Florida wants to be the first state in the nation to charge most of its Medicaid recipients a monthly premium as well as $100 for using the ER for routine care. But even supporters acknowledge that the new fees, which the state legislature passed recently as part of a sweeping Medicaid measure, face long odds of getting federal approval. Today, four states ? Illinois, Rhode Island, Vermont and Wisconsin ? have Medicaid premiums. But those fees, in accordance with federal law, apply only to people who make more than 150% of the federal poverty level ? $16,335 annually for an individual or $33,525 for a family of four. Florida, however, wants to impose the $10 monthly premium on all Medicaid enrollees who aren't in nursing homes. At least two-thirds of Medicaid recipients in Florida, and in the U.S. as a whole, have incomes of less than 150% of the poverty level.