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Florida is 1 of 11 states declining to accept federal money to expand Medicaid

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With the end of the COVID public health emergency, 1.7 million people in Florida will soon lose their Medicaid health coverage. Despite that, officials have no plans to expand Medicaid in Florida.

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Millions of people will start seeing notices next month that their health care coverage is going away. The Biden administration's decision to end the COVID public health emergency also ends a temporary expansion of the Medicaid program. In Florida, state officials expect more than 1.5 million people to lose coverage. As NPR's Greg Allen reports, Florida is one of 11 states that declined to accept the federal government's regular Medicaid coverage.

GREG ALLEN, BYLINE: When the COVID pandemic took hold in early 2020, Kristen Garner, like many Americans, found herself suddenly without a job. She had been working as a server at a restaurant on the beach in Pensacola. She applied for unemployment and food stamps and found that with no income, she now qualified for health insurance under Medicaid.

KRISTEN GARNER: It was awesome. I was able to go get my teeth cleaned. I was able to get X-rays done. It was great. It was a big help.

ALLEN: Garner is a single mom with a 10-year-old son. Florida has some of the nation's toughest restrictions on who's eligible for Medicaid. Because of that, it's second only to Texas in the large number of people who are uninsured. At the start of the pandemic, Congress passed a bill signed into law by President Biden that prevented anyone from being disenrolled from Medicaid. That means once you qualified, you kept your coverage, even after you went back to work. Now, with the public health emergency expiring, states can begin kicking people off Medicaid. In Florida, the administration of Governor Ron DeSantis says the first group of notifications to some 900,000 people will start going out in April.

Holly Bullard is with the Florida Policy Institute.

HOLLY BULLARD: We know a large portion of those 900,000 cases - that a lot of those folks will be falling back into the coverage gap.

ALLEN: Kristen Garner may be one of those people. She's back doing her job as a restaurant server, but she makes too much to qualify for Medicaid. And it may be too little to be eligible for coverage through the Affordable Care Act. She worries she may lose something most people take for granted.

GARNER: Just being able to pay to go see a doctor, being able to pay for medications.

ALLEN: Officials in Florida say they're working to make sure people know their Medicaid coverage is ending, helping them find other options if they're available. But Alison Yager with the Florida Health Justice Project says it's a massive undertaking.

ALISON YAGER: This is going to be the biggest bureaucratic challenge that states around the country have faced for their Medicaid programs in decades.

ALLEN: Officials call it Medicaid unwinding. Eventually, they say close to 2 million people may be disenrolled in Florida, leaving many of them without a health plan. With hundreds of thousands of people soon losing coverage, health care advocates and Democrats in Florida have renewed a push for the state to expand eligibility for Medicaid. Republicans who control the legislature have consistently blocked Medicaid expansion and have made no moves to change course in the current session. In many of the 39 states that have adopted it, Yager says Medicaid expansion has been bipartisan, and it's yielded good results.

YAGER: Every state - red states, blue states, purple states - that have expanded Medicaid have found it to be a good deal for the state's coffers and, more importantly, a good deal for the state's residents.

ALLEN: In North Carolina, after years of resisting it, the Republican-led Legislature now is poised to pass a Medicaid expansion bill. In South Dakota, overcoming resistance from the Republican governor and lawmakers, voters in November expanded Medicaid coverage through a referendum. That may be a model for Florida. Several health care advocacy groups are working together to put a similar initiative on the ballot in Florida in 2026.

Greg Allen, NPR News, Miami.

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