Pediatric Associates, one of Florida's largest pediatric practices, has taken the state to court, accusing the Florida Agency for Health Care Administration of using a "deeply flawed" Medicaid rate-setting formula that slashed payments and is putting routine kids' care on the chopping block.
In the lawsuit filed Tuesday, the group says the new payment system has cut reimbursements so sharply that some offices cannot cover basic costs and may have to scale back or stop seeing Medicaid patients altogether. The complaint describes the situation as urgent after what it calls months of dead-end talks with regulators, and says parents and pediatricians in South Florida are already reporting clinic closures and appointment shortages.
As reported by Orlando Sentinel, Pediatric Associates operates about 95 offices with more than 400 providers and cares for roughly 300,000 children on Medicaid across Florida. The complaint alleges the state’s revised methodology has cut core pediatric rates by around 15% statewide and by as much as 20% to 30% in some counties. The practice estimates that those changes have resulted in about $15 million less in payments every month. The lawsuit asks AHCA to restore funding lost since February 2025 and to correct the rate calculations for the 2026–2027 rate year.
What the suit says
The filing argues that AHCA misapplied technical pieces of the Medicaid formula and did not properly account for pediatric-specific visit codes or the real costs of running kids' practices. April Andrews-Singh, general counsel for Pediatric Associates, said the group tried repeatedly to resolve the dispute before heading to court. "We were forced to take this step because families and their children cannot wait any longer for action," she said, according to Orlando Sentinel. The lawsuit asks a judge to order AHCA to fix its methodology and restore payments so clinics can stay financially afloat.
Clinics warn families could lose care
Pediatric Associates says in the complaint that some clinics in Miami have already closed and that others, including practices in Broward County, are at risk of shutting down if rates are not corrected. Dr. Tamika Maxwell of Lauderdale Lakes told the court that without changes to the reimbursement formula, it would be too expensive for her practice to keep treating Medicaid patients. According to the filing, closures and cutbacks would leave low-income families facing longer drives and longer waits for routine checkups, vaccines, and dental services.
Why it matters
AHCA sets reimbursement levels for Medicaid services under oversight from the federal Centers for Medicare & Medicaid Services, according to the Agency for Health Care Administration. Florida has long wrestled with complaints that low Medicaid reimbursement makes it tough for families to find doctors, and advocates warn that additional cuts could widen gaps in preventive care and pediatric dentistry access. A previous legal battle over pediatric Medicaid rates pushed the state to make changes, including a federal settlement about a decade ago documented by WFSU.
Legal next steps
The new lawsuit asks for past payments to be restored and for corrections to the rate methodology for the 2026–2027 year, and it indicates the group could also seek court orders to block further cuts while the case plays out. Pediatric Associates says it pursued all available administrative avenues before filing and portrays the legal fight as necessary to head off immediate harm to families. AHCA declined to comment on the pending case, according to the original reporting.
The dispute now becomes an early test of how Florida balances budget constraints with its responsibility to maintain access to care for children on Medicaid. With Pediatric Associates saying it serves roughly 300,000 Medicaid patients and warning that millions of children could be affected by lower payments, clinics and families across the state will be watching closely to see how and how quickly the agency responds.
