Miami-Dade Congressman Calls for Fix to Medicaid Formula That Cuts Pediatric Reimbursements

Florida pediatricians are receiving 15 percent less reimbursement for their services, according to a calculation error in the state’s Medicaid funding formula. The error stems from how the Agency for Health Care Administration, or AHCA, allocated costs for behavior analysis services, which are used primarily by children with developmental conditions such as autism.

Carlos Curbelo, a former U.S. Congressman for South Florida, said the state added these services to traditional Medicaid coverage to help families access needed therapies. However, the AHCA calculated the cost of these services as though they were used equally by children and adults. In reality, the source notes that the services are used almost exclusively by kids.

Because of this miscalculation, dollars intended for behavior analysis services were distributed across age groups where utilization was low. This pulled money from the broader pool that pays for children’s primary care, including checkups and routine treatments. Curbelo stated that nearly $300 million has been lost from Florida’s pediatric primary care in under two years since the funding change took effect.

The reduction in payments affects the doctors who treat common childhood illnesses like ear infections and the flu. Curbelo, who serves on the Miami-Dade County School Board, said the policy change risks making it harder for millions of Florida children to access pediatric care. Many of these children rely on Medicaid and come from families facing financial pressure.

Curbelo urged policymakers to address the flaw in the reimbursement system to support the front-line doctors serving the state. He noted that while the state has invested billions in areas like school policing and the opioid crisis, it must also ensure pediatricians are fairly compensated. Last month, state officials rescued 163 children from human traffickers, a win Curbelo acknowledged while emphasizing the need for healthcare support.

The former representative, who served in Congress from 2015 to 2019, asked the AHCA to review its funding formula. The goal is to ensure children with autism and other conditions receive necessary resources without defunding the doctors who provide general care. Curbelo said the state should fix the error to properly invest in pediatric care for its growing population.