DeSantis pushed lawmakers to purge Medicaid, records show

Nearly 100,000 Floridians may have lost their health insurance under a plan that Ron DeSantis quietly pitched to the Florida Legislature, according to records obtained by Seeking Rents.

Graphic credit: Center for Children and Families, Georgetown University

This is Seeking Rents, a newsletter and podcast devoted to producing original journalism — and lifting up the work of others — about Florida politics, with an emphasis on the ways that big businesses and other special interests influence public policy in the state. Seeking Rents is produced by veteran investigative journalist Jason Garcia, and it is free to all. But please consider a voluntary paid subscription, if you can afford one, to help support our work. And check out our video channel, too.

Aides to Florida Gov. Ron DeSantis quietly devised a plan to kick as many as 100,000 Floridians off their health insurance — including mothers of children as young as six years old, according to records obtained by Seeking Rents.

The Republican governor’s proposal was intended to cull Medicaid, the safety net healthcare program that provides insurance to impoverished families and disabled Floridians. It went far further than a narrower version of the plan that was eventually considered by the Florida Senate during this year’s legislative session.

DeSantis, the records show, also lobbied behind the scenes for that pared-back proposal, which still would have stripped an estimated 30,000 to 40,000 Floridians of their Medicaid eligibility.

The governor’s team supplied senators with talking points and rebuttals to criticism from public health organizations, disability rights activists and anti-poverty advocates who warned that the legislation would leave thousands more working people without health insurance across Florida — a state that already has one of the worst uninsured rates in the nation.

The DeSantis plan reflected the longtime wishes of a constellation of conservative policy groups, particularly the Foundation for Government Accountability, a Naples-based think tank that has worked closely with the DeSantis administration during his tenure as governor. DeSantis has adopted many FGA priorities as his own — including, most recently, efforts to weaken child-labor laws and to erect additional barriers to unemployment benefits.

One of the FGA’s principal funders in recent years has been the billionaire shipping-supply magnate Richard “Dick” Uihlein, who, along with this wife, has donated more than $4.9 million to Ron DeSantis’ various political campaigns since 2018, according to state and federal campaign finance records. More than half of that money was spent in support of DeSantis’s failed run for president in 2024 — something DeSantis is expected to try again again in 2028.

With DeSantis leaning in, Republican leaders in the Florida Senate muscled the proposed Medicaid purge through their chamber on a party-line vote. But the legislation was never considered in the House of Representatives, where the state House speaker has repeatedly clashed with the governor over the past year.

But the idea is by no means dead. It could potentially be resurrected later this month, when Florida’s GOP-controlled Legislature convenes for a special session to finalize a new state budget. The budget session is currently scheduled to begin May 12.

A staffer at the Agency for Health Care Administration sent proposed Medicaid legislation to the Floria Senate a few months before the start of the 2026 session.

The Medicaid cuts would have been implemented through a mechanism that supporters typically brand as “work requirements” — but which can be better thought of as paperwork requirements, since the vast majority of able-bodied Medicaid recipients already work.

Under work reporting requirements, Medicaid recipients generally must prove that they are working, training or in school for at least 80 hours every month — or that they quality for an exemption to the requirements— in order to continue receiving healthcare coverage through the public program.

It’s a system that has led to disastrous consequences in other states, both for low income families and for taxpayers.

An April 2024 episode of “Last Week Tonight with John Oliver” took a deep dive into Medicaid, including flaws in work reporting requirements.

Arkansas, for instance, briefly implemented work reporting requirements for Medicaid in 2018 and immediately saw more than 18,000 people lose insurance coverage — primarily because they failed to regularly report their work status or provide sufficient documentation for an exemption. Researchers also found that the requirements led to no significant change in employment levels, according to KFF, a research and journalism nonprofit covers health policy across the country.

More recently, after Georgia enacted a work reporting requirement, auditors found that the state ended up spending twice as much on administrative overhead as on actual healthcare.

Indeed, anti-poverty advocates have been arguing for years that work reporting requirements — which many states, including Florida, have also imposed on other safety net programs, such as cash assistance and food stamps — do far more to hurt working families than to help them.

Rather than helping people find sustainable employment in which they can work themselves out of poverty, work reporting requirements can instead create barriers that block some people from receiving badly needed aid they should be eligible for and push others into erratic, poor-paying and poverty-entrapping jobs — all while enriching private contractors hired to administer the programs.

The economic news podcast “The Uncertain Hour” devoted a season to investigating who actually benefits from work reporting requirements.

Florida’s Republican leadership has rejected Medicaid work reporting requirements in the past. But the concept is back in favor with GOP politicians across the country following the passage of President Donald Trump’s “One Big Beautiful Bill Act,” a sweeping tax-and-spending package signed into law last year that pairs tax breaks primarily benefitting wealthy Americans and large corporations with deep cuts to safety net programs like Medicaid.

