Phew! If you thought the legislative session was over and we could all breathe a sigh of relief, think again. I don’t know about you, but I’ve been glued to the updates from Tallahassee this week. It feels like we are officially heading into “overtime.”
I talk to practice owners every day who are just trying to keep their doors open. They want to serve kids and get paid fairly. But right now? The news coming out of the Capitol is a bit of a roller coaster. (No-joke, I’ve had to double-check my sources twice this morning just to stay current).
Here is the lowdown on what is happening in Tallahassee and why it matters for your clinic’s bottom line.
The $1.4 Billion Standoff
The biggest headline right now is the Special Session scheduled for May 12–29. Why are they going back? Because the budget is stuck. Senate President Albritton and House Speaker Perez are currently staring each other down over a $1.4 billion gap.
From what I’ve seen, the state is bracing for a leaner year. Lawmakers are talking about “fiscal responsibility,” which is usually code for “budget cuts.” For those of us in the pediatric therapy world, that phrase always makes my stomach drop. We need to watch this session closely. If they can’t bridge that gap, the “cliff” everyone is worried about might arrive sooner than expected.
The “ABA Shift” Alarm
I’ve been hearing some concerning whispers about a funding shift. There is a growing alarm among pediatric clinicians that routine care dollars, the money that funds your speech, OT, and PT services, are being squeezed.
Where is it going? It looks like a significant portion is being redirected toward ABA (Applied Behavior Analysis) services.
Now, don’t get me wrong. ABA is vital. But I’ve seen this movie before. When one bucket of money grows, another usually shrinks. If you feel like your authorizations are getting tighter or the “necessity” goalposts are moving, this shift might be the reason why. It is more important than ever to document your clinical necessity with surgical precision.
New Eyes on the Books: The Fraud Task Force
Wait! What? Yep, there is a new sheriff in town. Actually, two. Chief of Staff James Uthmeier and Alex Harris are leading a new Public Assistance Fraud Task Force.
While they are mostly looking for big-time bad actors, these things usually lead to increased audits for everyone. I struggled with the idea of “more oversight” at first too. But look at it this way: clean billing is your best defense. If your clinic operations are tight and your modifiers are correct, you have nothing to fear.
A Quick 2026 Rate Recap
Amidst the chaos, let’s keep our eyes on the numbers we do know. As of right now, the 2026 Medicaid rates are holding at:
- $58.11 for evaluations.
- $20.33 for 15-minute treatment visits.
We also still have that 105.6% MPIP (Medicaid Physician Incentive Program) bump for pediatric E/M codes. It isn’t a gold mine, but it is a baseline. I always tell my clients to build their business metrics around these hard numbers rather than “hoped-for” increases.
SMMC Transition: Check Your Paperwork!
Finally, we are deep into the Statewide Medicaid Managed Care (SMMC) transition. I cannot stress this enough: check your credentialing.
I’ve seen too many clinics lose weeks of revenue because a single provider wasn’t properly linked to the new plan. It’s boring, tedious work. I know! But the alternative is claim denials and a massive headache in June.
If you haven’t logged into your portal this week to verify your status, consider this your friendly nudge. (Or a shove, depending on how much coffee you’ve had!)
Staying Sane in the Chaos
It’s a lot to process. Between the $1.4B gap and the shifting funds, it’s easy to feel like the rug is being pulled out from under you. But remember, you are not alone in this. We are watching the Tallahassee feeds so you don’t have to spend your weekends reading budget amendments.
Keep focusing on those kids. Keep your documentation sharp. And please, keep an eye on those SMMC portals!
You’ve got this!
– Aaron and the Extra Mile Team