifting large sums to family or friends.
Selling assets (like real estate, cars) for less than they're worth.
Creating certain types of trusts without proper legal planning.
How the penalty works:
If a disqualifying transfer is found, a penalty period begins, during which Medicaid won't pay for care.
The penalty length is determined by dividing the value of the transferred asset by the average monthly cost of private nursing home care in Florida, say this law firm.
When the penalty period starts:
It starts not from the date of the transfer, but from the date the applicant would have otherwise qualified for Medicaid, notes this law firm.
Exemptions & Planning:
Transfers at fair market value, paying off mortgages, or transferring a home to certain relatives (like a child under 21 or a disabled child) can be exempt.
Elder law attorneys help with strategies like irrevocable trusts to protect assets legally, state this
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