409.915 County contributions to Medicaid.—Although the state is responsible for the full portion of the state share of the matching funds required for the Medicaid program, the state shall charge the counties an annual contribution in order to acquire a certain portion of these funds.
1(1)(a) As used in this section, the term “state Medicaid expenditures” means those expenditures used as matching funds for the federal Medicaid program.
(b) The term does not include funds specially assessed by any local governmental entity and used as the nonfederal share for the hospital directed payment program after July 1, 2021. This paragraph expires July 1, 2025.
(2)(a) For the 2013-2014 state fiscal year, the total amount of the counties’ annual contribution is $269.6 million.
(b) For the 2014-2015 state fiscal year, the total amount of the counties’ annual contribution is $277 million.
(c) By March 15, 2015, and each year thereafter, the Social Services Estimating Conference shall determine the percentage change in state Medicaid expenditures by comparing expenditures for the 2 most recent completed state fiscal years.
(d) For the 2015-2016 state fiscal year through the 2019-2020 state fiscal year, the total amount of the counties’ annual contribution shall be the total contribution for the prior fiscal year adjusted by 50 percent of the percentage change in the state Medicaid expenditures as determined by the Social Services Estimating Conference.
(e) For each fiscal year after the 2019-2020 state fiscal year, the total amount of the counties’ annual contribution shall be the total contribution for the prior fiscal year adjusted by the percentage change in the state Medicaid expenditures as determined by the Social Services Estimating Conference.
(3)(a)1. The amount of each county’s annual contribution is equal to the product of the amount determined under subsection (2) multiplied by the sum of the percentages calculated in sub-subparagraphs a. and b.:
a. The enrollment weight provided in subparagraph 2. is multiplied by a fraction, the numerator of which is the number of the county’s Medicaid enrollees as of March 1 of each year, and the denominator of which is the number of all counties’ Medicaid enrollees as of March 1 of each year. The agency shall calculate this amount for each county and provide the information to the Department of Revenue by May 15 of each year.
b. The payment weight provided in subparagraph 2. is multiplied by the percentage share of payments provided in subparagraph 3. for each county.
2. The weights for each fiscal year are equal to:
WEIGHTS
FISCAL YEAR
ENROLLMENT
PAYMENT
2013-14
0%
100%
2014-15
0%
100%
2015-16
20%
80%
2016-17
40%
60%
2017-18
60%
40%
2018-19
80%
20%
2019-20+
100%
0%
3. The percentage share of payments for each county is:
COUNTY
SHARE OF PAYMENTS
Alachua
1.278%
Baker
0.116%
Bay
0.607%
Bradford
0.179%
Brevard
2.471%
Broward
9.228%
Calhoun
0.084%
Charlotte
0.578%
Citrus
0.663%
Clay
0.635%
Collier
1.161%
Columbia
0.557%
Dade (Miami-Dade)
18.853%
Desoto
0.167%
Dixie
0.098%
Duval
5.337%
Escambia
1.615%
Flagler
0.397%
Franklin
0.091%
Gadsden
0.239%
Gilchrist
0.078%
Glades
0.055%
Gulf
0.076%
Hamilton
0.075%
Hardee
0.110%
Hendry
0.163%
Hernando
0.862%
Highlands
0.468%
Hillsborough
6.953%
Holmes
0.101%
Indian River
0.397%
Jackson
0.219%
Jefferson
0.083%
Lafayette
0.014%
Lake
1.525%
Lee
2.512%
Leon
0.929%
Levy
0.256%
Liberty
0.050%
Madison
0.086%
Manatee
1.623%
Marion
1.630%
Martin
0.353%
Monroe
0.262%
Nassau
0.240%
Okaloosa
0.567%
Okeechobee
0.235%
Orange
6.682%
Osceola
1.613%
Palm Beach
5.899%
Pasco
2.392%
Pinellas
6.645%
Polk
3.643%
Putnam
0.417%
Saint Johns
0.459%
Saint Lucie
1.155%
Santa Rosa
0.462%
Sarasota
1.230%
Seminole
1.740%
Sumter
0.218%
Suwannee
0.252%
Taylor
0.103%
Union
0.075%
Volusia
2.298%
Wakulla
0.103%
Walton
0.229%
Washington
0.114%
(b)1. The Legislature intends to replace the county percentage share provided in subparagraph (a)3. with percentage shares based upon each county’s proportion of the total statewide amount of county billings made under this section from April 1, 2012, through March 31, 2013, for which the state ultimately receives payment.
2. By February 1 of each year and continuing until a certification is made under sub-subparagraph b., the agency shall report to the President of the Senate and the Speaker of the House of Representatives the status of the county billings made under this section from April 1, 2012, through March 31, 2013, by county, including:
a. The amounts billed to each county which remain unpaid, if any; and
b. A certification from the agency of a final accounting of the amount of funds received by the state from such billings, by county, upon the expiration of all appeal rights that counties may have to contest such billings.
