Until early 2025, Florida Medicaid paid for behavior analysis (BA) services, the state's term for ABA, directly through what is called fee-for-service. On February 1, 2025, that changed. Children enrolled in a Statewide Medicaid Managed Care (SMMC) health plan now get BA approved and paid by that plan. This guide explains what moved, what stayed the same, and where to turn when something goes wrong.
What exactly changed on February 1, 2025?
The Agency for Health Care Administration (AHCA) says it plainly on its Behavior Analysis Services Information page: "Beginning February 1, 2025, behavior analysis services are reimbursed by Florida SMMC plans. All claims for BA services delivered on and after February 1, 2025, must be submitted to the recipient's SMMC plan." Children who are not enrolled in a plan stay in fee-for-service.
In practice, that moved four jobs from the state to the plans. In its August 12, 2026 presentation to the ABA Task Force, AHCA listed them as:
- Authorization: the plan reviews and approves (or denies) the behavior plan and hours.
- Provider networks: the plan decides which BA providers are in network.
- Care coordination: the plan's care coordinators help connect services.
- Provider payment: the plan pays the BA provider.
AHCA reported that 98.9% of recipients receiving BA services are enrolled in an SMMC plan. So for nearly every Florida family using Medicaid ABA, the health plan is now the main point of contact.
What stayed the same?
The benefit itself did not change because of the move. The rules are still in the Florida Medicaid Behavior Analysis Services Coverage Policy, adopted in Rule 59G-4.125 of the Florida Administrative Code and effective February 10, 2025. Section 1.2 of that policy says managed care plans must follow it, and that services for plan members "must not be subject to more stringent service coverage limits than specified in Florida Medicaid policies."
That means the core rules are the same whether the state or a plan is paying: coverage for recipients under 21, a physician's order and a Comprehensive Diagnostic Evaluation (CDE) to start, prior authorization, up to 40 hours a week as the policy's ceiling, and no copay. The full list is in our guide to Florida Medicaid ABA coverage in 2026.
What can differ from plan to plan is the process: which forms the plan uses, how a provider submits requests, which BA providers are in network, and how quickly the plan's care coordinators respond.
Who approves ABA now: my child's plan or the state?
AHCA's step-by-step list for families is short:
- Go to your doctor and get a written order for BA services.
- Have a comprehensive diagnostic evaluation completed by a qualified licensed practitioner.
- Choose a BA provider.
- The BA provider sends a BA service request to your child's plan, or to Acentra (AHCA's quality improvement organization) if your child is not in a plan.
- The plan or Acentra makes a decision based on the information provided and medical necessity.
- You and the provider are told the outcome.
AHCA also says the CDE must be sent with the prior authorization request, and that a plan "may also require copies of previously administered CDEs" or an updated CDE in some situations, for example when a child's condition changes or a child moves to Florida.
A federal rule now sets decision clocks. Under 42 CFR 438.210, for rating periods starting on or after January 1, 2026, a Medicaid managed care plan must make a standard authorization decision within state time frames that may not exceed 7 calendar days, and an expedited decision within 72 hours, with possible extensions of up to 14 days in some cases. See our guide to the federal prior authorization rule.
Which plan is my child in, and which region?
AHCA runs the SMMC program in nine regions. These are the regions AHCA lists in its 2024 and 2025 program highlights:
| Region | Counties |
|---|---|
| A | Bay, Calhoun, Escambia, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Okaloosa, Santa Rosa, Taylor, Wakulla, Walton, Washington |
| B | Alachua, Baker, Bradford, Citrus, Clay, Columbia, Dixie, Duval, Flagler, Gilchrist, Hamilton, Hernando, Lafayette, Lake, Levy, Marion, Nassau, Putnam, St. Johns, Sumter, Suwannee, Union, Volusia |
| C | Pasco, Pinellas |
| D | Hardee, Highlands, Hillsborough, Manatee, Polk |
| E | Brevard, Orange, Osceola, Seminole |
| F | Charlotte, Collier, DeSoto, Glades, Hendry, Lee, Sarasota |
| G | Indian River, Martin, Okeechobee, Palm Beach, St. Lucie |
| H | Broward |
| I | Miami-Dade, Monroe |
Your child's plan name and member services number are on the plan ID card. If you are not sure which plan your child is in, Florida's Medicaid enrollment site (flmedicaidmanagedcare.com) lists plan phone numbers, and Choice Counseling can help at 1-877-711-3662.
