Florida’s leading pediatric provider for children on Medicaid is requesting that the state weigh in on alleged errors in rate calculations that have cost pediatricians millions and some providers to turn away Medicaid patients.
The funding changes have allegedly cost about $15 million per month for core pediatric care, according to a complaint submitted to the Florida Division of Administrative Hearings by Pediatric Associates, a pediatric provider with about 97 offices in the state and which serves more than 300,000 Florida children on Medicaid.
The provider filed the complaint June 23 against the Florida Agency for Health Care Administration, which oversees the regulation of health care facilities and services in Florida, and administers the state’s Medicaid program.
The group raised concerns of what they called “rate-setting errors,” and one issue described was that a traditionally covered service for behavior analysis was switched into a separate pool of money covering core pediatric services.
That’s been particularly concerning for providers, since Florida’s facing a similar surge to other states of rapid growths to behavior analysis-therapy spending, although the group says that these services are usually provided to only a small subset of children.
Additionally, it said the agency adopted “flawed rates” which have “significantly defunded core pediatric care under Florida Medicaid.” A request for comment is pending with an agency spokesperson.
“Millions of children across the State of Florida depend on Medicaid to access high-quality pediatric care,” the complaint says. “Tragically, recent changes to how AHCA funds pediatric Medicaid care now jeopardize this vulnerable population’s access to pediatric care.”
According to the Center for Medicare and Medicaid Services, Florida is fourth in the highest Medicaid child enrollment with about 2.3 million, below California, Texas and New York. For a child under 18 to be eligible for Medicaid, their household income would need to be at 138% of the federal poverty line.
The group is looking for Florida to correct its alleged errors in methodology and to provide public notice for significant proposed changes to its methods. Additionally, they’re looking for a formal hearing to contest and terminate these rules they say defund children’s care.
Rasciel Socarras, a Miami-based pediatrician at Pediatric Associates, said the issue is so pressing because of how costly it’s become, so much that smaller offices may not be able to take in Medicaid patients at all due to these changes.
“We value ourselves in that we provide the best care for these kids that really need it, and I hate to see them lose access at some point just because of these miscalculated errors,” Socarras said.
This reporting content is supported by a partnership with Freedom Forum and Journalism Funding Partners. USA Today Network-Florida First Amendment reporter Stephany Matat is based in Tallahassee, Fla. She can be reached at SMatat@usatodayco.com. On X: @stephanymatat.
This article originally appeared on Tallahassee Democrat: Pediatric provider fights Florida Medicaid funding formula
Reporting by Stephany Matat, USA TODAY NETWORK – Florida / Tallahassee Democrat
USA TODAY Network via Reuters Connect
By Stephany Matat, USA TODAY NETWORK – Florida | USA TODAY Network
