A large children's healthcare provider is challenging the Florida agency overseeing Medicaid, claiming it incorrectly cut reimbursement rates, jeopardizing care for the children served by the group.
Pediatric Associates, which says it is the largest children's healthcare provider in the state serving 300,000 clients with offices throughout Florida, filed a challenge with the Division of Administrative Hearings on Tuesday, alleging the Agency for Health Care Administration incorrectly changed Medicaid reimbursement rates for 2025 and 2026.
If the issue isn’t corrected for the upcoming 2026-27 rates, Pediatric Associates could have to drop services to Medicaid recipients, the filing states.
"If the children I care for every day lose access to pediatric care, it would be absolutely devastating," Dr. Rasciel Socarras, a Pediatric Associates practitioner based in North Miami, said in a statement. “I know from experience that if action is not taken, more families will end up relying on emergency rooms for everyday care — or worse, skipping care entirely.”
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The filing from Pediatric Associates cites the move by AHCA in 2025 to include applied behavioral analysis services in its main pediatric services costs — instead of a fee-for-service basis — as the start of the problem.
AHCA then used a consultant to help develop new rates that included applied behavioral analysis services, but the complaint alleges the analysis allowed for newborns and adults to be included in those cost estimates, even though those populations don’t use those services. That led to lower rates for main pediatric services, such as the kind provided by Pediatric Associates.
“Overall, Florida has experienced a roughly 15% drop in reimbursement for core pediatric care —approximately $15 million per month in cuts to essential funding — even as the cost of providing this care has risen in South Florida’s Regions F through I, where Pediatric Associates’ Medicaid patients are concentrated,” the filing states.
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An AHCA spokesperson didn’t immediately respond to an email seeking comment Tuesday.
The complaint states Pediatric Associates met with AHCA representatives five times between January and May, but the agency hasn’t taken adequate steps to address the situation.
In its filing, Pediatric Associates asks for administrative proceedings to review and overturn AHCA’s rate decisions.
According to Pediatric Associates, the care it provides to children on Medicaid is at stake in the case.
“AHCA’s changes … have significantly lowered funding for pediatric care, making it economically infeasible for Pediatric Associates and other similarly situated providers to serve Medicaid patients under this model,” the filing states.
