Florida Medicaid Expansion Initiative (2022)

Florida Medicaid Expansion Initiative
Election date November 8, 2022
Topic Healthcare
Status Not on the ballot
Type Constitutional amendment	Origin Citizens

The Florida Medicaid Expansion Initiative (Initiative #18-16) was not on the ballot in Florida as an initiated constitutional amendment on November 8, 2022.

Measure design

The measure was designed to expand Medicaid coverage to individuals over age 18 and under age 65 who have incomes at or below 138 percent of the federal poverty level.

Text of measure

Ballot title

The proposed title was as follows:

“

Provide Medicaid Coverage to Eligible Low-Income Adults

”

Ballot summary

The proposed ballot summary was as follows:

“

Requires State to provide Medicaid coverage to individuals over age 18 and under age 65 whose incomes are at or below 138 percent of the federal poverty level and meet other nonfinancial eligibility requirements, with no greater burdens placed on eligibility, enrollment, or benefits for these newly eligible individuals compared to other Medicaid beneficiaries. Directs Agency for Health Care Administration to implement the initiative by maximizing federal financial participation for newly eligible individuals.

”

Constitutional changes

See also: Article X, Florida Constitution

The measure would have added a new section, Section 33, to Article X of the Florida Constitution. The following underlined text would have been added:

Note: Hover over the text and scroll to see the full text.

SECTION 33. Provide Medicaid Coverage to Eligible Low-Income Adults.

(a) MEDICAID COVERAGE FOR LOW-INCOME ADULTS. The State shall provide Medicaid benefits to Low Income Adults over age 18 and under age 65 whose income is one-hundred thirty-eight percent (138%) of the federal poverty level or below, and who meet other nonfinancial eligibility requirements of the federal Medicaid statute. The State shall not impose on Low Income Adults any greater or additional burdens or restrictions on eligibility, enrollment, or benefits than on any other population eligible for medical assistance.

(b) DEFINITIONS. For the purposes of this section, the following words and terms shall have the stated meanings:

(1) “Low Income Adults” refers to those individuals over age 18 and under age 65, whose income is one-hundred thirty-eight percent (138%) of the federal poverty level or below, as described by and using the income methodology provided for by the federal Medicaid statute at 42 U.S.C. § 1396a(a)(10)(A)(i)(VIII), and who meet applicable non-financial eligibility conditions for Medicaid under 42 CFR Part 435, Subpart E.

(2) “Agency for Health Care Administration” or “Agency” refers to the single State agency responsible for administering Florida’s Medicaid plan pursuant to 42 U.S.C. § 1396a(a)(5) and § 409.902, Fla. Stat.

(3) “State Plan Amendment” refers to the document(s) the State submits to the Centers for Medicare and Medicaid Services (CMS) for review and approval before making a change to its program policies, including setting forth the groups of individuals to be covered.

(4) “Centers for Medicare and Medicaid Services” refers to the agency responsible for administering the Medicaid program at the federal level, including review and approval of State Plan Amendments.

(c) IMPLEMENTATION.

(1) Within 90 days of voter approval of this Section, in order to implement the provision of Medicaid coverage to Low Income Adults and obtain Federal Medical Assistance Percentage funds for the cost of their coverage, the Agency for Health Care Administration shall submit a State Plan Amendment and all other necessary documents, as well as take any additional necessary steps to seek required approvals from the Centers for Medicare and Medicaid Services to include Low Income Adults as a coverage group in Florida’s Medicaid program.

(2) Nothing in this Section shall limit the Legislature from enacting laws consistent with this Section. Specifically, it is consistent with this section to add a new subsection (section (9) below) to Fla. Stat. 409.903 Mandatory payments for eligible persons.—

(9) A person over age 18 and under age 65 whose income is 138 percent of the poverty level or below.

Support

Florida Decides Healthcare sponsored the initiative.

