What types of policy changes does Florida Medicaid issue?

Florida Medicaid regularly publishes coverage updates including prior authorization requirement changes, billing code additions or deletions, plan-type coverage modifications, and clinical policy revisions. PolicyChanges.app monitors these notices and summarizes the impact for providers.

How often does Florida Medicaid update its policies?

Florida Medicaid typically releases policy bulletins on a rolling basis throughout the year. Our system checks for new updates daily and adds them to this feed as soon as they are identified.

How many Florida Medicaid policy changes are tracked here?

This page currently tracks 32 documented Florida Medicaid policy changes. New items are added as they are identified.

What should I do when Florida Medicaid changes a prior authorization policy?

Review each change's effective date and action-required notes. Update your billing and clinical workflows before the effective date to avoid claim denials. Each policy detail page on PolicyChanges.app includes a plain-English summary and action items.

Florida Medicaid Policy Changes & Prior Auth Updates

We track 32 documented policy changes from Florida Medicaid across FL. Each entry includes an AI-generated plain-English summary, effective date, affected billing codes, and a direct link to the original Florida Medicaid notice. Use the related links below to narrow results by specialty or state, or sign up for a free daily alert to receive new Florida Medicaid updates automatically.

Low impact
Medicaid Provider Payments Week of 06/19/2025
Florida Medicaid·Effective Jun 19, 2025
Florida Medicaid provider payments scheduled for Thursday, June 19, 2025 will be delayed by one day due to a federal holiday bank closure. Payments will be available Friday, June 20, 2025 instead, with normal Thursday schedule resuming June 26, 2025.
Medium impact
Medicaid Provider Payments Week of 06/30/2025
Florida Medicaid·Effective Jul 3, 2025
Florida Medicaid payments scheduled for July 4th (Thursday) will be delayed until Tuesday, July 8, 2025 due to Department of Financial Services year-end processing and the July 4th holiday. The payment issue date on remittance advice will still show July 3, 2025, but actual funds won't be available until July 8th.
Medium impact
Comprehensive Intellectual and Developmental Disabilities Managed Care Waiver
Florida Medicaid·Identified Jun 16, 2026
Florida is expanding its Comprehensive Intellectual and Developmental Disabilities Managed Care Waiver from two regions to statewide coverage, increasing enrollment capacity and adding participant-directed options for companion, personal supports, and skilled nursing services. This affects billing for intellectual and developmental disability services under Florida Medicaid managed care.
Low impact
Managed Medical Assistance Amendment Request
Florida Medicaid·Identified Jun 16, 2026
Florida is seeking federal approval to amend its Medicaid Managed Medical Assistance program to add a new Family Home Health Aide Services Program for medically fragile children. A 30-day public comment period began July 18, 2025, with public hearings scheduled for July 28-29.
High impact
State Fiscal Year 2025-26 Diagnosis-Related Groups and Enhanced Ambulatory Patient Groups Solventum Grouper Version Update
Florida Medicaid·Effective Jul 1, 2025
Florida Medicaid updated to Solventum grouper version 2025.2.2 for DRG and EAPG hospital billing, resulting in higher reimbursement rates. Providers must submit claim adjustments for services with discharge dates July 1-23, 2025 to receive the increased payments.
Medium impact
Prescribed Pediatric Extended Care (PPEC) Services Fee Schedule Increase
Florida Medicaid·Effective Jul 1, 2025
Florida Medicaid has increased fee schedule rates for PPEC (Prescribed Pediatric Extended Care) services codes T1025 and T1026 effective July 1, 2025. Providers must submit claim adjustments for services billed between July 1-August 1, 2025 to receive the higher reimbursement rates.
Medium impact
Referring, Ordering, Prescribing, and Attending (ROPA) Provider Long Term Care Fee-for Service Claim Requirements
Florida Medicaid·Effective Oct 11, 2025
Florida Medicaid has updated ROPA edit 1976 for Long Term Care claims, effective July 25, 2025. Starting October 11, 2025, claims will be denied if either the Referring OR Attending Provider NPI is missing or invalid (previously required both to be missing). There is a 60-day grace period from August 11 to October 11, 2025 where claims will still pay despite the missing information.
Medium impact
Coverage of Congenital Cytomegalovirus (CMV) Screening - Key Medicaid Information for Fee-for-Service and Managed Care Providers
Florida Medicaid·Effective Jul 1, 2024
Florida Medicaid now provides additional reimbursement of $21.05 for congenital CMV screening (CPT 87496) for qualifying newborns, paid separately from DRG payments. Providers can submit claim adjustments for services back to July 1, 2024.
Medium impact
Statewide Medicaid Managed Care: Non-Emergency Dental Services in Ambulatory Surgical Center and Outpatient Hospital Settings Effective October 1, 2025
Florida Medicaid·Effective Oct 1, 2025
