Florida’s Medicaid crisis

Florida’s Medicaid crisis is wild—30-33% of the state’s $120-$125B budget, or $38-$40B, goes to it in 2025, covering 4.5M people. But where’s the money? Not the front lines. A PA seeing a Medicaid patient for a 15-min follow-up (CPT 99213) gets just $25-$35 in fee-for-service—peanuts compared to Medicare’s $90-$100. Most patients are in managed care, where rates can drop even lower thanks to MCOs skimming 10-15% for profit. Meanwhile, if that patient ends up in the hospital, Medicaid forks out $2,000-$2,500 PER DAY (based on DRG averages adjusted to 2025). Hospitals grab 20-25% of the pot, long-term care takes 25-30%, and drugs eat up more. Primary care? A measly 10% or less. The system’s upside-down—underpaying prevention while dumping cash into inpatient crises. 

I predict DPC to replace insurance based primary care entirely.

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