Florida Medicaid enrollment projected to top 5 million this year

State economists forecast there will be more than 5 million Floridians enrolled in Medicaid when Fiscal Year 2022 (FY22) ends on June 30, 2021 – nearly 1.3 million more than on June 30, 2019.

According to updated projections reviewed Friday by the Social Services Estimating Conference, enrollment will increase by 11.4% to 5,042,246 in Florida’s Medicaid system. Enrollment was 3.814 million in FY20.

The revised estimate is about 200,000 more enrollees than economists projected in March when they forecast 4,835,582 Floridians would be on Medicaid when FY22 ended, a 7.1% increase.

The 4% increase in projected enrollment from 7% to 11% could translate into as much as $1.5 billion in additional Medicaid costs.

The state’s $100 billion FY22 budget includes about $44 billion in health care spending largely subsidized by federal pandemic assistance, including about $34 billion for Medicaid, up from $31.6 billion the previous year.

The Social Services Estimating Conference (SEC) includes economists from state agencies, the Governor’s Office and the Legislature’s Office of Economic & Demographic Research (EDR) who meet regularly to update economic projections. Lawmakers rely on the economists’ three-year financial forecasts and EDR data to build the state’s budget.

During a July 23 SEC meeting, state Medicaid Director Tom Wallace said 10,000 Floridians a week enrolled in the program between April and mid-July.

While the enrollment pace is slackening compared to April and May 2020, when Florida lost an estimated 1.1 million jobs, “it’s still 10,000 people” each week, every week, Wallace said.

In December, the SEC forecast 4.588 million Floridians would enroll in Medicaid in FY22. Economists revised that projection in March to 4.835 million.

That revised March projection proved inadequate when FY22 began on July 1 with 4,846,412 already enrolled in Medicaid – nearly 11,000 more than were projected to be enrolled when the year ended.

Much of the increased costs associated with the enrollment boost will be covered by federal pandemic assistance.

In June, U.S. Department of Health & Human Services Secretary Xavier Becerra extended the federal public health emergency, and the additional 6.2% hike in the federal Medicaid match rate funding, through Dec. 31.

EDR Coordinator Amy Baker explained while the federal funding boost covers enrollment increases, it also restricts the state’s capacity to remove people from the Medicaid rolls if they qualified before March 18, 2020, even if changed circumstances would normally disqualify them from being eligible.

The projections are guesstimates of when that federal public health emergency is declared over and “normal” is restored.

Among other assistance programs growing dramatically during the pandemic is the Temporary Assistance for Needy Families (TANF) program which is cash assistance, or “welfare,” for qualified families

“This is the category we have seen the largest growth in,” Wallace said.

In March, the SEC projected TANF enrollment would increase 4% to 1.667 million by June 30, 2022. In May, Florida’s TANF caseload was 1.655 million.

The revised estimate is 1.699 million Floridians will qualify for TANF by June 30, 2022, a 5.9% increase – nearly 2% higher than March’s forecast.

Using an economic forecasting model based on studies of post-pandemic economic recoveries, state economists project it could take 12-15 months to claw back to pre-pandemic employment levels and trim back the state’s Medicaid rolls.

Over the long-term, economists predict Medicaid enrollment will dip by 2% in FY23, with the elimination of the public health emergency, and continue to decline each year through FY 27 when the state’s Medicaid enrollment is forecast to be 4.69 million – about 350,000 fewer enrollees than projected for FY22.