Tag: Florida

Alternative Headline: Florida Autism Therapy Providers Say Medicaid Transition Puts Kids at Risk

[MM Curator Summary]: ABA therapy providers in Florida warn that Medicaid’s switch to managed care is causing massive payment delays, denials, and cuts that threaten children’s access to autism care.

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Companies that provide therapy to children with autism are speaking out, saying they may have to stop serving some of Florida’s most vulnerable children if problems with a new Medicaid reimbursement system aren’t resolved.

Autism therapy providers warn of crisis amid Medicaid changes

“They owe us a lot of money. And it’s not just us. It’s statewide. It’s across the board,” said Alicia Anthony-Zabala, who owns Missing Piece ABA in Tampa.

“The clients we serve are in jeopardy of losing their services,” said Sara Beeler of Mindful Masterpieces in Naples.

The ABC Action News I-Team has learned the issues started in February, when Florida’s Medicaid program transitioned to a managed care system.

Providers say since that transition, payments have been delayed or denied, putting businesses, children and families at risk.

Thousands of Florida children receive ABA through Medicaid

For Anthony Meoni, who has been diagnosed with autism spectrum disorder, Missing Piece ABA offers what his family believes is his best chance to thrive.

Anthony struggles with communication and social interaction.

He’s not alone.

According to the CDC, the prevalence of autism spectrum disorder nationwide has grown from 1-in-150 children in 2000 to 1-in-31 today.

That represents about 3.1 percent of all children.

Anthony is among an estimated 41,000 Florida children who receive ABA, or Applied Behavioral Analysis therapy through Medicaid.

“ABA is the only approved scientifically-based documented treatment for autism,” Anthony-Zabala said.

ABA therapy uses positive reinforcement and consistent practice to change children’s negative behaviors.

“A lot of these kids can’t go to school”

“Some of our companies are the only lifeline these parents have to kind of work through some of these behaviors,” said Aerial Lufkin, of Sunshine ABA in Orlando.

“The majority we service are all day every day,” Beeler said. “It’s very important because the majority of clients we have don’t have other options as far as attending school or a regular daycare because they don’t provide the types of therapy they need.”

“A lot of these kids can’t go to school. Or they do go to school and they get sent home because of their behavior. Parents are having to pick them up,” said Anthony-Zabala.

Representatives of four ABA providers recently told the I-Team their businesses are struggling after Medicaid changed to a statewide managed care program in February.

“People weren’t fully prepared for a big transition like this. This is very huge and it’s really affected everyone in the state,” Lufkin said.

They say the problems stem from the way Sunshine Health, the company that administers Medicaid claims for the state, pays providers.

“Prior to this, every Thursday we would get a lump-sum deposit. So we would bill and pretty much get what we billed,” Anthony-Zabala said.

“It’s created a huge spiral in my finances”

Providers say now payments are sporadic.

“Because the payments are so spaced out, it makes it impossible to budget because you don’t know how much money you’re getting and when you’re getting it,” said Pearson Klein of Behavior Modification Solutions ABA in Ocala.

“We’ve seen no payments on some of the claims for many weeks now,” Beeler said.

Some claims submitted in February and March are still listed as “pending”.

Anthony-Zabala says claims she submitted for a single client were approved in some cases and denied in others.

“We were only reimbursed 8 out of 34 claims. And when we went back into the portal, the system, it just said that they were being denied due to no Medicaid ID… even though the Medicaid ID was on the denial,” Anthony-Zabala said.

“They’ll say a Medicaid number isn’t listed on the paperwork, but on the denial, it’s clearly listed,” Beeler said.

And providers say getting answers about the denials isn’t easy.

Alicia Anthony-Zabala

“We will sit on the phone for hours and generally get no resolution to the reason why we were calling,” Beeler said.

Under the new system, providers say reimbursement rates were also cut by 20 percent, even though they have to pay their staff the same amount.

Some companies say they’re on the brink of having to close.

“Most of us are four to six weeks away. If this continues… the lack of reimbursement… four to six weeks,” Anthony-Zabala said.

She estimates she is owed about $80,000 for claims she has submitted to Sunshine Health but haven’t been paid.

“It’s just created a huge spiral in my finances,” Klein said.

He said if his business shut down, 35 to 40 people would lose their jobs.

