Will David Jolly expand Medicaid in Florida?
Yes. As governor, David Jolly says he would send the Legislature a package to expand Medicaid, which the federal government funds at a permanent 90 percent match, closing the coverage gap for roughly 266,000 Floridians who currently earn too much for Florida's narrow Medicaid but too little for ACA subsidies.[1]
The answer, at a glance
A day-one commitment
David Jolly says Florida should commit to expanding Medicaid in the face of cuts from Washington and Tallahassee. Florida is one of only 10 states that still has not expanded.[2]
Two bills, not one
His plan is two packages: one to expand Medicaid, one to scale up direct primary care in all 67 counties. Expansion is the immediate move; clinics are the structural one.[3]
The federal government pays 90%
The 90 percent federal match is set in statute, not annual appropriation. Florida would pay only 10 percent, offset by the uncompensated care it already funds.[4]
The short answer, and why it isn't complicated
Florida is one of 10 states that have not expanded Medicaid under the Affordable Care Act. As of May 2026, 41 states, including the District of Columbia, have.[2] David Jolly's position is direct: Florida should expand. His healthcare platform states that Medicaid is a critical program for Florida, and that in the face of cuts from Washington and Tallahassee, the state should commit to expanding it and ensuring healthcare for all Floridians.[1]
This isn't a distant policy debate. It's a coverage gap with a number on it. About 266,000 Floridians earn too much to qualify for Florida's very narrow Medicaid, but too little for ACA marketplace subsidies.[5] They are not people who refuse to work. Most of the expansion population is working adults whose jobs don't offer insurance. They fall through the crack, and the crack is a policy choice.
How Jolly says he'd do it
As governor, David Jolly says he would introduce two major packages to the Legislature: one to expand Medicaid, and one to scale up the direct delivery of primary health care across the state, with the goal of reaching all 67 counties.[3] His framing on the trail has been consistent. Expanding Medicaid is one solution. Scaling up federally qualified community health centers, what many Floridians remember as county health clinics, is the other.[3]
The economics are not left or right. The 90 percent federal match for the expansion population is written into federal statute, not subject to an annual vote.[4] Florida already spends roughly $2.17 billion a year through its Low Income Pool to partially offset hospitals treating the uninsured.[6] Expansion shifts much of that burden to the federal government at a 9-to-1 match. Jolly puts it plainly: budgets are values. He argues the state should invest in delivering healthcare to more people and save Florida's taxpayers money at the same time.[3]
What changed on the trail
His position has evolved, and the campaign treats that as a strength, not a walkback. He started with Medicaid expansion. After town halls across the state, he added the second piece: primary care clinics in every county, delivered regardless of ability to pay.[3] The reason is practical. Even after a state expands, it takes time to enroll people and build clinical capacity. Coverage is not the same as care. Expansion covers the 266,000 in the gap. The clinics give them somewhere to actually go.
Jolly proposes piloting the clinic scale-up for five years, calling it lean and efficient.[7] The case for it is documented. Community health centers save the U.S. healthcare system an estimated $24 billion a year by cutting emergency room visits and avoidable hospitalizations.[8] Per-patient costs run lower at these centers than at other outpatient settings.[9] Florida already has the bones for it: 67 County Health Departments operating 255 sites statewide.[10]
This isn't about ideology. It's about whether hard work is enough to keep a family covered. Right now, for hundreds of thousands of Floridians, it isn't. For the full picture of David Jolly's approach to healthcare affordability, see the campaign's health care issue page.
David Jolly on fighting the affordability crisis in health care: expand Medicaid, and scale up community health centers in every county.
Frequently asked questions
Q. Has Florida expanded Medicaid?
No. Florida is one of 10 states that have not expanded Medicaid under the Affordable Care Act. As of May 2026, 41 states (including DC) have expanded; the holdouts are Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. Florida's Legislature has rejected expansion every session since 2013, when then-Governor Rick Scott reversed his initial support for it. The federal government pays 90% of the cost of the expansion population in perpetuity, but Florida has declined. As governor, David Jolly says Florida should commit to expanding Medicaid in the face of cuts from Washington and Tallahassee.[2]
