The Florida Medicaid fee schedule for 2026 includes major updates. New pediatric rates pay 106.3% of Medicare. Transparency rules now require public rate comparisons.
Quick Summary:
- Pediatric enhanced rates effective through September 2026
- $15 minimum wage built into all fee schedules
- New federal transparency requirements by July 2026
- Telehealth fees increased to $31.85
- Medicare alignment focus for better provider participation
- Access official schedules through AHCA Rule 59G-4.002
Page Contents
- 1 What Is the Florida Medicaid Fee Schedule?
- 2 2026 Florida Medicaid Rate Updates
- 3 How Florida Medicaid Compares to Medicare
- 4 Important 2026 Rule Changes
- 5 How to Access Florida Medicaid Fee Schedules
- 6 Revenue Protection Tips for Providers
- 7 Estate Recovery Warning
- 8 Where to Find Official Information
- 9 Frequently Asked Questions
- 9.1 What is the Florida Medicaid fee schedule for 2026?
- 9.2 How much does Florida Medicaid pay compared to Medicare?
- 9.3 Where can I download the 2026 Florida Medicaid fee schedule?
- 9.4 What are the pediatric enhanced Medicaid rates in Florida?
- 9.5 When does Florida publish Medicaid transparency reports?
- 9.6 What is Florida Medicaid estate recovery?
What Is the Florida Medicaid Fee Schedule?
The Florida Medicaid fee schedule lists what providers get paid. The Florida Agency for Health Care Administration (AHCA) sets these rates.
They control all Medicaid payments in Florida.
Two Main Payment Models
Fee-for-Service (FFS): AHCA pays a fixed amount per service. Providers bill directly to the state. Rates are listed in official AHCA fee schedules.
Managed Medical Assistance (MMA): Private health plans manage care under the Statewide Medicaid Managed Care (SMMC) system. These plans negotiate their own provider rates.
2026 Florida Medicaid Rate Updates
Florida made significant changes to Medicaid reimbursement in 2026. These updates affect doctors, therapists, and direct care workers.
Pediatric Enhanced Rates
Doctors treating patients under 21 get higher pay. The enhanced rate is 106.3% of Medicare rates. This applies to evaluation and management codes only.
Effective dates: October 1, 2025 through September 30, 2026.
This increase helps ensure kids access quality care. More pediatricians may accept Medicaid patients.
Minimum Wage Adjustments
All fee schedules now include a $15 minimum wage. This affects direct care employees. It even covers 1099 contract workers.
Florida permanently adjusted rates to meet this standard. Workers get fair pay. Providers receive higher reimbursement to cover costs.
New Federal Transparency Requirements
By July 1, 2026, Florida must publish complete fee schedules online. The state must also compare Medicaid rates to Medicare rates.
This federal rule helps everyone see payment gaps. Transparency shows where Medicaid pays less than Medicare. It pressures states to improve provider payments.
Sample Provider Fees for 2026
| Service | 2026 Rate |
|---|---|
| Vaccine Administration (First dose) | $24.01 |
| Telehealth Originating Site Fee | $31.85 |
| Pediatric E&M Codes | 106.3% of Medicare |
The telehealth fee increased from $31.01 in 2025. This supports virtual care access.
How Florida Medicaid Compares to Medicare
Florida Medicaid historically pays 30% to 40% less than Medicare. This gap makes some doctors refuse Medicaid patients.
Payment Adequacy Focus
New 2026 federal oversight focuses on “Payment Adequacy.” States must prove rates are high enough. Providers need fair pay to participate.
Florida now faces pressure to align closer to Medicare. Better rates mean better patient access.
Important 2026 Rule Changes
Several policy updates took effect in 2025 and 2026. Providers and patients should know these changes.
Psychologist Overpayment Window
As of January 1, 2026, insurers have less time to claim overpayments. The window dropped from 30 months to 12 months.
Licensed psychologists get more protection. Old claims expire faster.
Mandatory Background Screening
All healthcare practitioners must complete updated background screening. This applies to initial licensure and renewals.
Effective date: July 1, 2025.
Compliance is mandatory. Check AHCA requirements before renewing your license.
