The state's Medicaid overhaul also requires beneficiaries to pay a $10 per person monthly premium, according to state health officials, meaning $40 for a family of four. Advocates warn those monthly charges add up and will overburden the state's poorest.

Florida lawmakers passed sweeping changes to the Medicaid program this past session, placing the care of the state's most vulnerable residents, mostly children, into the hands of private providers and hospital networks. Lawmakers said the roughly $20 billion a year Medicaid costs are a strain on a tight state budget and the program couldn't continue without changes.

The bills expand on a controversial five-county pilot program that pays for-profit providers a set fee to cover recipients and allows providers great flexibility in determining patient coverage. Doctors have dropped out of the program, complaining of red tape and that the insurers deny the tests and medicine they prescribe. Patients have complained they struggled to get doctor's appointments. Supporters of the overhaul say new accountability measures will address those concerns.

But the state needs permission from federal health officials to continue the plan. The parties have been negotiating for about six months and talks are likely to continue into next year.

New Jersey lawmakers tried a similar proposal earlier this year, moving Medicaid participants into managed care plans and requiring a $25 copay for non-emergency room ER visits.

In 2003, Oregon increased Medicaid premiums for poor adults to between $6-$20 and enrollment dropped by nearly half, or roughly 50,000 people. Enrollment dipped 30 percent in Missouri in the two years following the 2005 introduction of new premiums in 2005. In Maryland, 28 percent of children dropped out in one year after some participants at higher income levels were charged $37 monthly premiums, according to the report.

"Florida's eligibility levels for families are not generous. That's why these premiums would have such a devastating effect. No other state is charging premiums to kids uniformly at this income level."

But Florida lawmakers say Medicaid patients should not receive better or worse benefits than residents who pay for private insurance and want Medicaid recipients to chip in on costs.

The $100 copay shouldn't be an issue because more families will receive medical treatment from primary care clinics instead of relying on emergency rooms for minor problems.

"I do not believe Medicaid recipients will drop out because the benefits in Medicaid are very generous and other health care options are unavailable," said Sen. Joe Negron, who spearheaded the passage of the health bills.