One thing that confuses many parents: some Medicaid plans share a brand name with a company's employer or military plans. For example, Aetna Better Health of Florida is a Medicaid plan, and it is separate from Aetna's employer plans. A provider that is in network with one is not automatically in network with the other, so always ask about the exact plan on your child's card.
What happened to children who were already in therapy?
AHCA required plans to offer a continuity-of-care period during the move, so that "no recipient misses a medically necessary service and providers are paid for services delivered in good faith." In AHCA's April 2025 continuity-of-care highlight, plans were required to honor prior authorizations for BA for a minimum of 90 days, and each plan listed its own commitments: every plan agreed to cover ongoing treatment for up to 120 days after enrollment, and to pay non-network BA providers their prior rate for 60 to 120 days, depending on the plan.
Those transition windows applied to the 2025 move. They are a good example of a broader rule, though: when a child changes plans, AHCA's materials describe continuity of care as making sure services "continue seamlessly" when an enrollee moves from one plan, provider or delivery system to another. If your child changes plans, ask the new plan in writing how its continuity-of-care period works and how long it lasts.
Can I change my child's plan to keep a provider?
Sometimes. Florida's Medicaid enrollment site says you may change plans during the first 120 days of enrollment. After that, you can change during your yearly 60-day open enrollment period, or at other times with a "state-approved For Cause reason." Florida law (s. 409.969) says good cause includes poor quality of care, lack of access to necessary specialty services, and an unreasonable delay or denial of service, and AHCA decides whether good cause exists.
Before you switch, check that your child's BA provider is in the new plan's network, ask whether a new authorization will be needed, and ask the new plan about its continuity-of-care period. Our guide to finding a Medicaid ABA provider explains how to check networks.
What problems have families raised since the change?
The ABA Task Force's approved minutes give a public record. At the first meeting on August 12, 2026, public comments included "concerns expressed related to provider terminations and continuity of care for recipients." At the August 31 meeting, speakers raised access to medically necessary care, continuity of care, utilization management and other issues. These are comments from the public, not findings, but they match the questions families most often bring to providers.
The task force has not changed any rules. Its recommendations are due December 31, 2026, and any change would come later through law or rule. See our explainer on the 2026 ABA Task Force.
Where do I go when something goes wrong?
Use the right channel for the problem:
- A question or a delay: call your plan's member services first (the number is on the card). If that does not help, call the Medicaid Helpline at 1-877-254-1055 (TDD 1-866-467-4970), Monday to Friday, 8 a.m. to 5 p.m. Eastern. AHCA's BA page says to call the helpline to report issues receiving BA services.
- A complaint: anyone can file one with AHCA through the Florida Medicaid complaint form, and you get a tracking number. AHCA says complaints are prioritized by urgency.
- A denial, reduction or stop: this is not a complaint. You have appeal rights: a plan appeal first, then a Medicaid fair hearing. The deadlines are short. See Medicaid ABA appeals and fair hearings.
- A question about the BA program itself: AHCA lists bacomments@ahca.myflorida.com.
A gentle next step
If Medicaid ABA is working for your child, the main things to keep current are the physician's order, the CDE, the behavior plan and the six-month reassessments. If it is not working, you have options, including appeals and other coverage. Our guide to options after losing Medicaid ABA walks through them. If your family has, or may get, an employer plan or TRICARE, Hope Center for Behavior Change can run a free benefits check. See insurance at Hope Center or call 561-337-8865.