Op-ed: Florida’s next governor has the chance to make medicaid work better

Florida’s Voice
By: Stan Soloway, CAMI Board Chair

TALLAHASSEE, Fla. – With the One Big Beautiful Bill Act now law, the work of successfully implementing its Medicaid provisions falls largely to the states. This includes implementing mandatory systems to confirm enrollee addresses and prevent simultaneous enrollment across states; work requirements for able-bodied adults; and rigorous new program-integrity measures with enforceable accountability benchmarks.

As each state begins to tackle this long list of challenges, few states are better positioned than Florida. Not only has the Sunshine State already taken preemptive action, but as one of the few states that didn’t expand Medicaid under the ACA, Florida carries a comparatively smaller Medicaid enrollment base, making the broader challenge of implementation more manageable.

Despite these advantages, Florida’s ability to comply with OBBBA’s obligations will require a governor who walks in the door on day one with a plan that will enable Florida to turn a federal Medicaid overhaul into actual results for both taxpayers and patients.

Fortunately, the Florida legislature has begun taking action. During the 2025 session, Florida’s State Senate voted to establish the Joint Legislative Committee on Medicaid Oversight, a clear sign that the legislature understands the need for stronger accountability mechanisms and more transparent governance. Subsequently, the 2026 session saw a push to enact an Eligibility Assistance Program in the Department of Children and Families, focused on tightening eligibility verification and modernizing program administration, which is in line with OBBBA’s requirements at the federal level.

Florida’s next governor will have to carry this momentum forward, providing the executive leadership and resources needed to translate these legislative steps into permanent improvements for Florida’s Medicaid program.

Florida’s Medicaid program is one of the largest in the country. It covers over 4 million people and reimburses health providers billions of dollars every year. But with scale comes complexity, and complexity too often drives waste. It builds up in outdated systems, in eligibility that hasn’t been reviewed in years, and in duplicative processes that incur avoidable costs each day. OBBBA’s new verification and accountability requirements give Florida a policy foundation to address these problems.

The challenge for the next governor will be to ensure the state has the technology and other infrastructure to back it up. Indeed, even though Florida is not subject to the biggest changes, because the state did not extend Affordable Care Act coverage to low income adults, the challenges remain substantial.

That is where the opportunity is most concrete. The Florida Agency for Healthcare Administration, or AHCA, which serves as the state’s Medicaid agency is in the middle of a multi-year technology modernization effort called Florida Health Care Connections, or FX, which is designed to move the state from its aging provider claims payment system to a more integrated, data-connected Medicaid enterprise.

The vision behind FX is for a provider claims payment system that talks to other state systems and analytics tools to identify questionable claims and improved stewardship of Medicaid funds. Fortunately, the system-build incorporates an independent contractor to verify contract compliance. Unfortunately, Florida’s previous massive system overhauls have rarely been successful. As such, it is crucial that the next Governor take the time to assess why and where those failures occurred—and how FX can avoid the same pitfalls.

Programs such as personal care services are a good example of where better data and better administration can make a measurable difference. Nonmedical services delivered at home serve some of Florida’s most vulnerable residents with dignity. Ensuring that the program is administered well, that resources reach eligible patients, and that billing is accurate is not a partisan issue. Rather, it is a basic obligation of good government.

The same principle applies to other long-term care, behavioral health, and home and community-based services, where Florida has seen rapid enrollment growth and where administrative complexity can translate into waste if oversight does not keep pace.

In the end, real results will be up to Florida’s next governor, for they will need to ensure that completing this critical modernization is a top priority, and that it gets the necessary funding and top level support it requires (although 90% of the cost is borne by the federal government.) This means treating technology not as a back-office function, but as a core operational component of a program that accounts for the second largest share of the annual budget.

Floridians who rely on Medicaid deserve a program that operates timely and efficiently, and all of the State (and federal) taxpayers deserve assurance that their money is being well spent. Florida has a chance to show the rest of the country what it looks like to implement Medicaid reform the right way. That’s a major challenge for the next governor. It’s also a tremendous opportunity.