OPINION
A decade ago, as speaker of the Florida House of Representatives, I led the fight against Medicaid expansion under Obamacare.
It wasn't a popular position in many circles, but it was the right one for Florida.
Today, the evidence overwhelmingly validates that decision.
Florida has demonstrated to the nation how to embrace fiscal responsibility while caring for the truly needy. Since 2020, Florida has saved the federal government at least $53 billion by refusing to expand Medicaid.
We rank 43rd in the nation in per capita Medicaid spending.
The false narrative pushed by expansion advocates has always been that opposing Medicaid expansion meant abandoning the vulnerable.
Nothing could be further from the truth.
Our resistance was driven precisely by our commitment to caring for the truly needy: children of low-income households, pregnant women, elderly adults, and people with disabilities.
By keeping our Medicaid program focused and fiscally sustainable, we've been able to protect those who need help while keeping taxes low and avoiding the budget-busting expansion that has strained other states' healthcare systems.
Florida has proven that a different path is possible.
But now, this successful model faces an unprecedented threat — not from policy failures, but from federal bureaucratic obstruction in Washington, D.C. Even after Congress, through the One Big Beautiful Bill Act (OBBBA), made clear that conservative Medicaid models like Florida’s pass muster, the Centers for Medicare and Medicaid Services (CMS) has been slow-walking approval of Florida's 2025 statewide hospital preprint for over 200 days.
This delay is just the latest in a collection, some dating back to the Biden administration.
These payments are critical to hospitals across our state, especially in rural and small urban areas, helping to minimize the losses they incur when treating Medicaid patients.
Without them, hospitals face massive losses on each Medicaid patient, creating a crisis that threatens their survival—especially in the most underserved communities.
Florida’s delay stands out compared to the rest of the country. All but five statewide hospital preprints have been approved.
Other high-spending states like Illinois and New York received recent approvals.
Minnesota — a state with the second-highest Medicaid spend per enrollee in the country and making national headlines every day for fraud in its social welfare programs — is currently operating under a multi-year approval from the CMS. Yet Florida, a model of fiscal responsibility, remains in bureaucratic limbo.
If this delay continues, it will blow a multi-billion-dollar hole in Florida's state budget, forcing impossible choices: raise taxes on hardworking Floridians, cut other services, or allow hospitals to close.
That will devastate communities across our state.
This situation, imposed by Washington bureaucrats, could force Florida to fund its Medicaid program in other ways, like raising the very property taxes our governor and legislature seek to shrink.
These are the same hospitals that serve our most vulnerable populations — the very people we've fought to protect through responsible Medicaid policy.
The timing of this delay raises even more concerns.
Democrats are currently working to put Medicaid expansion on the ballot in 2028. If the CMS continues blocking Florida's hospital preprint, it will undermine our state's fiscal success story and provide ammunition for those seeking to force costly Medicaid expansion on Florida.
Ten years ago, this writer stood firm against Obamacare expansion because he believed Florida could chart a better course.
The evidence has proven that belief correct.
We've protected our most vulnerable citizens, maintained fiscal discipline, and avoided the budget disasters that have plagued expansion states.
The federal government should be championing Florida's success for other states, not undermining it.
Our healthcare providers need these critical payments.
Our most vulnerable citizens need a sustainable Medicaid system. And our taxpayers deserve a government that rewards fiscal responsibility rather than punishing it.
The time for delay is over. I urge the CMS to approve Florida's hospital preprint now.
Steve Crisafulli is a Scholar in Residence at The James Madison Institute and also serves as Chair of the Republican State Leadership Committee. He served as Speaker of the Florida House of Representatives from 2014-2016.
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