I don’t know about you, but I was really hoping to have a nice, quiet Friday without a legislative cliffhanger. I’d already started mentally preparing for the weekend when the news broke: Tallahassee is heading into overtime.
If you’ve been following my updates here at Extra Mile Billing, you know I’ve been obsessively tracking the Medicaid rate increase conversations. Well, the clock ran out on the regular 60-day session, and the House and Senate still haven’t shook hands on the final numbers.
So, what does that mean for us? It means we’re headed for a Special Session starting April 20th.
I’ll be honest, every time I hear the phrase “Special Session,” my eyes start to glaze over just a little bit. It sounds like a lot of dry political maneuvering (it is). But then I remember what’s actually on the line: your reimbursement rates, the viability of your practice, and the care for the thousands of Florida kids who rely on us. Suddenly, “budget drama” becomes very real, very fast.
Why the “Budget Overtime” Matters to Your Bottom Line
Here is the deal: the state must pass a balanced budget by June 30th to avoid a government shutdown. But before they can do that, they have to agree on how much to spend and where to put it.
Right now, the House and Senate are staring at each other across a $1 billion gap. If you include what they call the “sprinkle list”, which is basically discretionary funding for specific projects, the gap is closer to $2.6 billion. (no-joke)
For most of the clinic owners and therapists I talk to, this can feel like watching a game where you don’t know the rules but you’re the one paying for the tickets. But here is the “why” behind my concern: the Medicaid rate increases we’ve been advocating for are caught in this crossfire. Until that budget is signed, sealed, and delivered, those rate hikes are just lines on a wish list.
I’ve seen this play out before. When the legislature goes into a Special Session, things can move quickly, or they can stall out in a game of political chicken. My job is to make sure you know exactly what’s happening so you aren’t caught off guard when July 1st rolls around.
The $7.1M PDN Push: Protecting Medically Fragile Kids
One of the most critical pieces of this budget puzzle is the $7.1 million push for Medicaid Private Duty Nursing (PDN) rate increases.
I was looking at some of the advocacy data earlier this week, and the reality is heartbreaking. We are seeing more and more medically fragile children in Florida who can’t get the care they need because the rates simply don’t cover the cost of providing the service.
If we don’t get this $7.1M across the finish line during the April 20th session, the crisis for these families is only going to deepen. I’ve spent years looking at pediatric billing Florida data, and the margins for PDN are already razor-thin.
I’m encouraging everyone, especially those of you who provide nursing services or work with these complex cases, to keep the pressure on. This Special Session isn’t just about big-picture numbers; it’s about the kid in the wheelchair who needs a nurse to go to school. It’s about the practice owner who is wondering if they can afford to keep their doors open.
A Shout-out to Our SLPs: FLASHA School Office Hours
Switching gears for a second, because I know your brain is probably full of budget numbers, I wanted to highlight something awesome that started today.
FLASHA (the Florida Speech-Language and Hearing Association) has kicked off their School Office Hours. If you are an SLP working in the school system, or if your practice contracts with schools, you need to be in these sessions.
I realize that for many of you, school billing feels like a completely different beast than private insurance or Medicaid. (Sound familiar?) It’s confusing, the paperwork is endless, and the rules seem to change every time the wind blows.
These office hours are a fantastic resource to get your questions answered by people who actually know the landscape. I’ve always said that knowledge is power in this industry, and FLASHA is giving you a direct line to that knowledge. Don’t go it alone!
Some Peace of Mind: Sunshine Health Holiday Update
I wanted to share a quick win that might actually help you sleep better tonight.
Duenna Dorsett, the VP at Sunshine Health, has officially confirmed that all 2026 Federal holidays are covered. I know, I know: billing for holidays sounds like the most “Necessary Evil” topic ever.
But think about it: how many times have you had a payment delayed or a claim bounce because of a holiday schedule you didn’t account for? I talked to one clinic owner last year who nearly missed payroll because of a bank holiday timing issue.
Having this official confirmation from one of our major payers means one less thing on your “To-Do” list. We can plan our billing cycles, our revenue projections, and our staff schedules with total confidence for the rest of the year. It’s a small thing, but in our world, small things are what keep the lights on.
How to Navigate the “Wait and See” Period
So, what do we do between now and April 20th?
I don’t know about you, but I hate the “Wait and See” game. I’m a doer. I want to solve the problem and move on. But when it comes to the Florida Legislature, sometimes we have to be patient: and strategic.
Here is what I recommend for your practice right now:
- Audit Your Medicaid Mix: Take a look at your current caseload. If the rate increases don’t go through as planned, how will that affect your Q3 and Q4 revenue? If you’re not sure, it might be time for a billing health score checkup.
- Stay Vocal: Don’t assume someone else is doing the advocacy work. Call your representatives. Mention the April 20th Special Session. Mention the pediatric Medicaid rate increases. Let them know that their delay has real-world consequences for kids.
- Prepare for July 1: Whether it’s dry needling for OTs or the anticipated rate changes, make sure your administrative team is ready. The last thing you want is a pile of “Pending” claims in July because you weren’t prepared for the shift.
I realize that navigating the politics of healthcare billing can feel like a full-time job on top of your actual full-time job. I’ve been in the trenches of medical billing for a long time, and I still get frustrated by how slow the wheels of progress turn.
But here’s the good news: we are in this together. Extra Mile Billing isn’t just about processing claims; we’re about keeping you informed so you can focus on what you do best: helping kids.
This blog has already gone a bit long (I get passionate about this stuff!), but I wanted to make sure you had the full picture. The “Budget Overtime” isn’t just political theater; it’s the final hurdle for a better 2026 for all of us.
If you have questions about how these legislative shifts might impact your specific billing setup, or if you’re just feeling overwhelmed by the constant changes, reach out. We’re here to help you cross that finish line, no matter how many overtimes it takes.
You’ve got this!
Aaron and the Extra Mile Team