Effective October 1, 2025, payment responsibility for non-emergency dental outpatient anesthesiology and sedation services performed in hospitals or ASCs will transfer from Florida Medicaid dental plans to Medicaid health plans. This change is designed to reduce administrative complexity and simplify billing for providers.
Low impact
The Agency for Health Care Administration Seeks Stakeholder Input on Florida’s Application for Federal Rural Health Transformation Grant Program
Florida Medicaid·Identified Jun 16, 2026
Florida's Agency for Health Care Administration is seeking stakeholder input for a federal Rural Health Transformation Grant Program application that could bring over $500 million to improve rural healthcare delivery, technology adoption, and workforce retention over 5 years.
Low impact
Reminder - The Agency for Health Care Administration Seeks Stakeholder Input on Florida’s Application for Federal Rural Health Transformation Grant Program
Florida Medicaid·Identified Jun 16, 2026
Florida's Agency for Health Care Administration is seeking stakeholder input for a federal Rural Health Transformation Grant Program application. Healthcare providers can submit ideas for rural care improvements, technology solutions, and workforce strategies until September 16, 2025.
Medium impact
Engagement Opportunity for Providers Serving Individuals with Developmental Disabilities
Florida Medicaid·Effective Oct 1, 2025
Florida is launching the Intellectual and Developmental Disabilities Comprehensive Managed Care (ICMC) Program on October 1, 2025, through Florida Community Care (FCC). Providers serving individuals with developmental disabilities should attend community meetings to learn about enrollment, service benefits, and program requirements.
Low impact
Reminder - The Agency for Health Care Administration Seeks Stakeholder Input on Florida’s Application for Federal Rural Health Transformation Grant Program
Florida Medicaid·Identified Jun 16, 2026
Florida's Agency for Health Care Administration is seeking final stakeholder input for a federal Rural Health Transformation Grant Program application, with submission deadline at 5:00 PM today (September 16, 2025). This grant opportunity could bring over $500 million to Florida over 5 years to improve rural healthcare delivery, technology adoption, and workforce retention.
Medium impact
Enhanced Ambulatory Patient Grouping (EAPG) Payment System Educational Session
Florida Medicaid·Effective Oct 15, 2025
Florida AHCA is hosting an educational session on October 15, 2025, to explain the Enhanced Ambulatory Patient Grouping (EAPG) payment system updates for the 2025-2026 rate year. This virtual meeting will cover annual update processes and answer questions about EAPG-based payments for hospitals and ambulatory surgical centers.
Low impact
Diagnosis Related Group (DRG) Payment System Educational Session
Florida Medicaid·Effective Oct 14, 2025
Florida AHCA is hosting an educational session on October 14, 2025, about the Diagnosis Related Group (DRG) payment system updates for the 2025-2026 rate setting year. This is an informational meeting for hospitals eligible for Florida Medicaid DRG-based payments to learn about annual rate updates and the Agency's process.
Medium impact
Reminder of Florida Medicaid's Reimbursement for Rapid Whole Genome Sequencing
Florida Medicaid·Effective Jan 1, 2024
This is a reminder that Florida Medicaid covers rapid whole genome sequencing (CPT codes 81425, 81426, 81427) for patients 20 years or younger with complex illness of unknown cause in ICU settings. Independent laboratories and hospitals can bill these codes with specific fee schedule amounts ranging from $1,262 to $2,717, effective since January 1, 2024.
Medium impact
Medicaid Modernization: New Provider Enrollment System
Florida Medicaid·Identified Jun 16, 2026
Florida Medicaid is launching a new provider enrollment system in early 2026 as part of AHCA Enterprise modernization. Providers must complete pending enrollments in the current system, update account information, and prepare for transition to the new streamlined enrollment platform.
Low impact
Rescheduled Session: Diagnosis Related Group (DRG) Payment System Educational Session
Florida Medicaid·Effective Nov 12, 2025
Florida AHCA has rescheduled an educational session about the Diagnosis Related Group (DRG) payment system for November 12, 2025. This is an informational webinar for hospitals eligible for Florida Medicaid DRG-based payments to learn about annual updates and the 2025-2026 rate setting year.
Medium impact
Medicaid Modernization: Start Preparing for New Provider Enrollment System
Florida Medicaid·Effective Jan 1, 2026
Florida is launching a new Medicaid provider enrollment system in 2026 to modernize and streamline enrollment, renewal, and account maintenance processes. Providers must prepare by completing pending enrollments, updating account information, and maintaining active accounts in the current system before the transition.
Medium impact
Medicaid Provider Payments Week of 11/24/2025
Florida Medicaid·Effective Nov 28, 2025
Florida Medicaid provider payments for the week of 11/24/2025 will be delayed by one day due to funding verification delays. Payments will be issued Friday 11/28/2025 instead of the regular Thursday schedule, with normal scheduling resuming December 4, 2025.
Medium impact
