Building an 'accountability wall' around Florida’s Medicaid program Image By Jason Brodeur President Trump’s rallying cry for a “Big, Beautiful Bill” captured a simple yet powerful principle: every government dollar should build something worthy of public trust. Florida embraces that spirit as it confronts the rising cost and complexity of Medicaid, a program that now consumes nearly 40% of all state Health and Human Services spending, and roughly $33.4 billion in the FY 2024‑25 budget. While Medicaid is a federal‑state partnership, ultimate stewardship rests with the states that design, contract and police day‑to‑day operations. Floridians deserve the same transparency and efficiency President Trump demanded in his broader agenda, and robust, state‑led oversight is the surest way to deliver it. Vigilant oversight Medicaid’s scale alone justifies constant vigilance. Nationally, the improper‑payment rate fell to 5.09 percent in 2024, yet that still translated into $31.1 billion in questionable outlays. Florida, with more than 4.3 million enrollees, confronts the same risk: even a small error rate can siphon hundreds of millions from patient care. Recent headlines underscore the point. In April 2025, Centene, Florida’s largest Medicaid managed‑care contractor, agreed to pay $67 million after its pharmacy‑benefit arm failed to pass drug‑rebate savings to taxpayers. At the provider level, the Attorney General’s Medicaid Fraud Control Unit (MFCU) secured dozens of convictions last fiscal year. A Jacksonville provider was ordered to repay more than $55,000 for falsified claims. These incidents highlight two realities: fraud and waste occur across the delivery chain, from global corporations to individual caregivers. Florida already has statutory authority to investigate, recover and sanction wrongdoing. What is missing is a fully integrated, preventive oversight architecture that stops improper payments before they happen and recovers every misused dollar afterward. Five steps to accountability Florida, therefore, proposes a five‑part strategy to erect a modern “accountability wall.” Real‑time data analytics will expand predictive‑modeling platforms, so pharmacy, managed‑care and eligibility feeds are ingested nightly, and anomalies are flagged within 24 hours. Third‑party audits, rotated every three years, will provide a fresh perspective on capitation invoices, encounter‑data completeness and pharmacy‑rebate accounting, preventing the blind spots revealed in the Centene case. Dedicated fraud‑detection units within the Office of Medicaid Program Integrity will double their forensic‑accounting capacity by reinvesting recovered funds, requiring no new general‑revenue dollars. Enhanced provider screening will automate cross‑checks with federal exclusion lists and state licensing boards at enrollment and every 90 days. Finally, work and community‑engagement requirements, piloted under Section 1115 waiver authority, will align program use with need while preserving coverage for children, seniors and individuals with disabilities. Collectively, these measures transform post‑payment policing into proactive prevention, embodying the efficiency and stewardship President Trump champions. Federal accommodations needed Washington sets baseline rules, but meaningful oversight thrives on state innovation. Florida, therefore, requests three federal accommodations. First, an enhanced 90/10 federal match for advanced analytics tools would accelerate deployment without burdening state coffers. Second, outcome‑based waivers would allow Florida to reinvest a share of recovered funds into community‑health initiatives, turning savings into prevention. Third, a single, jointly designed audit protocol would replace layered federal reviews, reducing duplication and enabling investigators to act in real time. These reforms do not seek more money. They seek smarter rules that recognize states as laboratories of accountability; precisely the federalist bargain envisioned in the “Big, Beautiful Bill.” Florida’s message is clear: every Medicaid dollar must reach the patient it was meant to serve or be swiftly reclaimed for public good. By erecting a 21st‑century oversight system rooted in data, independence and shared accountability, the state will protect vulnerable citizens and conscientious taxpayers alike. That is how Florida intends to build a truly “big, beautiful” Medicaid program and lead the nation in stewardship. Jason Brodeur is a state senator representing Florida’s 10th district. He serves on the Appropriations Committee on Health and Human Services. *The opinions expressed in this column are those of the author and do not necessarily reflect the views of HealthPlatform.News.