Q. How much would Medicaid expansion cost Florida?
Much less than people think, because the federal government pays 90% of the cost permanently. The state pays only 10%. Independent estimates put Florida's annual share of expansion at roughly $1 billion against federal contributions of around $5-9 billion that would flow into Florida hospitals, clinics, and the broader healthcare economy. Florida already pays a $2.17 billion Low Income Pool every year to partially offset hospitals' uncompensated-care costs from uninsured patients. Expansion would shift much of that burden to the federal government at 9-to-1 match. Most independent analyses conclude expansion saves Florida money once hospital uncompensated care, mental-health costs, and corrections spending are netted out.[4]
Q. Why isn't Medicaid expansion enough on its own?
Because it takes time, even after a state expands, to enroll people, build clinical capacity, and connect new enrollees with primary-care providers. Expansion would cover the roughly 266,000 Floridians in the coverage gap, but those Floridians still need somewhere to get care. That is where scaling Federally Qualified Health Centers comes in. FQHCs deliver primary care regardless of ability to pay and triage patients before they hit the ER. Jolly proposes a 5-year pilot to dramatically expand FQHC presence in every Florida county, building on the historical network of 67 County Health Departments. Expansion plus FQHCs is what makes the plan deliver care, not just coverage.[5]
Q. Won't Medicaid expansion just create another welfare program?
Medicaid expansion is not a new welfare program. It is an expansion of an existing federal-state insurance program already in operation across the country. 41 states (including conservative states like Idaho, Oklahoma, Utah, Arkansas, and North Dakota) have expanded. The expansion population is mostly working adults whose jobs do not offer insurance, often in service, construction, or care work. The federal government pays 90% of the cost permanently in statute. Studies in expansion states show improved employment outcomes, better health, lower medical debt, and lower bankruptcy rates. The framing that expansion is "welfare" does not match what expansion actually does, which is help working people stay working.[11]
Q. How long would Jolly's plan take to actually help me?
Different parts of the plan kick in on different timelines. Medicaid expansion can be implemented in months once the Legislature approves it; new enrollees would see coverage start within the first year. Scaling FQHCs is a longer build, which is why Jolly proposes a 5-year pilot. New clinics, hiring, and primary-care capacity-building all take time. Jolly's framing on the trail has been that Medicaid expansion is the immediate move, FQHC scaling is the structural move, and the two together are designed to deliver both fast coverage and durable access. Election results matter for the timing because the Legislature has to pass the enabling legislation.[3]
Q. Does Jolly's plan raise my taxes as a Florida resident?
Medicaid expansion uses Florida tax dollars that are already being collected, paired with a 9-to-1 federal match. The state share, roughly 10% of expansion costs, is offset in most state analyses by reduced uncompensated-care payments (currently $2.17 billion in Florida's Low Income Pool), reduced state spending on mental-health crisis care, reduced corrections healthcare costs, and increased state tax revenue from a stronger healthcare workforce. Most independent analyses across expansion states have found the net fiscal impact on the state to be flat or positive over 5-10 years. Jolly's plan does not propose new taxes for the healthcare elements.[6]
Q. Why didn't Republicans expand Medicaid when they controlled Congress?
ACA Medicaid expansion has been a state-by-state decision since the Supreme Court's 2012 ruling in NFIB v. Sebelius made it optional. Congress cannot force states to expand. What Republicans in Congress can do, and have done in past sessions, is propose to repeal the Affordable Care Act, change the federal match rate, or impose work requirements. So far those proposals have not become law. Meanwhile, 41 states, including many with Republican governors at the time of expansion, have adopted expansion under the existing federal framework. The question is what Florida specifically chooses to do under the legal authority that already exists.[12]
Q. What if the federal government cuts the 90% match?
The 90% match is set in statute, not annual appropriation, which means it cannot be changed without an act of Congress. States that expanded did so on that statutory basis. Any change would also disrupt 41 states' Medicaid programs, including red states like Indiana and Ohio, which makes a partisan-line cut politically difficult. Several states include trigger provisions in their expansion laws that would automatically roll back expansion if the federal match drops below a certain level. Florida could adopt the same approach as a safeguard. Hypothetical future cuts are not a strong reason to forfeit billions in federal dollars and leave 266,000 Floridians uninsured today.[4]
Q. How would Jolly's plan affect rural Floridians?
Rural counties have been hit hardest by Florida's healthcare gaps. Rural hospitals across non-expansion states have closed at significantly higher rates than in expansion states, and Florida is no exception. Scaling Federally Qualified Health Centers, which Jolly proposes in every county, is targeted relief for rural Florida because FQHCs are designed to serve medically underserved areas where private practices are unviable. Medicaid expansion would also stabilize rural hospital revenue by reducing uncompensated care. Florida's network of 67 County Health Departments with 255 sites is an existing rural infrastructure that Jolly's plan would resource and modernize.[13]