Opposition

Arguments

• Skylar Zande, Florida state director of Americans for Prosperity, wrote, "Expansion would push tens of thousands who weren’t eligible for Medicaid before expansion to be kicked off the health plans they currently have and like, and force them to use the broken Medicaid system. It would also devastate our state budget. Medicaid already accounts for one-third of state spending. Expansion would cost Florida taxpayers at least an additional $1 billion a year, leading to huge tax increases while restricting funding for other services. And the proposal itself violates the state constitution."

Path to the ballot

See also: Laws governing the initiative process in Florida

The state process

In Florida, the number of signatures required for an initiated constitutional amendment is equal to 8% of the votes cast in the preceding presidential election. Florida also has a signature distribution requirement, which requires that signatures equaling at least 8% of the district-wide vote in the last presidential election be collected from at least half (14) of the state's 28 congressional districts. Signatures remain valid until February 1 of an even-numbered year. Signatures must be verified by February 1 of the general election year the initiative aims to appear on the ballot.

Proposed measures are reviewed by the state attorney general and state supreme court after proponents collect 25% of the required signatures across the state in each of one-half of the state's congressional districts (222,898 signatures for 2024 ballot measures). After these preliminary signatures have been collected, the secretary of state must submit the proposal to the Florida Attorney General and the Financial Impact Estimating Conference (FIEC). The attorney general is required to petition the Florida Supreme Court for an advisory opinion on the measure's compliance with the single-subject rule, the appropriateness of the title and summary, and whether or not the measure "is facially invalid under the United States Constitution."

The requirements to get an initiative certified for the 2022 ballot:

• Signatures: 891,589 valid signatures
• Deadline: The deadline for signature verification was February 1, 2022. As election officials have 30 days to check signatures, petitions should be submitted at least one month before the verification deadline.

In Florida, proponents of an initiative file signatures with local elections supervisors, who are responsible for verifying signatures. Supervisors are permitted to use random sampling if the process can estimate the number of valid signatures with 99.5% accuracy. Enough signatures are considered valid if the random sample estimates that at least 115% of the required number of signatures are valid.

Details about the initiative

• The initiative was approved for circulation on December 12, 2018.
• Florida Decides Healthcare ended its efforts to place the measure on the 2020 ballot, citing changes made by Florida House Bill 5 of 2019 which banned proponents from paying signature gatherers by the signature and instead requiring them to be paid by the hour. Florida Decides Healthcare spokesman Dan Newman said, "The voter-led campaign to expand Medicaid isn’t going anywhere. We were hustling to put health care directly on the 2020 ballot because it is clear that Floridians overwhelmingly support Medicaid expansion, but state legislative changes at the end of the session just made that a hill too steep to climb. The Legislature’s actions created confusion and uncertainty in the funding community, and that was certainly the Legislature’s intent. Lots of politicians did everything in their power this year to keep Floridians from voting on this." The group said it would try to put the measure on the 2022 ballot.
• On November 14, 2019, the Florida House and Senate filed briefs with the Florida Supreme Court arguing that the measure violates the state's single-subject rule and is misleading. The Senate also questioned the validity of the signatures collected for the measure since the signature requirements changed based on the results of the 2020 presidential election. The Florida Supreme Court was set to hear arguments on February 6, 2020.
• On December 18, 2020, Florida State Senate president Wilton Simpson (R) filed a document with the Florida Supreme Court stating "... The Secretary has calculated that 222,898 signatures are necessary for judicial review pursuant to § 15.21 Fla. Stat. and Laws of Florida Chapter 2020-15 § 6. It also shows the Initiative presently only has 90,420 signatures and is well short of the revised threshold."
• Sponsors did not submit the required number of signatures to qualify for the ballot by the deadline on February 1, 2022.

See also

2022 measures

• 2022 ballot measures
• Healthcare on the ballot

Florida

• Florida ballot measures
• Florida ballot measure laws

News and analysis

• Ballot measure lawsuits
• Ballot measure readability
• Ballot measure polls

External links

• Initiative 18-16 information
• Initiative 18-16 full text