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State submits waiver seeking lifelong Medicaid eligibility for permanently disabled individuals; CMS signaled reluctance
Summary
AHCA told lawmakers it submitted an 1115 waiver amendment on Nov. 5 to pursue continuous Medicaid eligibility for permanently disabled Floridians as directed by 2025 legislation; AHCA noted a July 17 CMS letter indicating the agency does not anticipate approving new continuous-eligibility demonstrations but that negotiations and federal public comment will follow.
TALLAHASSEE — The Agency for Health Care Administration reported to a House subcommittee that it has submitted a federal 1115 waiver request to implement a 2025 law meant to provide continuous Medicaid eligibility for individuals with permanent disabilities.
"We submitted the completed waiver request to CMS for federal review and approval" on Nov. 5, Anne Dalton, AHCA assistant deputy secretary for Medicaid policy and quality, told the Health Facilities and Systems Subcommittee. Dalton said the legislation directs AHCA to pursue federal approval to allow lifelong Medicaid eligibility for qualifying permanently disabled individuals unless a significant change in condition or finances occurs.
Dalton cautioned that CMS issued a July 17 letter stating it "does not anticipate approving new state proposals under section 1115 demonstration authority that would allow for expanded continuous eligibility." She added that AHCA will continue to work collaboratively with CMS in hopes of negotiating an approval or acceptable alternative.
Members asked why AHCA submitted the waiver after the Oct. 1 date referenced in the statute. Dalton said drafting an 1115 application is complex, requires stakeholder input and a federally required public-comment period. She said AHCA sought to prepare a complete submission to avoid deficiencies that could cause further delays.
The agency also outlined process steps: AHCA began implementation work in July 2025, developed a formal waiver request in September, published a Florida Administrative Register notice to start a 30-day state public-comment period, held two public meetings in October, and then submitted the completed waiver to CMS on Nov. 5.
Dalton said if the waiver is accepted as complete by CMS, the federal agency will open its own 30-day federal public-comment period and then negotiate with the state; she warned that 1115 authority does not impose a strict federal timeline for final approval or denial. On committee questioning, Dalton said AHCA has asked stakeholders for input and will continue to pursue the federal authority while coordinating operational planning with the Department of Children and Families to reduce service disruptions while waiting for approval.
No formal committee action on the waiver was taken at the meeting; members asked AHCA to provide updates to the committee and to confirm whether the legislation was included in the budget-implementation bill (AHCA staff said it was signed as part of the budget bill).