One of the main ways the federal law slashes Medicaid spending is by forcing states to impose work reporting requirements on enrollees. That provision alone is expected to lead to nearly 5 million more Americans becoming uninsured over the next decade, according to an analysis by the nonpartisan Congressional Budget Office.

But Trump’s OBBBA only imposes work reporting requirements on states that have expanded Medicaid to more Americans under the Affordable Care Act, the healthcare expansion passed under former President Barack Obama. And Florida is one of 10 states that has refused to expand Medicaid eligibility under the ACA, which is more commonly known as Obamacare.

That has left hundreds of thousands of Floridans trapped in what policy analysts call “the coverage gap” — making too much money to qualify for Medicaid but too little to qualify for federal Obamacare subsidies that would help them afford individual health insurance plans on the private market.

Ron DeSantis — and Republicans in the Florida Senate, at least — want to impose work reporting requirements anyway.

And that makes the proposal especially destructive.

Because Florida has refused to expand Medicaid eligibility, the income thresholds to qualify are exceptionally low. For instance, a single mother with two children can’t get coverage for herself through Medicaid in Florida unless she makes less than $8,000 a year.

The minimum wage in Florida is currently $14 an hour. Someone working 80 hours a month at a minimum wage job — the kind of job that rarely comes with employer-sponsored health insurance — would earn a little more than $13,000 a year. That’s enough to make them ineligible for Medicaid.

So even if a Medicaid work reporting regime functioned exactly as promised — if it didn’t leave tens of thousands of eligible Floridians without health insurance because of bureaucratic mistakes — it would still end up forcing even more people into the coverage gap.

The number of Floridians at risk of losing insurance varied under the plan that the DeSantis administration pitched to the Legislature and the narrower version that passed the Senate. But the fallout would have been substantial under either approach.

AHCA sent rebuttals to aides to Sen. Don Gaetz (R-Niceville), the sponsor of the work reporting requirements legislation, following criticism during a public hearing on the bill.

By far the biggest difference between the two plans was how they treated parents or caretakers of school-aged children. (Adults without kids are already barred from Medicaid entirely.)

DeSantis’ original proposal, which Seeking Rents obtained through a public records request, would have imposed work reporting requirements on parents once their children turned six years old. The Senate plan, by contrast, would have waited until their kids turned 14.

There were smaller differences, as well. The governor’s plan would have mandated work reporting requirements for young people raised in foster care once they reached age 23. The Senate plan would have delayed the requirement for former foster care youth until age 26.

The differences added up. Staffers at the Agency for Health Care Administration, the department that administers the Medicaid program, estimated that DeSantis’ proposal would have forced roughly 280,000 Floridians currently receiving Medicaid to begin regularly reporting their work status or documenting their eligibility for an exemption.

The Senate plan would have impacted roughly 112,000 Floridians.

Either way, the DeSantis administration was counting on big savings. An agency analysis produced by AHCA for the Senate predicted that one-quarter of Medicaid enrollees subjected to work reporting requirements would have ended up losing their eligibility.

That, they calculated, would have led to roughly 28,000 fewer Medicaid recipients and a corresponding reduction in annual Medicaid spending of around $80 million under the Senate plan — and roughly 70,000 fewer enrollees and around $200 million in spending cuts under the DeSantis proposal.

(Those projected savings do not account for the substantial amount of taxpayer money the state would likely have to pay outside vendors — such as Deloitte, the contractor behind Florida’s problem-plagued unemployment system — to administer a new work reporting regime.)

AHCA prepared a spreadsheet comparing the impact of work reporting requirements in the DeSantis plan and the Senate plan, which mirrored provisions in the federal One Big Beautiful Bill Act. (Highlighting in original document.)

Those estimates may also have been an undercount. The records obtained by Seeking Rents show that AHCA staffers later told Senate staffers that work reporting requirements may actually have resulted in 35 percent of those impacted losing their eligibility.

That would mean approximately 39,000 Floridians could have lost their health insurance under the Senate plan — and 98,000 could have under the DeSantis plan.

An excerpt from a talking points document that AHCA staffers sent to the Florida Senate during the 2026 session. (Highlighting added for emphasis)

At this point — with so much lingering animosity among Republican leaders in the Capitol — it seems unlikely that lawmakers will return to the Medicaid legislation during their upcoming budget special session. The Legislature is currently expected to reconvene from May 12 to May 29.

But DeSantis and legislative leadership have shown before that they are willing to set aside personal grievances and cram controversial policies into budget bills at the very last moment — particularly when it is important to a billionaire megadonor.

And even if work reporting requirements are not revived this year, the idea is unlikely to completely disappear in Tallahassee.

While term limits will force DeSantis out of the Governor’s Office at the end of this year, the frontrunner to replace him — U.S. Rep. Byron Donalds, a Republican from Naples — is raising millions of dollars from many of the very same special interests that DeSantis has relied upon.

In fact, one of Donalds’ single-biggest donors is Dick Uihlein — the right-wing billionaire and Foundation for Government Accountability financier who, records show, has already put at least $2 million into Donalds’ campaign.