If ABA companies close, parents would also be impacted.

“Likely they would have to quit their jobs. Someone would have to make the decision to say home. Or hire some private care,” Beeler said. “It’s very expensive.”

Response to providers’ concerns

We contacted Florida’s Agency for Healthcare Administration, or AHCA, about the providers’ issues but have not heard back.

We also reached out to a spokesperson from Sunshine Health.

She emailed the following statement, which addresses concerns we forwarded to the company about patient privacy and reimbursement:

“Sunshine Health takes its responsibility to protect member and provider information seriously, maintaining strict compliance with HIPAA regulations to ensure all protected health information (PHI) is handled securely and appropriately.

“Access to our Provider Portal is restricted to Providers who are Covered Entities and/or their Business Associates who are authorized to handle PHI under the terms of our access agreement. Users are required to only access records for which they have a legitimate business need. The identity verification data requested reflects information typically received by providers at the point of service and is designed to help return member information efficiently and without limiting the ability of members to get the care they need when they need it.”

“Sunshine Health partners closely with our valued network of providers to deliver high quality care to our members. The state of Florida transitioned Behavioral Analysis (BA) services to managed care health plans on Feb. 1, 2025, and we have invested significant effort into making this transition as seamless as possible for both our members and provider partners. As a managed care health plan for the State of Florida, we adhere to all state requirements about how services can be billed. In an effort to be a good partner, we have been working closely to educate providers on these processes through Provider Town Hall trainings, Provider Engagement Team outreach, and quick resource guides to ensure they understand any requirements in order to deliver the best care to our members.”

Anthony-Zabala worries if the program isn’t fixed, Anthony and the other children her company cares for could be at risk of losing the progress they’ve made.

“Every small achievement, no matter how small, is a milestone. That’s why you get up every day and you believe in it. And you believe in these kids and you fight for them,” she said.

https://www.newsbreak.com/tampa-bay-28-563666/4182961849225-autism-therapy-providers-warn-of-crisis-amid-medicaid-changes

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Alternative Headline: Florida Boosts Cancer Screening

[MM Curator Summary]: Florida Medicaid’s financial incentive program boosted colorectal cancer screening rates by 4.4 points in under a year, impacting over 100,000 enrollees.

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Key takeaways:

• A Florida initiative helped improve colorectal cancer screening by 4.4 percentage points among Medicaid enrollees.
• State had significant increases for individuals aged 45 to 55 years.

A Florida health initiative prompted a significant increase in colorectal cancer screening for eligible individuals with Medicaid within the state, demonstrating the strategy’s effectiveness and ability to target urgent public health needs.

Florida incentivized Medicaid managed care plans to focus on screening uptake with financial relief. The results included a 4.4 percentage-point increase in overall screening in less than a 

Christopher R. Cogle

“The results were larger than expected,” Christopher R. Cogle, MD, professor of medicine at University of Florida and founding director of Florida Health Policy Leadership Academy, told Healio. “In just 9 months, we brought 100,000 Floridians up to speed for colorectal cancer screening, and for many of them, this was their first encounter with health care.”

“When large health systems try new interventions at the practice level, they might only get a few hundred patients up to speed with colorectal cancer screening,” he added. “Florida tried something new. It aimed for system-level change and found a scale of improvement that was larger than even the largest hospitals in the state.”

Financial relief for better uptake

Colorectal cancer incidence continues to rise in the U.S.

Nationally, a projected 154,270 cases will be diagnosed, and 52,900 people will die of the disease this year, according to American Cancer Society’s Cancer Statistics 2025 report. Only lung/bronchial cancer will cause more mortality among malignancy types.

Patients enrolled in Medicaid have “disproportionally and persistently low” screening rates compared with those with private insurance, researchers wrote.

“Coming out of COVID, we saw a cancer screening gap,” Cogle said.

Approximately 70% to 80% of individuals enrolled in Medicaid are covered through managed care, private insurance companies contracted to help manage costs, Cogle said.

“Today’s managed care plans agree to handle both the medical needs of patients as well as their health-related social needs,” he added.

At the same time, state agencies wield significant “leverage” with these agreements.

“Every Medicaid managed care plan has clear performance measures in their state contracts,” Cogle said. “These plans aren’t just processing claims. They’re competing on quality, because that’s what drives their payment.”

