TALLAHASSEE, Fla. (FNN) — A Florida Senate committee on Monday advanced SB 1758, legislation that would impose Medicaid work reporting requirements in a state that has not expanded Medicaid under the Affordable Care Act. Advocates say the proposal would push thousands of low-income Floridians into the state’s existing coverage gap and create new administrative barriers for people with serious illnesses.

The bill goes beyond the recently passed federal measure, H.R. 1 — known as the One Big Beautiful Bill Act — which exempts non-expansion states from federal Medicaid work reporting requirements. Critics argue Florida lawmakers are moving forward despite that exemption.

Bill Would Add Work Reporting and “Deathbed Exemption”

SB 1758 would require certain Medicaid recipients to document at least 80 hours per month of work or qualifying activities to maintain coverage. The bill includes exemptions, including a recently added provision that would exempt terminally ill parents only if they can prove a life expectancy of six months or less.

Sadaf Knight, CEO of Florida Policy Institute, said the amendment would require a single mother who is terminally ill and earning less than $8,000 a year to meet monthly work reporting requirements unless she can demonstrate a six-month prognosis.

“It is hard to grasp how we arrived at a policy that effectively asks someone facing the end of their life to prove they are dying quickly enough to keep their Medicaid,” Knight said.

Opponents say the proposal would increase administrative costs while stripping coverage from residents who are already working or unable to work due to caregiving responsibilities or medical conditions.

Advocates Warn of Coverage Gap, Legal and Fiscal Risks

Florida is one of 10 states that has not expanded Medicaid, leaving an estimated 260,000 residents in the coverage gap — earning too much to qualify for traditional Medicaid but too little to receive federal marketplace subsidies.

More than two dozen organizations signed a letter urging members of the Senate Appropriations Committee to reject the bill. Signatories include the American Cancer Society Cancer Action Network, American Heart Association, American Lung Association, Southern Poverty Law Center, UnidosUS, The AIDS Institute, Florida Policy Institute, Florida Voices for Health and 1199SEIU.

Melanie Williams of Florida Health Justice Project called the bill “fiscally reckless,” noting that the state has already spent $1 million defending wrongful Medicaid terminations in federal court and that the Department of Children and Families has reported budget constraints in addressing court-mandated changes.

Rachel Klein of The AIDS Institute said federal law prohibits non-expansion states from implementing Medicaid work requirements and warned the measure could face legal challenges. Others argued the costs of building a new reporting system would outweigh any potential savings.

Advocates say the Legislature should focus instead on expanding access to affordable coverage amid rising health care costs and expiring enhanced premium tax credits.