Florida
Pediatric Associates Files Lawsuit Against DeSantis Administration Over Medicaid Payment Issues Impacting Local Children
Florida’s largest Medicaid pediatric healthcare provider is suing the administration of Gov. Ron DeSantis, alleging it erred when Medicaid officials adjusted the managed care rates paid to health plans for providing applied behavioral analysis services to children with autism who…
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Key points
- Pediatric Associates is suing the DeSantis administration over Medicaid payment calculations affecting children with special needs.
- The lawsuit seeks $300 million in funding that the provider claims it has been denied for 20 months.
- Local pediatric healthcare could be at risk, potentially impacting hundreds of thousands of families in Escambia County.
NewsWK — In a significant development for families in Escambia County, Pediatric Associates, Florida’s largest Medicaid pediatric provider, is suing the administration of Governor Ron DeSantis. The lawsuit claims that the state has made errors in calculating new managed care rates for applied behavioral analysis (ABA) services, which are essential for children with autism and special needs.
The provider, which serves over 300,000 Medicaid-eligible children in South Florida—accounting for about 15% of the state’s pediatric Medicaid population—has accused the Agency for Health Care Administration (AHCA) of jeopardizing pediatric care for countless families. According to the lawsuit, Pediatric Associates is seeking $300 million in Medicaid funding that it alleges it has been denied over the past 20 months due to a revised payment schedule implemented in February 2025.
“AHCA’s changes have jeopardized pediatric care for hundreds of thousands of Florida families. Many pediatricians caring for children on Medicaid are now being paid less than it costs to provide care,” the attorneys for Pediatric Associates stated. The lawsuit indicates that the new payment structure has caused significant financial strain on healthcare providers, potentially forcing them to either continue providing care at a loss or exit the Medicaid system altogether.
The implications of this lawsuit could be far-reaching for local residents. If Pediatric Associates succeeds, it may lead to increased funding for Medicaid services that directly affect children in Pensacola and Escambia County. This could help ensure that local pediatricians are adequately compensated, thus allowing them to continue providing vital services to families that rely on Medicaid for their children’s healthcare needs.
Before proceeding with the lawsuit, Pediatric Associates reportedly met with AHCA multiple times to discuss their concerns over the new Medicaid payments. They assert that the errors in rate calculations have not only impacted their operations but also the overall quality of care available to Medicaid recipients in Florida.
As the state mandates that most Medicaid recipients enroll in managed care plans, the resolution of this issue is critical. Pediatric Associates argues that the current funding model has drastically reduced reimbursement rates for pediatric care, with some counties experiencing cuts of 20% to 30%. With rising costs of care, the administration’s miscalculations have the potential to leave hundreds of thousands of children without essential healthcare access.
Dr. Rasciel Socarras, a pediatrician with Pediatric Associates, emphasized the urgency of the situation, stating, “If the children I care for every day lose access to pediatric care, it would be absolutely devastating. I know from experience that if action is not taken, more families will end up relying on emergency rooms for everyday care—or worse, skipping care entirely.” The case highlights the pressing need for state officials to address these funding discrepancies to ensure that healthcare services remain available for vulnerable children.
This article was produced with the assistance of AI and reviewed by our editorial team.
Based on reporting originally published by Florida Phoenix. Read the original story.
