House Speaker Designate Sam Garrison Talks Medicaid Expansion, Looming Cuts

By Christine Sexton, Florida Phoenix

Rep. Sam Garrison, selected Thursday to become the next speaker of the Florida House, is playing down estimates that the state could lose billions of dollars over the next few years for Medicaid.

Instead, Garrison touted Florida’s decision to not expand Medicaid access to low-income adults as a wise choice and reiterated his opposition to making the safety-net program available to low-income childless adults.

“I think we’re seeing the wisdom of the decision that was made,” Garrison said, referring to the House’s steadfast refusal to expand Medicaid under the federal health care law often referred to as Obamacare.

“I mean, these Medicaid issues have been worked through the state House for a number of years. Speaker [Daniel] Perez has been very solid on this, very firm, on his commitment on this. We’re going to be fiscally responsible. That’s our No. 1 responsibility.”

The federal One Big Beautiful Act cuts nearly $1 trillion over a decade to Medicaid, the health care safety net for the poor, elderly, and disabled. On Wednesday, Florida Medicaid director Brian Meyer told members of a House Health Care Budget Subcommittee that Florida will lose $3.8 billion in Medicaid funds because of changes in the law championed by President Donald Trump

Specifically, beginning in 2028, Florida will have to begin reducing its directed payment program (DPP) — supplemental payments to hospitals — by 10% annually, eventually capping the payments to no more than 110% of Medicare rates.

Medicaid serves the vulnerable and is jointly administered by the state and federal government. Medicare is run by the federal government only and is for people aged 65 and older. Medicare reimbursements are far more generous than Medicaid reimbursements.

House Republicans selected Garrison, R-Fleming Island, Thursday as speaker designate; his two-year term as speaker will span the 2027 and 2028 legislative sessions, which is when the DPP cuts start to take effect.

Garrison, now chairman of the powerful House Rules Committee, served as chair of the health care spending panel under former House Speaker Paul Renner and is keenly aware of Medicaid financing and helped to expand the direct-payment program.

In his acceptance speech — in which warned about being complacent — Garrison opined, “It takes commitment to master the intricacies of health care systems and Medicaid.”

Aasked by reporters about the looming DPP reductions, Garrison said:

“Medicaid in the state of Florida is obviously a massive issue. There are a ton of people who rely on that service. We need to make sure that the money we are spending — and we are spending a lot of money on Medicaid — is getting to the people who need it, and we’re using those dollars as efficiently as possible. That’s a focus of the Speaker Perez. It’s been a focus of [House Budget Committee] Chair [Lawrence] McClure. It’s going to be a focus of [mine].”

What is DPP?

Florida relies on Medicaid managed-care plans to deliver health care to the majority of its beneficiaries. DPP provides funding for hospitals and physicians providing inpatient and outpatient services to Medicaid managed-care enrollees.

DPP helps bridge the gap between the actual cost of caring for Medicaid patients and the amount the facilities are reimbursed for caring for the patients.

Florida does not fund its DPP program with state general revenue dollars. The required state match needed to draw down federal matching Medicaid dollars comes from a local government special assessment charged solely to hospitals. The state uses the revenues generated to draw down additional federal Medicaid funding. 

State-directed payments are used to boost payments at private, public, and cancer hospitals.