Florida Medicaid's Rapid Whole Genome Sequencing (RWGS) Billing Guidance Webpage
Florida Medicaid·Effective Jan 1, 2024
Florida Medicaid has updated billing guidance for Rapid Whole Genome Sequencing (RWGS) for children under 21 in pediatric ICUs. Prior authorization requirements have been waived for SMMC health plans, and hospital providers will receive additional reimbursement on top of DRG payments.
Medium impact
Behavioral Analysis Services Transition from Health Network One / HN1) to In-House by Community Care Plan
Florida Medicaid·Effective Jan 1, 2026
Effective January 1, 2026, Community Care Plan (CCP) will manage behavioral analysis services in-house instead of through Health Network One. Out-of-network providers have a 60-day continuity of care period through March 1, 2026, for claim payments during member transitions.
Medium impact
Medicaid Provider Payments Week of 12/22/2025 and 12/29/2025
Florida Medicaid·Effective Dec 22, 2025
Florida Medicaid provider payments will be delayed due to Christmas and New Year's Day bank closures. Payments normally issued Wednesday December 24, 2025 and December 31, 2025 will instead be available Friday December 26, 2025 and Friday January 2, 2026.
Medium impact
UnitedHealthcare, Inc. (United) Vendor Transition to Medical Transportation Management, Inc. (MTM)
Florida Medicaid·Effective Mar 1, 2026
Effective March 1, 2026, UnitedHealthcare's non-emergency medical transportation services in Florida regions B, D, and I will transition from United to Medical Transportation Management, Inc. (MTM). All pre-scheduled transportation trips after February 28, 2026 will automatically transfer to MTM with new contact numbers for scheduling.
High impact
Missing National Provider Identification (NPI) on Provider File Action Needed by 3/26/2026
Florida Medicaid·Effective Mar 27, 2026
Florida Medicaid providers with missing National Provider Identification (NPI) numbers in their provider files must update their information by March 26, 2026. Starting March 27, 2026, an active NPI will be required to submit claims via Direct Data Entry on the Florida Medicaid Provider Secure Web Portal.
Medium impact
Moratorium on Enrollment of New Durable Medical Equipment, Prosthetics, Orthotics, and Suppliers
Florida Medicaid·Effective Mar 20, 2026
Florida has imposed a 6-month moratorium on new Durable Medical Equipment (DME) provider enrollment effective March 20, 2026. No new DME provider applications will be accepted after this date, though existing providers can continue billing and applications submitted before March 20th will still be processed.
High impact
Children’s Medical Services (CMS) Plan Transition
Florida Medicaid·Effective Oct 1, 2026
Effective October 1, 2026, Florida's Children's Medical Services (CMS) Plan will transition from Sunshine State Health Plan to Molina Healthcare of Florida. Current CMS Plan recipients will be automatically transferred to Molina, and providers wanting to continue participating in the CMS Plan must enroll with Molina.
Low impact
Engagement Opportunity for Providers Servicing Individuals with Developmental Disabilities
Florida Medicaid·Identified Jun 16, 2026
Florida Medicaid is hosting community meetings across the state for providers serving individuals with developmental disabilities to learn about the Intellectual and Developmental Disabilities Comprehensive Managed Care (ICMC) Program operated through Florida Community Care. These are informational meetings scheduled from April through July 2026.
Medium impact
Children’s Medical Services (CMS) Plan Transition Stakeholder Meeting
Florida Medicaid·Effective Oct 1, 2026
Florida's Children's Medical Services (CMS) Plan is transitioning from Sunshine State Health Plan to Molina Healthcare of Florida, Inc. effective October 1, 2026. Molina is hosting stakeholder meetings in May and June 2026 to help providers, families, and advocates understand the transition process.
Low impact
Moratorium on Enrollment of Adult Day Care Providers (Miami-Dade County)
Florida Medicaid·Effective May 1, 2026
Florida Medicaid has imposed a temporary 6-month moratorium on enrollment of new Adult Day Care Providers (Provider Type 67 with specialty 113) in Miami-Dade County, effective May 1, 2026. Existing providers can continue billing for services, but no new applications will be accepted during this period.
Medium impact
Agency for Health Care Administration Continues to Promote the “From the Start” Initiative with State and Local Partners
Florida Medicaid·Identified Jun 16, 2026
Florida Agency for Health Care Administration announced the 'From the Start' maternal health initiative for Florida Medicaid, which will provide enhanced prenatal and postpartum coverage including unlimited doula services, remote patient monitoring for high-risk pregnancies, and incentives for achieving care milestones. All Medicaid managed care plans in Florida will universally cover these expanded benefits and wrap-around services.
Medium impact
Children’s Medical Services (CMS) Plan Transition Stakeholder Meeting
Florida Medicaid·Effective Oct 1, 2026
The Children's Medical Services (CMS) Plan is transitioning from Sunshine State Health Plan to Molina Healthcare of Florida effective October 1, 2026. Molina is hosting stakeholder meetings across Florida in June 2026 to support this transition.

