TAMPA, Fla. — Companies that provide therapy to children with autism are speaking out, saying they may have to stop serving some of Florida’s most vulnerable children if problems with a new Medicaid reimbursement system aren’t resolved.
“They owe us a lot of money. And it’s not just us. It's statewide. It’s across the board,” said Alicia Anthony-Zabala, who owns Missing Piece ABA in Tampa.
“The clients we serve are in jeopardy of losing their services,” said Sara Beeler of Mindful Masterpieces in Naples.
The ABC Action News I-Team has learned the issues started in February, when Florida’s Medicaid program transitioned to a managed care system.
Providers say since that transition, payments have been delayed or denied, putting businesses, children and families at risk.
Thousands of Florida children receive ABA through Medicaid
For Anthony Meoni, who has been diagnosed with autism spectrum disorder, Missing Piece ABA offers what his family believes is his best chance to thrive.
Anthony struggles with communication and social interaction.
He’s not alone.
According to the CDC, the prevalence of autism spectrum disorder nationwide has grown from 1-in-150 children in 2000 to 1-in-31 today.
That represents about 3.1 percent of all children.
Anthony is among an estimated 41,000 Florida children who receive ABA, or Applied Behavioral Analysis therapy through Medicaid.
“ABA is the only approved scientifically-based documented treatment for autism,” Anthony-Zabala said.
ABA therapy uses positive reinforcement and consistent practice to change children’s negative behaviors.
“A lot of these kids can’t go to school”
“Some of our companies are the only lifeline these parents have to kind of work through some of these behaviors,” said Aerial Lufkin, of Sunshine ABA in Orlando.
“The majority we service are all day every day,” Beeler said. “It’s very important because the majority of clients we have don’t have other options as far as attending school or a regular daycare because they don’t provide the types of therapy they need.”
“A lot of these kids can’t go to school. Or they do go to school and they get sent home because of their behavior. Parents are having to pick them up,” said Anthony-Zabala.
Representatives of four ABA providers recently told the I-Team their businesses are struggling after Medicaid changed to a statewide managed care program in February.
“People weren’t fully prepared for a big transition like this. This is very huge and it’s really affected everyone in the state,” Lufkin said.
They say the problems stem from the way Sunshine Health, the company that administers Medicaid claims for the state, pays providers.
“Prior to this, every Thursday we would get a lump-sum deposit. So we would bill and pretty much get what we billed,” Anthony-Zabala said.
“It’s created a huge spiral in my finances”
Providers say now payments are sporadic.
“Because the payments are so spaced out, it makes it impossible to budget because you don’t know how much money you’re getting and when you’re getting it,” said Pearson Klein of Behavior Modification Solutions ABA in Ocala.
“We've seen no payments on some of the claims for many weeks now,” Beeler said.
Some claims submitted in February and March are still listed as “pending”.
Anthony-Zabala says claims she submitted for a single client were approved in some cases and denied in others.
“We were only reimbursed 8 out of 34 claims. And when we went back into the portal, the system, it just said that they were being denied due to no Medicaid ID... even though the Medicaid ID was on the denial,” Anthony-Zabala said.
“They'll say a Medicaid number isn’t listed on the paperwork, but on the denial, it’s clearly listed,” Beeler said.
And providers say getting answers about the denials isn’t easy.
“We will sit on the phone for hours and generally get no resolution to the reason why we were calling,” Beeler said.
Under the new system, providers say reimbursement rates were also cut by 20 percent, even though they have to pay their staff the same amount.
Some companies say they’re on the brink of having to close.
“Most of us are four to six weeks away. If this continues... the lack of reimbursement... four to six weeks,” Anthony-Zabala said.
She estimates she is owed about $80,000 for claims she has submitted to Sunshine Health but haven’t been paid.
“It's just created a huge spiral in my finances,” Klein said.
He said if his business shut down, 35 to 40 people would lose their jobs.
If ABA companies close, parents would also be impacted.
“Likely they would have to quit their jobs. Someone would have to make the decision to say home. Or hire some private care,” Beeler said. “It’s very expensive.”
Response to providers’ concerns
We contacted Florida's Agency for Healthcare Administration, or AHCA, about the providers’ issues but have not heard back.
We also reached out to a spokesperson from Sunshine Health.
She emailed the following statement, which addresses concerns we forwarded to the company about patient privacy and reimbursement:
“Sunshine Health takes its responsibility to protect member and provider information seriously, maintaining strict compliance with HIPAA regulations to ensure all protected health information (PHI) is handled securely and appropriately.
“Access to our Provider Portal is restricted to Providers who are Covered Entities and/or their Business Associates who are authorized to handle PHI under the terms of our access agreement. Users are required to only access records for which they have a legitimate business need. The identity verification data requested reflects information typically received by providers at the point of service and is designed to help return member information efficiently and without limiting the ability of members to get the care they need when they need it.”
“Sunshine Health partners closely with our valued network of providers to deliver high quality care to our members. The state of Florida transitioned Behavioral Analysis (BA) services to managed care health plans on Feb. 1, 2025, and we have invested significant effort into making this transition as seamless as possible for both our members and provider partners. As a managed care health plan for the State of Florida, we adhere to all state requirements about how services can be billed. In an effort to be a good partner, we have been working closely to educate providers on these processes through Provider Town Hall trainings, Provider Engagement Team outreach, and quick resource guides to ensure they understand any requirements in order to deliver the best care to our members.”
Anthony-Zabala worries if the program isn’t fixed, Anthony and the other children her company cares for could be at risk of losing the progress they’ve made.
“Every small achievement, no matter how small, is a milestone. That's why you get up every day and you believe in it. And you believe in these kids and you fight for them,” she said.
.
St. Pete Sunday Market to move from Ferg's ahead of football season
The St. Pete Sunday Market just relocated to Ferg's Sports Bar & Grill back in June. A change that brought more opportunities for local vendors and more support for Ferg's following Hurricane Helene's displacement of the Tampa Bay Rays.
