Escambia and Santa Rosa counties’ hospitals and community health centers have seen their charity care costs climb 48% since FY 2022-23, an increase of $33.5 million, according to the Florida Agency for Health Care Administration’s (AHCA) annual Low Income Pool (LIP) Model Summary. The LIP program reimburses providers based on the cost of care they deliver to patients who can’t pay.
- Baptist Hospital, the area’s newest hospital, has absorbed 45% of that increase—$15.2 million—with its charity care cost nearly doubling, from $13.1 million in FY 2022-23 to $28.7 million for FY 2025-26. In FY 2022-23, Baptist was still in its inner-city location on E Street. The hospital moved into its $650 million campus in September 2023.
Not every provider saw costs rise. Community Health Northwest Florida, the area’s federally qualified safety-net clinic, saw its charity care cost drop $439,413—about 7%—from $6 million three years ago to $5.57 million this year, even as Medicaid enrollment in its service area collapsed.
The 2025-26 Breakdown
| Provider | 2025-26 Charity Care | Percentage |
|---|---|---|
| Baptist | $28,266,946 | 27.4% |
| Ascension Sacred Heart | $42,417,870 | 41.1% |
| HCA Florida West | $20,862,505 | 20.2% |
| Santa Rosa Medical | $4,857,762 | 4.7% |
| Lakeview Center—Escambia | $927,537 | 0.9% |
| Lakeview Center—Santa Rosa | $280,177 | 0.3% |
| Community Health NWFL | $5,571,059 | 5.4% |
| Total | $103,183,856 | 100.0% |
Why It’s Happening
The roots of the increase trace back to the COVID-19 Public Health Emergency, when states were required to keep nearly all Medicaid enrollees continuously covered in exchange for a temporary 6.2% boost in federal matching funds. That requirement drove Medicaid enrollment up by roughly 23 million people nationwide and 1.5 million in Florida between 2020 and 2023.
The continuous coverage requirement expired March 31, 2023. The DeSantis administration chose not to adopt any of the 23 flexibilities the Centers for Medicare and Medicaid Services (CMS) offered states to soften the impact of redeterminations.
In the first month after protections ended, 249,427 Floridians lost coverage—more than any other state in the country. About 82% were closed for procedural “red tape” reasons, not because they were determined ineligible.
Locally, the numbers followed the same pattern. According to the Florida Department of Health, Escambia County’s Medicaid enrollment fell from 87,328 in 2022 to 65,003 in 2025—a decline of 22,325 people, or 25.6%. Santa Rosa County fared better, dropping 8.7%, from 34,235 enrollees to 31,263.
- In 2022, 23.2% of the two counties’ residents were enrolled in Medicaid.
- Last year, that share had fallen to 17.5%.
- Over the same period, local charity care costs rose $33.5 million.
- LIP dollars covering it are drawn from state and local funds matched with federal Medicaid money—so the bill for Florida’s decision not to soften the Medicaid unwinding is being paid, in part, by Escambia and Santa Rosa taxpayers and by everyone whose insurance premiums absorb hospitals’ cost-shifting.
Community Health Northwest Florida tried to catch people before they fell through the cracks. In a June 2023 interview, CEO Chandra Smiley described the clinic’s effort to help patients navigate redetermination paperwork:
“We’re reaching out to our patients that we know are on Medicaid and making sure that if they need to be redetermined, we have staff that can help support them. If they’re eligible for coverage, we want to help them access that coverage. If there is no coverage that they’re eligible for, then we want to make sure that they’re on our sliding fee program and continue to receive their care through us.”
Yet Community Health’s own charity care cost fell even as local Medicaid enrollment cratered.
At its meeting on Thursday, the Escambia County Commission will vote on whether to approve a Low Income Pool Letter of Agreement between the county and ACHA, which will allow Community Health to participate in the AHCA’s Low Income Pool, in an amount not to exceed $447,664, which will provide matching funds to the clinic for the costs of uncompensated charity care for low-income individuals who are uninsured.
The commissioners will vote on a similar letter for Lakeview Center for $413,403.
