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AHCA says transfer of Children's Medical Services was administrative and seamless
Summary
The Agency for Health Care Administration told a House subcommittee that the transfer of the Children's Medical Services managed care plan to AHCA was an administrative move intended to align procurement and oversight and "seamless" for members and providers; lawmakers pressed the agency about reported cuts to private-duty nursing and the appeals process.
TALLAHASSEE — The Agency for Health Care Administration told the Health Facilities and Systems Subcommittee on Nov. 6 that the transfer of administration of the Children's Medical Services (CMS) managed care plan from the Department of Health to AHCA was strictly administrative and has not changed member enrollment or provider networks.
"This was essentially intended to be seamless to the members and to the providers," Brian Meyer, AHCA deputy secretary for Medicaid, said. He said the transfer took effect July 1, 2025, moved procurement and oversight under AHCA and included transfer of four FTEs to AHCA while allowing the Department of Health to repurpose 22 FTEs.
Representative Oliver, sponsor of House Bill 1085, described the legislative intent to streamline government and expand clinically necessary home-based options beyond private-duty nursing for medically fragile children.
Why it matters: AHCA said the move aligns the CMS plan procurement cycle with other statewide Medicaid managed-care procurements and gives AHCA's oversight structures responsibility for the plan. AHCA provided enrollment figures for context: about 110,219 members in the Title 19 Medicaid component and 14,359 in the Title 21 (CHIP) component as of September 2025.
Members pressed AHCA about reporting by the Tampa Bay Times that a health plan had cut private-duty nursing for more than 100 medically fragile children. "We are aware of that reporting," Meyer said, adding AHCA has obtained authorization and denial data, conducted case-file reviews with its chief medical officer and "do not...disclose that the health plan is acting inappropriately." He said members whose services are reduced can appeal and may request a Medicaid fair hearing.
Committee members sought data on the proportion of appeals overturned on review. Meyer said AHCA collects appeal and fair-hearing information and will follow up with the committee with specific percentages and member-level counts.
On vendor credentialing and therapy-provider quality concerns, Meyer said AHCA understands that one vendor used by a health plan included providers who were not properly credentialed or enrolled in Medicaid; AHCA said it is working with plans to communicate corrective steps, prioritize accelerated enrollment for affected providers, reimburse eligible past services retrospectively and ensure members transition to qualified providers.
The committee requested follow-up from AHCA on case counts, geographic impact and appeal outcomes. Meyer agreed to provide the committee staff with requested data and follow up with members.
The meeting moved on after the CMS update; no committee votes were taken on the item.
