Serving as the eyes and ears of Florida taxpayers, Florida TaxWatch annually reviews the state budget to prepare its Budget Guide, showing how hard-earned taxpayer dollars are spent. This year, consistent with a recommendation by Florida TaxWatch, line item 2923 of the 500-page General Appropriations Act appropriates $500,000 in nonrecurring funds to the Department of Management Services to contract for a comprehensive analysis to determine the fiscal impact and feasibility of extending the State Group Insurance Program (SGIP) to employees of the Florida College System.

There are numerous federal programs administered by states that provide assistance to low-income and needy families. During periods of economic downturn, like the recent COVID-19 pandemic, more Florida families turn to these government programs for assistance. One such safety net program is Medicaid, the joint federal-state health insurance program that provides medical coverage to more than five million low-income, elderly, disabled Floridians and children. Signed into federal law in 1965, Medicaid was created to improve the health of those individuals who might otherwise go without medical care for themselves and their children.

A fast-growing and aging U.S. population is posing concerns for physicians’ ability to meet patient demand in the future. Current and future population estimates from the U.S. Census Bureau indicate a projected growth of 34.8 million people from 2019 to 2034. An estimated 66% of this growth is attributed to people aged 65 or older. As such, physician shortages are especially concerning in the hospice and palliative care sector. As the population ages, the need for a higher volume of care and more specialized expertise will grow.

The development of hospice programs in Florida is regulated by a Certificate of Need (CON) program. Certificate of Need programs allow the entry of new service providers if the local community has a demonstrated need. Florida is one of 13 states and the District of Columbia that continues to utilize a CON program for the development of hospice services. As Florida’s population increases and ages, it will become more critical to facilitate the growth of hospice services in the way that best serves hospice patients and protects the interests of Florida taxpayers.

Florida’s economy is strong. If Florida were a country, its gross domestic product (GDP) would rank 14th among economies worldwide, and its ambitions do not stop there. Florida aims to be within the top ten economies by 2030. By this time, two in three jobs are expected to require specialized training, a credential, or a degree. To achieve its economic goal, Florida will need to continue developing its specialized workforce. With 120,000 students completing Florida College System (FCS) programs each year, the FCS plays a critical role in providing the talent pipeline necessary to reach Florida’s economic goal and does so at a very affordable cost to students and Florida taxpayers alike.

Florida TaxWatch is pleased to present taxpayers with a guide to the FY2022-23 state budget, which went into effect July 1, 2022. The report includes all appropriations for the new fiscal year— the General Appropriations Act (GAA), “back-of-bill” spending, and general bills—net of the Governor’s vetoes.

The 2022 legislative session is over, even if it ran a little long. Florida TaxWatch and the state’s taxpayers had a number of successes. Many bills and budget issues supported by our research and recommendations passed. Our research and input that raised concerns with legislation, helped to improve them or fail passage, including changes to the tax audit system and a very costly approach to improving data privacy

One of the fundamental responsibilities of government is to ensure the safety and welfare of those in its care. This includes our most vulnerable populations, such as children and families.

Similar to demographic trends across the U.S., Florida will encounter a rapid increase in the number of elderly residents requiring long-term care and services. Florida’s 65 and older population is anticipated to grow by 52.1 percent over the next two decades from 4.4 to 6.7 million elderly residents. A variety of continuum of care options exists to accommodate the impending rise in long-term healthcare utilization, ranging from nursing homes to home and community-based settings. Not only do these options differ in their public costs and quality outcomes, but the COVID-19 pandemic has spotlighted the importance of physical risk and exposure to infection when considering what long-term settings exist. Due to the projected growth in Florida’s elderly population over the coming decades, it will be critical to expand resources across the state’s entire continuum of care.

With more than 8,400 miles of coastline and a flat, low-lying coastal topography, Florida is especially vulnerable to the effects of sea level rise. Tens of thousands of Florida homes and businesses are at increased risk from sea level rise. Much of Florida’s critical infrastructure is at low elevations, designed and built with little consideration of future sea level rise. The physical effect of changing climate translates into real economic impacts.

Medicaid is a joint federal-state health insurance program that provides medical coverage to more than four million low-income Floridians. Administered by the state Agency for Health Care Administration, Medicaid is jointly funded through a federal cost-sharing agreement. During fiscal year 2020-21, Florida’s appropriated budget for Medicaid is $29.7 billion.

Even as the economic recovery begins to take form in Florida, the challenges confronting the state’s Medicaid system will remain a forefront issue. For this reason, it is important to understand how Florida’s Medicaid program has fared during the public health emergency and what economic challenges lie ahead as the state goes forward in recovery.