Pediatric group wins early legal battle against DeSantis administration and its Medicaid rates

A Florida administrative law judge ruled that Pediatric Associates, which treats about 15% of the state's pediatric Medicaid population, has standing to challenge Medicaid reimbursement rates set by the state's Agency for Health Care Administration in February 2025 and revised that November. A final hearing is scheduled for October 1-2.

The company alleges the rates were miscalculated by AHCA's actuarial consultants, who allegedly spread the costs of covering applied behavior analysis therapy for autistic children equally across all nine Medicaid regions and age groups regardless of actual need, cutting pediatrician payments by nearly $300 million over 20 months.

AHCA had argued Pediatric Associates lacked standing because the state pays managed care organizations rather than providers directly; the judge rejected that argument, citing prior appellate precedent. A legislatively mandated task force is separately reviewing the ABA delivery system and must report recommendations by December 31.

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