Change to Florida Medicaid Leads to Lawsuit. How It Could Affect Kids’ Checkups
The suit says flawed rate-setting has cut pediatric funding by 15% statewide and as much as 30% in some counties.
- On Tuesday, Pediatric Associates filed a lawsuit against the Agency for Healthcare Administration, alleging the agency failed to correct flawed Medicaid rate-setting calculations affecting children's care.
- The agency's methodology allegedly diverted funds from core pediatric care to autism behavior services, causing a roughly 15% reimbursement drop—approximately $15 million per month in lost essential funding.
- Pediatric Associates serves about 300,000 of the 2.3 million children on Medicaid in Florida. The lawsuit claims AHCA incorrectly allocated specialized autism funding to newborns, which independent experts verified as "deeply flawed."
- Dr. Tamika Maxwell warned that reimbursement cuts make treating Medicaid patients financially untenable for her practice. Some clinics in Miami are already closing, limiting access for children seeking care.
- The lawsuit seeks to restore funding lost since February 2025 to protect pediatric care for Florida children. Acadia Jacob, interim executive director of Florida Voices for Health, warned of "needless loss of access to care" at vulnerable times.
15 Articles
15 Articles
Florida’s Largest Pediatric Primary Care Provider Sues Florida Health Agency to Protect Children’s Access to Care
This week, Pediatric Associates (PA), the largest pediatric primary care provider in Florida, filed a lawsuit against the Florida Agency for Health Care Administration (AHCA), challenging a flawed rate-setting formula that has already drained hundreds of millions of dollars from Florida’s pediatric care system, pushing some clinics to leave the Medicaid program and putting at […]
Change to Florida Medicaid leads to lawsuit. How it could affect kids’ checkups
MIAMI — Pediatric Associates, Florida’s largest pediatric provider, is sounding the alarm about a change by the state that could make it difficult for doctors to treat children who are insured through Medicaid in the future. And it’s suing to…
Sun-Sentinel
Orlando SentinelPediatric Associates sues Florida’s health agency over ‘deeply flawed’ Medicaid rates
Pediatric Associates has sued Florida's Agency for Healthcare Administration, saying an error in Medicaid reimbursement threatens the healthcare of more than 2 million children.
Florida Phoenix
Largest Medicaid pediatric provider sues DeSantis administration over pay rates
Pediatric Associates is suing the DeSantis administration alleging it used bad math when calculating new managed care rates to account for the costs of covering applied behavioral analysis services for children with special needs or autism. This kind of care in Florida has exceeded $2 billion in the past, according to the state. (iStock/Getty Images Plus)Florida’s largest Medicaid pediatric healthcare provider is suing the administration of Gov.…
Children's health care provider challenges state over Medicaid rate change
A large children’s health care provider is challenging the state agency that oversees Medicaid, alleging it improperly reduced reimbursement rates and jeopardized care for children across Florida. Pediatric Associates, which says it is the largest children’s health care provider in the state and serves more than 300,000 patients through offices across Florida, filed a challenge Tuesday with the Division of Administrative Hearings. The group alle…
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