Medicaid Shift Threatens Closure of Treasure Coast Pediatric Clinics

Pediatric practices serving low-income children across Florida — including those relying on Medicaid-funded clinics in Martin, St. Lucie, and Indian River counties — may have only weeks of operating runway left if the state does not intervene in a funding crisis triggered by a policy change earlier this year, providers warned state officials this week.

The alarm stems from a February 2025 decision by the Agency for Health Care Administration to move Applied Behavior Analysis services — intensive therapy primarily used to treat children with autism — into Medicaid managed care. Intended to crack down on rampant billing fraud within the ABA sector, the shift has had an unintended consequence: it redirected a disproportionate share of Medicaid funding toward ABA services, which serve a relatively small share of Medicaid patients, leaving routine pediatric care practices facing sharply reduced reimbursements, officials said.

Smaller practices have been hit hardest, with many unable to accept the lower payment rates offered by health plans under the new structure. Larger, higher-volume operators have absorbed the cuts more readily — a disparity that providers warn could accelerate consolidation in an already strained primary care market and leave rural and underserved Treasure Coast communities with fewer options.

Pediatric providers said they broadly support the state's anti-fraud push, including a new Public Assistance Fraud Task Force jointly launched by Attorney General James Uthmeier and AHCA. But enforcement, they cautioned, cannot fix a structural funding imbalance fast enough to keep struggling practices afloat.

"Behavior analysis is about quality, not quantity," said C. Baker Wright, a Tallahassee-based behavior analyst. Wright argued that tighter controls on service authorizations — rather than across-the-board rate reductions — could rein in misuse without destabilizing the broader pediatric care system.

The Governor's Office has signaled a willingness to engage on the funding issue, though no formal remedy has been announced, providers said. The crisis landed in the middle of a contentious Special Session in Tallahassee dominated by separate battles over vaccine exemptions and AI regulation — both of which collapsed in the House — leaving Medicaid reform with little legislative oxygen this week.

Treasure Coast families whose children receive Medicaid-covered care should contact their pediatrician's office directly to confirm their provider remains in-network and can reach the St. Lucie County Health Department at (772) 462-3800 for referrals.

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