Florida’s 2020 Census undercount is costing the state at least $2.3 billion annually in federal Medicaid funding, according to a new report published on Tuesday by Florida TaxWatch.

The nonpartisan research institute found that the undercount of approximately 750,000 residents, or 3.48 percent of the state’s population, has resulted in reduced funding allocations for major healthcare programs, including the Children’s Health Insurance Program (CHIP), Medicare Disproportionate Share Hospital (DSH) payments, and the Supplemental Nutrition Assistance Program (SNAP). The report estimates that total federal funding losses due to the undercount will range between $11 billion and $21 billion by the end of the decade.

The U.S. Census Bureau’s population count directly affects the Federal Medical Assistance Percentage (FMAP), the formula used to determine federal Medicaid reimbursement rates. Florida’s FMAP for fiscal year 2024-25 stands at 57.17 percent, meaning the federal government provides $1.33 for every dollar the state spends on Medicaid-eligible expenses. If the undercounted 750,000 residents had been included in the 2020 Census, the report calculates that the FMAP would have increased to 59.78 percent, raising the federal match to $1.47 per state dollar spent.

The result is a projected loss of $2.3 billion in federal Medicaid contributions for fiscal year 2024-25 alone. With Florida expected to spend $15.6 billion in state funds on Medicaid in 2024-25, the total Medicaid budget, including federal contributions, is expected to reach $35.3 billion. The report indicates that correcting the undercount could have increased Florida’s federal Medicaid contribution from $19.7 billion to $22 billion for the fiscal year.

“In 2020, Florida’s census undercount cost the state one, potentially two, congressional seats and resulted in a loss of federal funding that will range from $11 billion to $21 billion by the end of the decade,” said Florida TaxWatch President and CEO Dominic M. Calabro

Beyond Medicaid, the census undercount affects other federally funded programs tied to population data. CHIP determines its maximum funding allotment based on the percentage of children under 19, a figure derived from census data. The Medicare DSH program, which allocates funding to hospitals treating high numbers of uninsured patients, calculates payments based on census-reported changes in the percentage of uninsured individuals under 65. Moreover, SNAP, which provides food assistance to low-income households, uses census-based participation rates to determine funding distributions and local program performance bonuses.

The report notes that census data informs projections used by the Florida Legislature’s Office of Economic and Demographic Research (EDR) and the University of Florida’s Bureau of Economic and Business Research (BEBR), which influence decisions on Medicaid enrollment, hospital capacity, and service availability.

These projections also affect the state’s Certificate of Need (CON) program, which regulates the establishment of healthcare providers, including hospice facilities. Florida’s 27 service areas use population data to determine provider allocations, meaning an undercount can result in artificially low provider caps and restricted healthcare access in high-growth regions.

“Looking ahead to the 2030 census, it is critical Florida works toward a complete and accurate count of all people living in Florida to effectively maintain the delivery of healthcare services,” said Florida TaxWatch Executive Vice President and General Counsel Jeff Kottkamp An accurate statewide count is important to securing the state’s deserved share of federal funding and compiling accurate data with which to plan for the health care needs of Floridians.”

The report’s methodology involved recalculating Florida’s per capita income (PCI) to reflect the census undercount’s impact on federal funding formulas. Florida’s adjusted three-year average PCI was calculated as $59,445, compared to the U.S. adjusted three-year average PCI of $62,876. The FMAP formula, which includes a factor based on state PCI relative to the national average, was then applied to determine the funding shortfall. The estimated Medicaid funding loss of $2.3 billion for 2024-25 was derived by comparing actual state spending to the amount Florida would have received under an adjusted FMAP.