In 2022, Florida used a financial relief, called alleviation of liquidated damages, to try and improve screening for colorectal cancer.

“Florida Medicaid created a new financing approach. It offered relief on other performance measures if plans made an extra push to raise cancer screening rates within the next 9 months,” Cogle said.

Cogle and colleagues conducted a comparative effectiveness analysis of Florida Medicaid enrollees eligible for colorectal cancer screening before and after the initiative to determine its efficacy.

The pre-initiative cohort included 187,295 individuals (54.5% aged 56-65 years; 30.5% white; 19.9% Hispanic; 19.4% Black) and the post-initiative cohort had 191,659 (52.6% aged 56-65 years; 30.3% white; 22% Hispanic; 19.2% Black).

The proportion of Medicaid enrollees who had up-to-date screening for colorectal cancer at the end of the policy served as the primary endpoint.

‘Encouraging example’

After accounting for attrition, the post-initiative cohort had a significantly higher proportion of individuals up to date with colorectal cancer screening compared with the pre-initiative cohort (51.3% vs. 46.9%; P < .001).

Screening significantly increased among individuals aged 45 to 55 years (31.3% to 38.6%; P < .001) and those aged 56 to 65 years (56.6% to 60.8%; P < .001).

“This trend suggests that the 2021 United States Preventative Services Task Force guideline update, which lowered the recommended screening age from 50 to 45, was being adopted early by physicians and embraced by patients, even within a Medicaid population that often faces significant barriers to preventive care,” Cogle said. “It’s a rare and encouraging example of rapid uptake of national guidelines in a resource-constrained environment.”

Conversely, screening decreased significantly for those aged 66 to 75 years (62% to 56.7%; P < .001).

Investigations into barriers to screening for this population deserve future investigations, researchers wrote.

However, the program’s overall success underscores the importance of long-term initiatives.

“The next step is to make successful policies durable,” Cogle said. “We also need to share results widely, through publications, conferences, and other forums, and explore how federal guidance can help scale proven models nationwide.”

Cogle emphasized this approach could be used to improve outcomes in other areas.

“We’ve used similar state-level financial incentives in Florida, and they consistently prompt health plans to focus intensely, at least for a time, on urgent health needs,” he said. “Cancer has shown us a new way to improve population health. This was an experiment in a high-priority cancer, but the lessons translate to maternal health, birth outcomes, adolescent mental health, and more.”

“This is much bigger than oncology,” he added. “Medicaid isn’t just a safety net. It’s the country’s largest public health laboratory. When you align quality goals, financing, and private sector engagement, you can achieve large-scale results and learn from it.”

https://www.healio.com/news/hematology-oncology/20250815/financial-relief-incentive-spiked-crc-screening-uptake-in-florida-medicaid-enrollees

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Alternative Headline: $67M Medicaid Deal Spurs Florida Feud

[MM Curator Summary]: 600 pages of newly released records revealing a $67 million Medicaid settlement in Florida has re-sparked political turmoil — after $10 million went to a nonprofit tied to Casey DeSantis and was used to oppose marijuana legalization.

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The documents reveal details of a $67 million settlement between Florida and the state’s largest Medicaid provider, meant to settle overbilling claims levied against a now-former pharmacy benefit manager.

Hope Florida began under the state Department of Children and Families in 2019 as a program aiming to connect people with local services that would help them become independent of public assistance. | Rebecca Blackwell/AP

TALLAHASSEE, Florida — A trove of records released by Florida Attorney General James Uthmeier has revealed new details about community-based welfare program Hope Florida and its financial and legal dealings, reviving one of the state’s largest political battles this year between Sunshine State Republicans.

The documents reveal details of a $67 million settlement between Florida and the state’s largest Medicaid provider, meant to settle overbilling claims levied against a now-former pharmacy benefit manager. The final drafts of the settlement included a $10 million donation to the nonprofit arm of Hope Florida, an effort spearheaded by first lady Casey DeSantis, which fell under scrutiny amid rumors about her plans to run for governor. The donation was later used to fund the campaign to defeat a marijuana initiative last year.

The roughly 600 pages of emails and drafts obtained first exclusively by POLITICO provided further detail on that settlement — but they don’t address the larger question of how the$10 millionwas steered to killing the marijuana initiative effort, known as Amendment 3. And they come as multiple players in the ongoing saga gear up for their own future political plans.