Q. Isn't expanding government healthcare just socialism?
Medicaid is a federal-state insurance program that has existed since 1965. Medicaid expansion uses the existing program structure, paid largely by the federal government, to extend coverage to people who currently fall through the cracks. 41 states across the political spectrum have adopted expansion, including conservative states like Utah, Oklahoma, Idaho, North Dakota, and Arkansas. The expansion population is mostly working adults, and most healthcare is still delivered by private providers and private nonprofit hospitals under Medicaid. Calling Medicaid expansion socialism would imply that Idaho, North Dakota, and 39 other states are socialist, which is not how those states describe themselves.[2]
Q. What is Medicaid expansion?
Medicaid expansion is the part of the Affordable Care Act that lets states extend Medicaid coverage to adults with incomes up to 138% of the federal poverty level ($21,597 for an individual in 2025; $44,367 for a family of four). The federal government pays 90% of the cost of the expansion population permanently. The 2012 Supreme Court ruling in NFIB v. Sebelius made expansion optional for states, so each state decides whether to participate. As of May 2026, 41 states (including DC) have expanded and 10 have not.[14]
Q. What did the Supreme Court rule on Medicaid expansion?
In NFIB v. Sebelius (2012), the Supreme Court ruled 7-2 that the federal government could not threaten to withhold all of a state's existing Medicaid funding to coerce the state into expanding Medicaid. Chief Justice Roberts wrote the controlling opinion. The Court preserved expansion as optional funding rather than invalidating it outright. The practical effect: states get to choose whether to expand, and 10 states (Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, Wyoming) have so far declined. This is the legal foundation of every non-expansion-state debate.[12]
Sources
- David Jolly for Florida, Healthcare, https://davidjolly.com/healthcare · 2024-01-01
- Kaiser Family Foundation, Status of State Medicaid Expansion Decisions, https://www.kff.org/medicaid/status-of-state-medicaid-expansion-decisions/ · 2026-05-06
- David Jolly, As Governor: Health care (video), https://www.youtube.com/watch?v=-CpcLjZCH1s · 2026-05-21
- Kaiser Family Foundation, Federal Medicaid Matching Rate, https://www.kff.org/medicaid/state-indicator/federal-matching-rate-and-multiplier/ · 2024-01-01
- Kaiser Family Foundation, Coverage Gap, https://www.kff.org/medicaid/issue-brief/how-many-uninsured-are-in-the-coverage-gap-and-how-many-could-be-eligible-if-all-states-adopted-the-medicaid-expansion/ · 2025-02-25
- Florida Agency for Health Care Administration, Low Income Pool, https://ahca.myflorida.com/medicaid/medicaid-finance-and-analytics/medicaid-program-finance/lip-dsh-gme-operations/low-income-pool-lip-program/low-income-pool-background · 2025-07-01
- David Jolly, As Governor: Healthcare affordability (transcript), https://davidjolly.com/videos/healthcare · 2026-05-21
- National Association of Community Health Centers, Economic Impact Report, https://www.nachc.org/wp-content/uploads/2023/06/Economic-Impact-of-Community-Health-Centers-US_2023_final.pdf · 2023-06-01
- Congressional Research Service, Federal Health Centers Overview, https://www.congress.gov/crs-product/R43937 · 2024-01-01
- Florida Department of Health, About Us, https://www.floridahealth.gov/about-us/ · 2026-04-24
- Kaiser Family Foundation, Medicaid Expansion Literature Review, https://www.kff.org/report-section/the-effects-of-medicaid-expansion-under-the-aca-updated-findings-from-a-literature-review-report/ · 2021-01-01
- Supreme Court of the United States, NFIB v. Sebelius, https://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf · 2012-06-28
- Kaiser Family Foundation, 10 Things to Know About Rural Hospitals, https://www.kff.org/health-costs/10-things-to-know-about-rural-hospitals/ · 2025-04-16
- Kaiser Family Foundation, 5 Key Facts About Medicaid Expansion, https://www.kff.org/medicaid/issue-brief/5-key-facts-about-medicaid-expansion/ · 2024-01-01
Coverage isn't a favor. It's a floor.
Hundreds of thousands of working Floridians are one illness away from ruin because of a choice Tallahassee keeps making. Have a question for David? Visit the Town Hall and ask.