Is it just me, or does Tallahassee feel like a suspense thriller lately? (And not the fun kind with popcorn.) I spent most of this week refreshing news feeds and talking to frantic practice owners. Everyone was looking for news on the budget. We’ve been hearing about this massive $1.4 billion gap for weeks. I honestly thought we’d have some clarity by now.
But, as it turns out, the political gears in Florida turn in mysterious ways.
If you were hoping the Special Session this week (April 20-24) would solve our funding woes, I have some news. It wasn’t about the money. Not yet, anyway. I’ve been digging through the updates to see what actually happened. I want to make sure you know exactly where your practice stands as we head into May.
The Special Session: Maps, Not Money
I don’t know about you, but when I hear “Special Session,” my brain immediately goes to “Budget Fix.” In the world of Florida Medicaid Updates, we are always waiting for the other shoe to drop. However, this week’s session was strictly about redistricting.
Yep. They spent the week drawing lines on maps.
The $1.4 billion budget gap is still sitting there. It is looming like a dark cloud over pediatric therapy billing. I talked to a provider yesterday who was convinced the rates were being cut this week. I had to talk them down from the ledge. (Phew!)
So, here is the deal. The budget talk has been pushed. The new target for the next budget session is May 12. Until then, we are in a bit of a “waiting game.” It’s frustrating. I know you want to plan your hiring. You want to know if you can afford that new equipment. But for now, we have to stay patient.
The ABA Funding Shift: Cause for Alarm?
This is where things get a bit sticky. I’ve started hearing major alarms raised about Medicaid funding. There is a move to shift funds from routine pediatric care over to Applied Behavior Analysis (ABA) services.
Now, don’t get me wrong. ABA is vital. I’ve seen the incredible impact it has on families. If you’re curious about adding it to your mix, check out this podcast episode on adding ABA to your practice.
But the concern here is about the “Routine Pediatric Care” bucket. If the state starts moving money from speech, occupational, and physical therapy to cover the rising costs of ABA, what happens to the rest of us?
I’ve seen this “robbing Peter to pay Paul” strategy before. It rarely ends well for the smaller clinics. If routine pediatric therapy gets squeezed, the reimbursement struggle will get real. I’m keeping a very close eye on this. It feels like a high-stakes game of musical chairs. And nobody wants to be the one without a seat when the music stops.
Let’s Talk Numbers: 2026 Medicaid Rate Recap
Since we are in this waiting period, it is a great time to audit your current billing. I realized recently that some of the practices I talk to are still a bit fuzzy on the current 2026 rates. Let’s do a quick recap so you can check your math.
Currently, we are looking at:
- Evaluations: $58.11
- Treatment: $20.33
- Pediatric E/M Codes: 105.6% of the Medicare rate.
These numbers are what we are working with right now. If your current billing doesn’t reflect this, you are leaving money on the table. (And we definitely don’t want that!) If you want to hear more about how these rates came to be, Aimee Brueck did a great deep dive on the Florida Medicaid Rate Increase podcast.
I’m constantly stressed for my clients when I see these numbers fluctuating. A few cents here or there might not seem like much. But over a thousand units? That’s a whole paycheck for a therapist.
The New Public Assistance Fraud Task Force
Wait! What? Yep, there is a new task force in town. Alex Uthmeier and Beau Harris are leading the charge on a new Public Assistance Fraud Task Force.
Now, I know most of you are doing everything by the book. You are dedicated to your kids. You are working late nights. But this task force is a reminder that compliance is a “necessary evil.” They are looking for discrepancies. They are looking for patterns that don’t make sense.
I always tell my clients: don’t give them a reason to look at you. Clear documentation and clean billing are your best friends. If you feel like your compliance is a bit shaky, you aren’t alone. I struggled with understanding the nuances of SLPA supervision for years until I finally sat down to map it out. You can actually check out our SLPA supervision survival guide for some help there.
Why the $1.4B Gap Matters for You
You might be thinking, “Aaron, I’m just a small clinic in North Florida. Why do I care about a billion-dollar gap in Tallahassee?”
I get it. It feels far away. But here is the reality. When the state has a deficit, they look for places to cut. Medicaid is often the first place they look. If the Tallahassee Special Session doesn’t find a way to bridge that $1.4 billion gap by May 12, the pressure on pediatric therapy billing will intensify.
We might see:
- Slower processing times for claims.
- Stricter authorization requirements.
- Possible rate freezes or (heaven forbid) reductions.
It’s scary. Boring. And yet, totally necessary to watch. I’m not saying this to freak you out. I’m saying this so you can be prepared. I’ve seen practices thrive during budget cuts because they were lean and their billing was airtight.
How to Stay Sane During the Wait
I don’t know about you, but when I can’t control the outcome, I focus on what I can control. Right now, that means your internal operations.
Have you checked your denial rates lately? Are your therapists staying on top of their notes? These are the things that keep your cash flow steady, even when Tallahassee is acting up.
If you’re feeling overwhelmed, feel free to explore our billing tips category. There is a ton of info there to help you tighten up your processes. Sound familiar? We’ve all been in that spot where we just want to focus on the kids and ignore the paperwork. But the paperwork is what pays for the toys, the rent, and the therapists.
Looking Ahead to May 12
So, what is the plan? We wait for May 12. That is the date when the real budget battle begins. I’ll be right here with you. I’ll be watching the livestreams. I’ll be reading the boring PDF reports so you don’t have to. (Seriously, every time I hear the word ‘appropriations,’ I begin slowly drifting off to sleep, but I do it for you guys!)
We are in this together. The Florida Medicaid landscape is always changing. It feels like a moving target. But as long as we stay informed and stay vocal, we can protect the services these kids need.
Final Thoughts for the Week
It’s been a long week. Between the maps in Tallahassee and the funding alarms, I think we all deserve a weekend.
Take a breath. Your rates are currently stable at $58.11 and $20.33. You are doing great work. The political noise is just that: noise: until the pens hit the paper on the budget.
If you have questions about how these potential shifts might impact your specific practice, don’t hesitate to reach out. I love talking shop and helping providers navigate these weird waters. You can find more updates in our news section as they break.
We’ll keep an eye on the ABA funding shift. We’ll keep an eye on the task force. And most importantly, we’ll keep an eye on each other.
You’ve got this!
- Aaron and the Extra Mile Team