Scrutiny of Hope Florida and the $10 million donation was led by state House Health Care Budget Chair Alex Andrade (R-Pensacola), who grilled state agency chiefs about Hope Florida during meetings he held earlier this year. Gov. Ron DeSantis has fired back at Andrade with questions about his ties to the medical marijuana industry, which footed the bill for Amendment 3.

Hope Florida began under the state Department of Children and Families in 2019 as a program aiming to connect people with local services that would help them become independent of government-subsidized public assistance. Casey DeSantis began promoting Hope Florida a short time after, and the program later spawned the Hope Florida Foundation, to help raise and distribute money without state restrictions. The $10 million donation from the otherwise-unrelated settlement agreement was by far the largest fielded by the foundation, which otherwise struggled to raise funds and manage key financial tasks, such as filing federal taxes.

The $10 million donation was part of a $67 million settlement offered by the state’s largest Medicaid contractor, Centene, and state lawmakers believe the entire amount should have been returned to the Legislature. Instead, a board overseeing the Hope Florida Foundation donated $10 million toward two nonprofits working to defeat Amendment 3. (Defeating the ballot initiative was a key priority of GOP Gov. Ron DeSantis.)

But the records, some of which were previously confidential under trade secret laws, show the $67 million amount was more than three times the actual loss incurred by the state when it was overbilled.

According to letters sent to the state by Centene, the settlement gave more than $19.4 million to cover the actual loss incurred by the state and another $36.8 million in profits collected by Centene’s former pharmacy benefit manager. There was an additional $10.8 million offered to cover any additional losses or costs associated with the state’s claim. Both sides agreed to cover their own legal costs.

Andrade believes Florida law mandates the entire settlement, including the $10 million donation, be returned to the Legislature. A letter drafted by lawyers from Centene, however, said the entire $67 million settlement was more than three times larger than the state’s actual financial loss.

The Florida settlement stems from an Ohio lawsuit alleging Centene’s former pharmacy benefit manager pocketed tens of millions in drug rebates meant to benefit the state’s Medicaid program. Centene subsequently established a $1.2 billion trust fund to settle similar claims filed by several other states.

“I am hopeful this will help the folks in the governor’s office gain a better understanding of the fact that FL is receiving 3.4 times more than the most aggressive actual damages calculation,” Mississippi lawyer Matthew C. McDonald wrote to Tallahassee lobbyist Crystal Stickle, as detailed in the records. “As we have discussed on multiple occasions, pursuing litigation in FL based on the conduct alleged in Ohio would result in the state recovering far less than is being offered as part of this settlement.”

The records also detail the roles played by several key officials who took part in putting the settlement together. They include emails from Chief Deputy Attorney General John Guard, who is still awaiting Senate confirmation after being nominated by President Donald Trump in late May to become a federal judge. Guard signed off on the finalized settlement in September after he removed the attorney general’s office as the designated recipient of the settlement funds because they involve Medicaid. Guard determined the funds should instead be managed by the state Agency for Health Care Administration, which regulates most of the state’s Medicaid program and is funded by $34.6 billion in federal and state dollars.

Guard, who previously prosecuted cases on behalf of the attorney general’s Medicaid Loss Control Unit, also said the settlement was different from others involving Medicaid funding.

“Normally, the federal share is explicitly detailed in the settlement agreement, and I am not sure AHCA wants us to get the remainder of the money,” Guard wrote in a Sept. 13 email to Andrew Sheeran, the top legal advisor at AHCA. “If it is just going to the Legislature and [general revenue], I can probably make it work, but I believe this is different than I have seen in a settlement with Medicaid monies.”

When Jeremy Redfern, spokesperson for the attorney general’s office, was asked if Guard would offer comment, he said the records spoke for themselves.

Uthmeier, who only met with Centene about the settlement when he was chief of staff for Ron DeSantis, appears to have had minimal involvement based on the records.

Uthmeier was appointed by DeSantis in February to replace former Attorney General Ashley Moody after she was appointed to the Senate. He is now gearing up for a race to keep his position in next year’s elections. Meanwhile, Casey DeSantis has been considering a run for Florida governor and has yet to make a decision.