Eligibility Income Limits
Regular Medicaid income limits through March 31, 2026:
- Individuals: $1,149 per month
- Couples: $1,552 per month
These thresholds determine patient eligibility. They don’t directly affect provider payments.
How to Access Florida Medicaid Fee Schedules
Providers need current fee schedules to bill correctly. AHCA provides official rate tables.
Step-by-Step Access Instructions
- Visit the official AHCA website at ahca.myflorida.com
- Navigate to the Medicaid section
- Find Rule 59G-4.002 resources
- Download PDF or Excel fee schedules
Available Schedules Include:
- Occupational therapy rates
- Personal care services
- Foster care payments
- Physician services
- Telehealth fees
- Vaccine administration
Update your billing system with current rates. Wrong rates cause claim denials.
Revenue Protection Tips for Providers
Accurate billing protects your practice revenue. Follow these best practices for 2026.
Use Official AHCA Fee Schedules
Always download the latest version from the Rule 59G-4.002 portal. Rates change throughout the year. Old schedules cause underpayment.
Verify Pediatric Enhanced Rates
Check if your services qualify for the 106.3% rate. Only evaluation and management codes for patients under 21 apply. Submit claims with correct modifiers.
Track Telehealth Fee Increases
The originating site fee is now $31.85. Update your billing templates. Don’t use the old $31.01 rate.
Monitor Transparency Publications
Watch for the July 2026 transparency reports. Compare your actual payments to published rates. Report discrepancies to AHCA.
Estate Recovery Warning
Florida Medicaid payments create potential debt. The state may seek repayment after a recipient dies.
Estate Recovery: Florida can file claims against a deceased Medicaid recipient’s estate. This recovers costs paid during the person’s lifetime.
Families should plan ahead. Consult an estate attorney if Medicaid paid for long-term care. Recovery can affect inheritance.
Providers are not liable for estate recovery. But patients’ families may have questions. Direct them to legal counsel.
Where to Find Official Information
Always verify Medicaid information through official sources. These trusted sites provide accurate data:
- Florida AHCA Official Site: ahca.myflorida.com – Fee schedules, rules, and provider resources
- Centers for Medicare & Medicaid Services: medicaid.gov – Federal guidelines and state comparisons
Check these sites regularly. Medicaid rules change frequently.
Last Updated: January 2026
Frequently Asked Questions
What is the Florida Medicaid fee schedule for 2026?
The Florida Medicaid fee schedule lists payment rates for medical services. AHCA sets these rates. Key 2026 updates include pediatric enhanced rates at 106.3% of Medicare, $15 minimum wage adjustments, and increased telehealth fees of $31.85.
How much does Florida Medicaid pay compared to Medicare?
Florida Medicaid typically pays 30% to 40% less than Medicare rates. However, new 2026 federal “Payment Adequacy” rules pressure Florida to align closer to Medicare. Pediatric services now reimburse at 106.3% of Medicare through September 2026.
Where can I download the 2026 Florida Medicaid fee schedule?
Visit ahca.myflorida.com and navigate to the Medicaid section. Access Rule 59G-4.002 resources to download PDF or Excel fee schedules. Schedules cover occupational therapy, personal care, physician services, telehealth, and vaccine administration.
What are the pediatric enhanced Medicaid rates in Florida?
Doctors providing care to patients under 21 receive 106.3% of Medicare rates for evaluation and management codes. This enhanced rate is effective October 1, 2025 through September 30, 2026. It improves access to pediatric care.
When does Florida publish Medicaid transparency reports?
By July 1, 2026, Florida must publish complete fee-for-service rate schedules online. Federal transparency requirements also mandate formal comparisons between Medicaid and Medicare rates. This helps identify payment gaps affecting provider participation.
What is Florida Medicaid estate recovery?
Florida Medicaid payments are considered debts against the recipient’s estate. After death, the state may file claims to recover costs paid during the person’s lifetime. This primarily affects long-term care recipients. Families should consult estate attorneys for planning.
Ready to verify your Medicaid rates? Visit the official AHCA website today to download the latest 2026 fee schedules and ensure accurate billing for your practice.
