As negotiations in the Legislature advance on Florida’s health care spending for Fiscal Year 2026-27, its two chambers remain divided on how aggressively to invest in the state’s strained behavioral health system.
Most notably, the House’s opening offer this week proposed nearly $115 million to fund an Institution for Mental Diseases (IMD) Medicaid waiver, which could substantially expand the state’s capacity to treat people with severe psychiatric and substance-use disorders.
The Senate, so far, has offered no comparable funding.
The chambers also disagree on funding for mental health treatment beds, with the House proposing nearly $46 million for bed-capacity maintenance and the Senate offering $16.5 million in return.
Both figures fall well below the $78.6 million earmarked last year and far short of the $95.4 million the Department of Children and Families previously requested.
For the 988 Suicide and Crisis Lifeline, the Senate proposed $9.6 million for oversight on Thursday. The House initially offered $7 million.
For opioid response, the Senate offered more than $33 million for treatment, recovery, housing and support services — slightly above the House’s $32.8 million — plus $14.4 million for prevention compared to the House’s $13.4 million.
The Senate wants $1.1 million for opioid technology and research, while the House offered less than half that sum.
Grants for central receiving facilities, triage hubs where people in mental health or substance-use crises can be assessed and routed to appropriate care rather than defaulting to a hospital emergency room or jail, would total $10.4 million under the Senate offer, compared to $3.2 million in the House.
Senators have also budgeted $4.25 million for a cost-of-living adjustment for mental health contracted agencies, a line item left blank in the House offer.
The chambers agreed on some priorities, including $15 million to redesign the Statewide Inpatient Psychiatric Program and $1 million for a crisis stabilization unit serving Citrus County.
The House’s $114.9 million IMD waiver proposal is contingent on federal approval Florida has not yet received, which may explain the Senate’s reluctance to set aside such a large chunk of funding.
In January, the state filed a pending application with the Centers for Medicare & Medicaid Services, requesting permission to bypass a 60-year-old federal restriction that bars Medicaid from covering most adults treated in large psychiatric or residential behavioral health facilities.
If approved, the waiver would allow Florida to draw down federal Medicaid matching funds for treatment it currently must pay for on its own.
The need is pressing. As Florida Politics reported last August, 772 criminal defendants deemed incompetent to stand trial were waiting beyond the state’s legally mandated 15-day transfer deadline to a psychiatric facility, with average waits of 121 days.
The Department of Children and Families operates just over 3,000 psychiatric beds statewide, running at 98% occupancy. A state-commissioned analysis, published in January 2025, projected Florida needed at least 1,602 additional forensic beds within five years just to maintain that strained level.
To reach a more sustainable 85% occupancy rate, the state would need more than 2,000 new beds.
The pattern of lawmakers funding less than is needed for increased bed capacity has persisted for years, sometimes with severe consequences. A report released in March by Disability Rights Florida found there were at least six preventable deaths in mental health hospitals over the past five years, linked to falsified patient safety checks and systemic failures in oversight.
In 2021, 37-year-old Tristan Murphy of Charlotte County killed himself with a chainsaw while suffering a schizophrenic break after spending 63 days in prison on a felony littering charge.
The tragedy led to a law passed last year to expand diversion and probation options for mentally ill inmates.
Some incidents were nonlethal but left permanent damage, including a 2019 case where a man cut off his penis and flushed it down a Broward County jail toilet while in solitary confinement.
Florida’s dearth of open beds also leaves the state and its localities vulnerable to legal action.
In 2006, a Pinellas County Judge fined then-Department of Children and Families Secretary Lucy Hadi $80,000 for inmate-to-bed delays affecting 237 inmates statewide, less than a third of the count the department acknowledged late last year under current Secretary Taylor Hatch.
Similar scenarios have triggered legal action in other states and led to at least one nuclear verdict. In 2023, a federal court fined the state of Washington $100 million for violating inmates’ due process rights by delaying competency services and failing to add enough mental health treatment facility beds.
Other, more modest rulings occurred in California, Maryland, Minnesota and Utah.
Budget negotiations began Tuesday and are expected to run through May 29.