The controversy and outrage among state lawmakers over Hope Florida’s $10 million donation throughout this year’s legislative session led them to strip funding for the program in this year’s state budget. The state Senate also failed to confirm Children and Families Secretary Taylor Hatch and AHCA Secretary Shevaun Harris due to concerns about the program. But most of the fury died down by the time Ron DeSantis signed this year’s budget at the end of June.

A spokesperson from Uthmeier’s office said the records were able to be released after months of talks with Centene and other lawyers involved with the settlement about releasing drafts of the agreement deemed confidential.

“The documents in question were considered ‘trade secret’ and required consent from Centene to release,” Uthmeier spokesperson Redfern said.

About 60 percent of Florida’s Medicaid budget is covered by federal dollars. McDonald’s letter estimates the overbilling led the state Medicaid program to miss more than $19 million in drug rebates, which is less than one-third of the $67 million offered in the settlement, and only half of the $39 million Andrade told reporters was federal money.

Andrade, the state lawmaker who has led the charge to further investigate Hope Florida, has yet to see the public probes he hoped to spur, though he claims both federal and state officials are investigating the nonprofit arm. In response to a state reporter’s X post on documents related to Hope Florida, Andrade cited a “selective compliance and arbitrary delay in the production of public records” in his own post, also tagging Uthmeier. The state representative has also demanded all of the records provided by Uthmeier’s office to POLITICO.

Andrade said that, even with an inflated settlement amount, the entire sum should have been treated as federal and state Medicaid dollars.

“Any argument to the contrary has come from those trying to cover up the fraud,” Andrade said. “Every legal defendant in the history of litigation has said their settlement offer is more than they believe they owe. This one is no different.”

Andrade had said in April his committee will resume its inquiry of Hope Florida during the legislative session next year. But as of Wednesday, Andrade said he was unsure if state House Speaker Daniel Perez (R-Miami) will make him health care budget chair for another year. He also said AHCA has refused to turn over records he requested several months ago.

“I’m certainly not going to look the other way while James Uthmeier and his office continue to make a mockery of the laws they’re entrusted to enforce,” Andrade said. “Until they produce their public records and act like transparency is important to them again, I obviously have more questions.”

CLARIFICATION: This report has been updated to specify the organizations the $10 million donation was made to.

https://www.politico.com/news/2025/08/06/newly-released-hope-florida-records-reignite-intra-gop-political-battle-00495069

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Alternative Headline: Florida Forfeits Billions in Aid

[MM Curator Summary]:  Florida has lost $2.2 billion in Medicaid funding for schools due to a decade-long failure to comply with federal reimbursement rules — a delay that may directly affect students mental health. 

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Florida lawmakers reached a rare consensus after the deadly Parkland school shooting: More money was needed for mental health counseling at schools.

“We haven’t put enough resources into mental health issues,” said then-Sen. Kathleen Passidomo, R-Naples. “And look what happens.”

Two years later, lawmakers passed a bill allowing Medicaid dollars assigned to school districts to be used for more types of care for kids, including counseling.

But state officials didn’t adopt the changes. And they have refused to comply with federal guidelines that would help school districts provide that care.

Florida schools have missed out on about $200 million a year in Medicaid funding — a total of $2.2 billion since 2014 — to support children’s mental health counseling, physical therapy and other services, advocates say.

Their calls to recoup funding come as schools face multimillion-dollar shortfalls in the budget year that began July 1 — and as kids struggle with the fallout from the COVID-19 pandemic.

They say the problems lie with the Florida Agency for Health Care Administration, which oversees Medicaid in the state and reports to Gov. Ron DeSantis. Documents show that for more than a decade, the agency hasn’t followed federal reimbursement guidelines for school-based services — one of the few areas of Medicaid the Trump administration and Congress have not targeted for reductions.

Governor Ron DeSantis speaks to reporters during a press conference on the airplane runway of Alligator Alcatraz in Ochopee , Florida on Friday, July 25, 2025. PHOTO BY AL DIAZ ad***@*********ld.com

The federal program provides in-school medical care and instruction for school-age children with physical or developmental disabilities who qualify for Medicaid. About 2 million children in Florida are on Medicaid, which provides free or low-cost health care to people who qualify.

Without the money, school districts have struggled to find therapists, nurses and others to treat children. Some kids experienced lower-quality care or had that care delayed during critical periods of their lives, observers say.