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Medicaid Provider Payments Week of 06/19/2025

Medicaid Provider Payments Week of 06/30/2025

Comprehensive Intellectual and Developmental Disabilities Managed Care Waiver

Managed Medical Assistance Amendment Request

State Fiscal Year 2025-26 Diagnosis-Related Groups and Enhanced Ambulatory Patient Groups Solventum Grouper Version Update

Prescribed Pediatric Extended Care (PPEC) Services Fee Schedule Increase

Referring, Ordering, Prescribing, and Attending (ROPA) Provider Long Term Care Fee-for Service Claim Requirements

Coverage of Congenital Cytomegalovirus (CMV) Screening - Key Medicaid Information for Fee-for-Service and Managed Care Providers

Statewide Medicaid Managed Care: Non-Emergency Dental Services in Ambulatory Surgical Center and Outpatient Hospital Settings Effective October 1, 2025

The Agency for Health Care Administration Seeks Stakeholder Input on Florida’s Application for Federal Rural Health Transformation Grant Program

Reminder - The Agency for Health Care Administration Seeks Stakeholder Input on Florida’s Application for Federal Rural Health Transformation Grant Program

Engagement Opportunity for Providers Serving Individuals with Developmental Disabilities

Reminder - The Agency for Health Care Administration Seeks Stakeholder Input on Florida’s Application for Federal Rural Health Transformation Grant Program

Enhanced Ambulatory Patient Grouping (EAPG) Payment System Educational Session

Diagnosis Related Group (DRG) Payment System Educational Session

Reminder of Florida Medicaid's Reimbursement for Rapid Whole Genome Sequencing

Medicaid Modernization: New Provider Enrollment System

Rescheduled Session: Diagnosis Related Group (DRG) Payment System Educational Session

Medicaid Modernization: Start Preparing for New Provider Enrollment System

Medicaid Provider Payments Week of 11/24/2025

Florida Medicaid's Rapid Whole Genome Sequencing (RWGS) Billing Guidance Webpage

Behavioral Analysis Services Transition from Health Network One / HN1) to In-House by Community Care Plan

Medicaid Provider Payments Week of 12/22/2025 and 12/29/2025

UnitedHealthcare, Inc. (United) Vendor Transition to Medical Transportation Management, Inc. (MTM)

Missing National Provider Identification (NPI) on Provider File Action Needed by 3/26/2026

Moratorium on Enrollment of New Durable Medical Equipment, Prosthetics, Orthotics, and Suppliers

Children’s Medical Services (CMS) Plan Transition

Engagement Opportunity for Providers Servicing Individuals with Developmental Disabilities

Children’s Medical Services (CMS) Plan Transition Stakeholder Meeting

Moratorium on Enrollment of Adult Day Care Providers (Miami-Dade County)

Agency for Health Care Administration Continues to Promote the “From the Start” Initiative with State and Local Partners

Children’s Medical Services (CMS) Plan Transition Stakeholder Meeting