Florida’s medicaid expansion effort delayed until 2028 as petition costs soar

TALLAHASSEE, Fla. — Florida’s most ambitious citizen-led push to expand Medicaid has hit a wall. Florida Decides Healthcare (FDH), the group leading the campaign, announced this week it is suspending efforts to qualify the measure for the November 2026 ballot, citing steep new costs and rules created by HB 1205, a sweeping petition-law overhaul signed earlier this year.

FDH officials say the law has made their work virtually impossible. What once cost hundreds of thousands of dollars now costs millions, with some counties raising petition verification fees by more than 3,000%. Other provisions have shortened deadlines, limited who can gather petitions, and raised penalties, creating what FDH Chair Mitch Emerson called “a death by a thousand cuts.”

“This campaign started and is still an effort to just ensure that all Floridians have access to healthcare,” Emerson said. “Politicians in Tallahassee passed HB 1205 with the intent of stripping citizens away from their First Amendment rights to participate in direct democracy… It was changing the rules in the middle of the game.”

Despite collecting hundreds of thousands of signatures and supportive polling, FDH admits it cannot meet the Feb. 1, 2026 deadline to submit the required 880,062 valid petitions. Instead, the group will regroup for 2028, when it can restart signature gathering in February 2026 with what Emerson described as “more runway.”

What HB 1205 Does

Passed in April on mostly partisan lines and signed by Gov. Ron DeSantis on May 2, HB 1205 imposed sweeping new rules on ballot petition drives.

The law requires circulators to be Florida residents and non-felons, limits each group to supporting only one initiative at a time, and cuts the petition submission window from 30 days to 10. It also raised fines and penalties for violations, created a $50,000 penalty for hiring out-of-state circulators, and ordered supervisors of elections to add new verification steps such as ID checks, petition scanning, and mailing notices to voters.

Perhaps most significantly, counties were authorized to raise signature verification fees, which FDH says has pushed the average cost from about 70 cents per petition to more than $4 in some places—while candidate petitions remain capped at 10 cents. As of this week, FDH had only 72,917 signatures validated, far short of the 880,062 needed to make the ballot.

DeSantis: “Reform is Needed”

DeSantis pushed lawmakers in January to toughen petition laws, citing fraud in prior cycles and the influence of well-funded special interests.

“The citizen initiative has really been transformed into a special interest initiative… Our constitution should not be for sale to the highest bidder,” DeSantis said. “Why start another election cycle where you have the old system, and then what if there’s fraud? … Let’s just get it right now.”

Supporters see HB 1205 as needed reform; critics see it as a direct attempt to shut down popular ballot measures such as Medicaid expansion and marijuana legalization before voters can weigh in.

Looming Coverage Cliff

The suspension lands as Florida braces for what Emerson called a looming “coverage cliff.”

Roughly 1.4 million Floridians now fall into the Medicaid “coverage gap.” Emerson warned that number could nearly triple to 3.7 million in January if federal Affordable Care Act subsidies expire without congressional renewal.

“Right now in Florida, one in 10 Floridians do not have health care, which is we're already 47th in the country. Come January, that number is going to jump to one in five,” Emerson said. “That is going to be an incredible burden for our tax coverage, for hospitals, for doctors— 1000s of people will die, needlessly.”

FDH estimates hospitals could face $5.2 billion in uncompensated care while the state leaves behind $10.5 billion annually in federal funds that expansion would secure.

What’s Next

Though the campaign is halting its 2026 ballot push, FDH says it is not giving up its legal fight. The group’s lawsuit against HB 1205 continues in federal court, with a trial set for January. Meanwhile, organizers are shifting focus to public education and coalition-building until they can start collecting signatures for the next cycle.

“We’re very confident,” Emerson said. “The work isn't, you know, stopping or pausing. It's continuing immediately, because we're just shifting.”

In the meantime, Florida remains one of just 10 states nationwide that has yet to adopt Medicaid expansion.