The state agency strayed from federal guidelines in 2014, when the U.S. government changed its rules regarding the reimbursements. Experts consulted by the Times said Florida is one of the few states, and perhaps the only one, that is using the outdated payment method.

The federal Center for Medicaid and Children’s Health Insurance Program Services warned the agency in 2020 that it was “not in compliance with current financing rules,” but no substantial action followed.

Over that time, instead of collecting $2.2 billion from federal coffers to cover school-based expenses, the state received about $250 million. With money tight, school officials want the agency to make the necessary fixes.

“This is a significant agency failure,” said Ken Kniepmann, former state assistant deputy secretary for Medicaid Policy and Quality at the agency. He was hired in part to improve the system but said he was later instructed to stop. “It’s really unconscionable. Nobody should be OK with this.”

A spokesperson for the agency said it did not have sufficient funding to update its reimbursement method until this year’s legislative session, and it is committed to getting it done next year.

Kniepmann said the agency had not asked the Legislature for permission to draw down the federal dollars needed to enact the changes until this year.

The Hillsborough County school board held a workshop in April to address the Medicaid funding gap. Hillsborough received about $6 million in Medicaid reimbursements a year ago for the services it provided, specialist Deneen Gorassini told her board, but would have gotten about $10 million more if the state agency followed federal guidelines.

It’s money that could have expanded medical and mental health services in schools.

Other districts experienced similar-sized gaps, according to Kniepmann’s calculations.

“If we can get (the agency) to do their job and submit a (state plan amendment), we could start getting reimbursed based on our expenses, which are way more than what we are getting reimbursed now,” Gorassini told the board.

Since 1997, the state has been reimbursing school districts for services — such as counseling or speech therapy — based on a flat rate.

In 2014, the federal government required states to reimburse school districts based on the actual costs of those services, which is much higher.

Five years ago, federal officials wrote Florida telling them it hadn’t adopted the change, and the state had 90 days to comply.

“Please note that you may not pay a rate from a fee schedule and use this as a certification of cost,” Center for Medicaid and CHIP Services acting director Todd McMillion wrote Florida officials in March 2020.

The center said it is working with the state to resolve the concerns listed in that letter.

Florida is still paying schools a flat rate that has changed little since 1997.

Karen Thomas, a Medicaid specialist for Leon County schools for more than 20 years, said that while the formulas are complex, the solution should be “extremely simple.”

“We’re 90% there, maybe 95% already, in the way we are doing things,” Thomas said of districts’ processes for collecting receipts and monitoring providers’ time. “They have everything they need to be in compliance with federal payment methodology. They just need to change the invoice, one line on the invoice. … The fault is squarely in the agency’s failure to come into compliance.”

The state has shown it can make the switch, Thomas said. She pointed out that when federal authorities ordered county health departments to start billing for actual costs instead of flat rates in 2020, the state quickly shifted.

She noted that school-based services are “a very niche portion” of the state’s Medicaid budget — somewhere in the neighborhood of 1% — and that over time agency officials have paid less attention to them, decreasing communication with school districts and reducing staff dedicated to the service.

The issue shouldn’t be a side note, as it affects the lives of some of Florida’s neediest children, she said. And the pandemic made kids’ mental health a national crisis.

“Kids used to miss school because of asthma,” Thomas said. “Now they’re missing school because of anxiety and depression.”

After the 2018 Parkland attack, state lawmakers wanted to make sure students were getting proper mental health assistance in schools. In 2020, they passed legislation allowing schools to use Medicaid dollars for other types of care. DeSantis signed it into law.

But his Agency for Health Care Administration never rewrote the agency’s rules to allow school districts to use the new law.

“The law was very clear,” said retired Sen. Bill Montford, D-Tallahassee, who sponsored the 2020 bill. “Why they didn’t do it I don’t know.”

Rep. Christine Hunchofsky, a Democrat who represents Parkland in the House, repeatedly has asked agency officials if the state is doing all it can to leverage federal money for student services. The issue comes up frequently on the Commission on Mental Health and Substance Use Disorder, to which Hunchofsky was appointed by the Republican House speaker.

She said the agency has provided few clear answers. Meanwhile, she’s heard plenty from the school districts, and said she plans to pursue the questions further.