3. By March 15 of the state fiscal year in which the state receives the certification provided for in sub-subparagraph 2.b., the Social Services Estimating Conference shall calculate each county’s percentage share of the total statewide amount of county billings made under this section from April 1, 2012, through March 31, 2013, for which the state ultimately receives payment.
4. Beginning in the state fiscal year following the receipt by the state of the certification provided in sub-subparagraph 2.b., each county’s percentage share under subparagraph (a)3. shall be replaced by the percentage calculated under subparagraph 3.
5. If the court invalidates the replacement of each county’s share as provided in this paragraph, the county share set forth in subparagraph (a)3. shall continue to apply.
(4) By June 1 of each year, the Department of Revenue shall notify each county of its required annual contribution. Each county shall pay its contribution, by check or electronic transfer, in equal monthly installments to the department by the 5th day of each month. If a county fails to remit the payment by the 5th day of the month, the department shall reduce the monthly distribution of that county pursuant to s. 218.61 and, if necessary, by the amount of the monthly installment pursuant to s. 218.26. The payments and the amounts by which the distributions are reduced shall be transferred to the General Revenue Fund.
(5) In any county in which a special taxing district or authority is located which benefits from the Medicaid program, the board of county commissioners may divide the county’s financial responsibility for this purpose proportionately, and each such district or authority must furnish its share to the board of county commissioners in time for the board to comply with subsection (4). Any appeal of the proration made by the board of county commissioners must be made to the Department of Financial Services, which shall set the proportionate share for each party.
(6)(a) By August 1, 2012, the agency shall certify to each county the amount of such county’s billings from November 1, 2001, through April 30, 2012, which remain unpaid. A county may contest the amount certified by filing a petition under the applicable provisions of chapter 120 on or before September 1, 2012. This procedure is the exclusive method to challenge the amount certified. In order to successfully challenge the amount certified, a county must show, by a preponderance of the evidence, that a recipient was not an eligible recipient of that county or that the amount certified was otherwise in error.
(b) By September 15, 2012, the agency shall certify to the Department of Revenue:
1. For each county that files a petition on or before September 1, 2012, the amount certified under paragraph (a); and
2. For each county that does not file a petition on or before September 1, 2012, an amount equal to 85 percent of the amount certified under paragraph (a).
(c) The filing of a petition under paragraph (a) does not stay or stop the Department of Revenue from reducing distributions in accordance with paragraph (b) and subsection (7). If a county that files a petition under paragraph (a) is able to demonstrate that the amount certified should be reduced, the agency shall notify the Department of Revenue of the amount of the reduction. The Department of Revenue shall adjust all future monthly distribution reductions under subsection (7) in a manner that results in the remaining total distribution reduction being applied in equal monthly amounts.
(7)(a) Beginning with the October 2012 distribution, the Department of Revenue shall reduce each county’s distributions pursuant to s. 218.26 by one thirty-sixth of the amount certified by the agency under subsection (6) for that county, minus any amount required under paragraph (b). Beginning with the October 2013 distribution, the Department of Revenue shall reduce each county’s distributions pursuant to s. 218.26 by one forty-eighth of two-thirds of the amount certified by the agency under subsection (6) for that county, minus any amount required under paragraph (b). However, the amount of the reduction may not exceed 50 percent of each county’s distribution. If, after 60 months, the reductions for any county do not equal the total amount initially certified by the agency, the Department of Revenue shall continue to reduce such county’s distribution by up to 50 percent until the total amount certified is reached. The amounts by which the distributions are reduced shall be transferred to the General Revenue Fund.
(b) As an assurance to holders of bonds issued before the effective date of this act to which distributions made pursuant to s. 218.26 are pledged, or bonds issued to refund such bonds which mature no later than the bonds they refunded and which result in a reduction of debt service payable in each fiscal year, the amount available for distribution to a county shall remain as provided by law and continue to be subject to any lien or claim on behalf of the bondholders. The Department of Revenue must ensure, based on information provided by an affected county, that any reduction in amounts distributed pursuant to paragraph (a) does not reduce the amount of distribution to a county below the amount necessary for the timely payment of principal and interest when due on the bonds and the amount necessary to comply with any covenant under the bond resolution or other documents relating to the issuance of the bonds. If a reduction to a county’s monthly distribution must be decreased in order to comply with this paragraph, the Department of Revenue must notify the agency of the amount of the decrease and the agency must send a bill for payment of such amount to the affected county.
(8) The agency may adopt rules to administer this section.
History.—s. 46, ch. 91-282; s. 8, ch. 96-417; s. 190, ch. 99-8; s. 26, ch. 2000-171; s. 11, ch. 2001-104; s. 3, ch. 2002-35; s. 452, ch. 2003-261; s. 3, ch. 2007-82; s. 12, ch. 2012-33; s. 10, ch. 2013-48; s. 7, ch. 2021-43; s. 27, ch. 2023-240; s. 30, ch. 2024-228.
1Note.—Section 30, ch. 2024-228, amended subsection (1) “[i]n order to implement Specific Appropriation 215 of the 2024-2025 General Appropriations Act.”
