{"id":5135,"date":"2026-06-23T22:11:00","date_gmt":"2026-06-23T22:11:00","guid":{"rendered":"https:\/\/orlandorelocationreport.com\/?p=5135"},"modified":"2026-06-23T22:11:00","modified_gmt":"2026-06-23T22:11:00","slug":"pediatric-associates-sues-floridas-health-agency-over-deeply-flawed-medicaid-rates","status":"publish","type":"post","link":"https:\/\/orlandorelocationreport.com\/?p=5135","title":{"rendered":"Pediatric Associates sues Florida\u2019s health agency over \u2018deeply flawed\u2019 Medicaid rates"},"content":{"rendered":"
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More than 2 million children are at risk of losing their primary medical care because of a Medicaid reimbursement flaw, and Florida\u2019s largest pediatric provider has sued the state agency it holds responsible.<\/p>\n

Read more Orange County bus stop shooting suspect arrested in New York by U.S. marshals<\/a><\/p>\n

Pediatric Associates, with 95 offices across the state and more than 400 providers, filed a lawsuit Tuesday against Florida\u2019s Agency for Healthcare Administration for failing to correct what it claims are flawed Medicaid rate-setting calculations. Pediatric Associates said it serves more of the 2.3 million children on Medicaid in Florida than any other practice, about 300,000. The group says it tried to avoid this lawsuit by notifying the state agency of the \u201cdeeply flawed\u201d methodology at five separate meetings.<\/p>\n

\u201cWhen reimbursement falls below the cost of care \u2014 which the state\u2019s flawed formula has allowed \u2014 pediatric practices are no longer able to sustainably care for Medicaid patients,\u201d the lawsuit states.<\/p>\n

Dr. Tamika Maxwell, with Pediatric Associates in Lauderdale Lakes, said if the Medicaid reimbursement formula isn\u2019t reassessed, it would be too costly for her practice to continue to treat Medicaid patients.<\/p>\n

\u201cWe are speaking up for children, not just those in our practice, but patients of all pediatricians to make it known to Floridians what is happening behind the scenes,\u201d Maxwell said.<\/p>\n

In its lawsuit, Pediatric Associates claims AHCA\u2019s flawed Medicaid rate-setting has dramatically reduced funding for pediatric care by as much as 20% to 30% in some Florida counties. Overall, Florida has experienced a roughly 15% drop in reimbursement for core pediatric care \u2014 approximately $15 million per month in cuts to essential funding \u2014 even as the cost of providing this care has risen, the lawsuit says.<\/p>\n

\u201cI know of some clinics closing their doors in Miami already, and more are at risk of doing so,\u201d Maxwell said.<\/p>\n

In its lawsuit, Pediatric Associates calls on AHCA to correct its methodology, change reimbursements in the upcoming 2026-2027 rate year, and restore funding lost since February 2025 to protect care for the children of Florida.<\/p>\n

<\/p>\n

\u201cWe take care of a wide range of patients, but a high percentage of Medicaid, and they are our neediest,\u201d Maxwell said.<\/p>\n

She said if primary care providers stop seeing children on Medicaid, more families will end up relying on emergency rooms for everyday care. \u201cThat increases the cost of medical care all around and will fall back on taxpayers,\u201d she said. \u201cThis is a problem that affects everyone, even if you are not a recipient of Medicaid.\u201d<\/p>\n

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Pediatric Associates said the lawsuit represents a last resort.<\/p>\n

\u201cWe have attempted for months to resolve this through good faith, direct engagement, and while the agency understands its error and the impact it will cause, it has failed to act,\u201d said Pediatric Associates General Counsel April Andrews-Singh. \u201cWe were forced to take this step because families and their children cannot wait any longer for action.\u201d<\/p>\n

<\/p>\n

When asked if it would reevaluate Medicaid reimbursement rates for children, an AHCA representative replied in an email that the agency doesn\u2019t comment on pending litigation.<\/p>\n

AHCA, under oversight from the Centers for Medicare & Medicaid Services, establishes reimbursement levels for all Medicaid services. These rate calculations\u00a0determine payments to providers who see patients covered by the government insurance.<\/p>\n

Acadia Jacob, interim executive director of Florida Voices for Health, noted that Florida children in low-income families have been losing their Medicaid coverage for the last couple of years due to various government policy decisions, and this new issue only hurts them further.<\/p>\n

\u201cIt is the state and national policy decisions that have created this perfect storm for children and families,\u201d she said.\u00a0 \u201cThe result is needless loss of access to care for children at the most vulnerable time of their lives.\u201d<\/p>\n

Jacob said the low reimbursement rates for children\u2019s primary care are also an issue for pediatric dentistry.\u00a0 Florida ranks 49th in the nation for Medicaid dental reimbursement rates. Her organization has heard from frustrated parents advocating for updated reimbursement rates for dentists.<\/p>\n

\u201cThey are not getting through to providers who accept their plans, and when they do find them, they have to drive across the state to get care,\u201d she said. \u201cWhat we are seeing is providers are not interested in losing money to serve Medicaid patients.\u201d<\/p>\n

South Florida Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com.<\/em><\/p>\n

Read more Blue Bamboo celebrates 10 years \u2014 with music, of course<\/a><\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

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.<\/p>\n","protected":false},"author":1,"featured_media":5134,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[31,13],"tags":[],"class_list":["post-5135","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-health","category-news"],"yoast_head":"\nPediatric Associates sues Florida\u2019s health agency over \u2018deeply flawed\u2019 Medicaid rates - Orlando Relocation Report<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/orlandorelocationreport.com\/?p=5135\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Pediatric Associates sues Florida\u2019s health agency over \u2018deeply flawed\u2019 Medicaid rates - 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