Montford, also executive director of the state’s superintendents association, said agency officials have told his group that they are preparing a rule revision to go into effect in mid-2026. That’s when states are supposed to comply with an updated 2023 federal guidance on school-based services.

But Kniepmann, who worked as associate director for health at the Florida Conference for Catholic Bishops before moving to the health agency, argued the state is stalling for reasons that remain unclear to him. He said the 2023 guidance was not intended to be a way for Florida to further delay implementing rules put in place more than a decade ago.

Every holdup, he and others said, means less money available to pay for medical and related services.

“Eleven years and $2.2 billion is not a little thing,” he said.

Hillsborough district officials, also leery of the state’s ability to pull off a new rule by mid-2026, said they are looking into a different approach to bring in more Medicaid money.

Gorassini told the board that her department would conduct a rate study for each service it provides and submit the updated amounts to the state for inclusion on the existing reimbursement schedule. Kniepmann said it’s a long-shot effort that requires a lot of work at the district level, adding that the agency has discouraged such an approach.

It’s worth a shot, though, Gorassini told the Hillsborough school board.

“We’ll never get what we spend,” she said. “But in the meantime we’re going to try to maximize our reimbursement.”

What’s really at stake is student health, said Thomas, the Leon County Medicaid specialist who also serves on the National Alliance for Medicaid in Education leadership team. Her district stands to reap about $2 million more per year if the change is made.

“That is the difference between being able to hire actual medical professionals who have the ability to recognize actual medical issues, and purchase medical equipment, actual things that could help the children that are most medically needy in this county,” she said. “When I can’t afford to pay for a nurse, all kids suffer.”

https://www.miamiherald.com/news/local/education/article311473610.html

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Alternative Headline: Florida Medicaid Expansion Push

[MM Curator Summary]: A Florida political committee raised record funds — $1.65 million — to push a Medicaid expansion amendment for the 2026 ballot.

A political committee seeking to pass a constitutional amendment to expand Medicaid coverage raised nearly $1.65 million from April 1 through June 30, by far the most money it has collected since being formed in 2018.

The Florida Decides Healthcare Committee pulled in $1,648,368 during the quarter, according to a newly filed report at the state Division of Elections. It also spent $1,628,241 during the quarter as it seeks to collect enough petition signatures to get on the November 2026 ballot.

Contributions during the period included $715,000 from the California-based Tides Foundation and $400,000 from the Orlando-based Florida Policy Institute, the report shows.

The proposed constitutional amendment, in part, would require the state to “provide Medicaid coverage to individuals over age 18 and under age 65 whose incomes are at or below 138 percent of the federal poverty level and meet other nonfinancial eligibility requirements.”

As of Friday afternoon, the committee had submitted 62,650 valid petition signatures to the state. It would need to submit at least 880,062 signatures to get on the ballot.

https://www.wusf.org/health-news-florida/2025-07-14/committee-pushing-florida-medicaid-expansion-raises-over-three-months

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Alternative Headline: Florida Medicaid Numbers Fall

[MM Curator Summary]: Florida’s Medicaid enrollment continues to decline, dropping over 643,000 since the start of 2024.

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Florida Medicaid enrollment continues to drop, information posted by the state Agency for Health Care Administration shows.

There were 4,155,487 Florida residents enrolled in the program as of May 30, the latest available data. That’s 68,110 fewer people since December 2024 and 643,662 fewer people than in January 2024.

Florida’s Medicaid caseload was at an all-time high in state fiscal year 2022-23, when total caseload for the safety net program was 5,575,548. The following year, the total caseload dropped by 13.3% to 4,836,670. Economists predicted there would be 4,226,199 enrolled in the program for state fiscal year 2025-26, which starts July 1 and ends June 30, 2026.

Legislators relied on those estimates when drafting the FY 25-26 Medicaid budget. That budget earmarks $36.53 billion to the state Agency for Health Care Administration, the agency that houses Florida’s Medicaid program.

Florida requires most of its Medicaid beneficiaries to enroll in managed care plans. As such, a breakout of Medicaid enrollment data shows that about 72% of the beneficiaries belong to a Medicaid managed care plan, or 3,006,980 as of May. Enrollment in managed care plans is down by 7,682 from January and 453,638 people from January 2024.

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