New numbers show counties will pay nearly $420M for Medicaid this year

With a potential cut in property tax revenue looming for Florida’s counties, other costs are on the rise.

The state’s top economists this week agreed that Florida’s 67 counties will be on the hook for nearly $420 million of what the state will spend on Medicaid this fiscal year.

Miami Dade ($69,356,749,) Broward ($34,672,150), Hillsborough ($30,915,054), Orange ($26,660,352), and Duval ($22,663,520), with their large populations, unsurprisingly, have the largest payments.

County Medicaid costs are then expected to jump to nearly $452 million a year from now, which is when Amendment 3 would take effect if passed. County-specific cost projections aren’t available for next year.

Amendment 3 — which will go before voters in November — would increase the homestead exemption for non-school ad valorem taxes to existing Florida residents from $50,000 now to $250,000 by 2028.

The Legislature could increase it thereafter. Initial estimates show that in its first year Amendment 3 would cut revenue to cities and counties by nearly $5 billion.

The reduction in revenue means counties would have less money to spend on services such as healthcare, parks, and police and fire that could end up competing against each other for funding. The Florida Association of Counties opposes Amendment 3.

Florida law requires counties to contribute to the costs of the Medicaid program, a safety net program that provides services to the poor, elderly, and disabled. Unlike Medicare, which is 100% federally funded, Medicaid is funded jointly by the federal and state governments.

How much each county contributes toward the state’s required contribution depends on a calculation based on the number of Medicaid residents in the county as a percentage of overall Medicaid enrollees in the state.

Twenty-nine “fiscally constrained counties” have their costs offset by the state. How much is offset is based on calculations developed by the Florida Department of Revenue.

Florida had nearly 3.9 million Medicaid enrollees as of June 30, 2026, according to the most recent state data.

On the healthcare front, county tax dollars help fund some of the state’s large public hospitals and allow them to maintain positive operating margins while offering life-saving services that aren’t revenue-generating lines of business, Safety Net Hospital of Florida Chief Executive Officer Justin Senior told Florida Public Radio.

Reduced revenue, Senior said, could force health systems to make difficult decisions about the services they provide.