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Florida Medicaid faces significant shifts in late September 2026, driven by new federal work requirements, ongoing state safety-net investigations, and debates over autism therapy budgets.

Medicaid Work Requirements are set to begin nationwide in January 2027 following federal policy changes. State discussions center on how beneficiaries must prove they are medically frail, with several Republican-led states pushing for immediate strict documentation rather than grace periods.

Hope Florida Investigation reports from late September 2026 highlight criticisms that the state's "Hope Florida" initiative quietly reallocated workforce and resources away from benefit offices that determine eligibility for Medicaid and food assistance. This follows an August 2026 grand jury finding regarding the administration's handling of settlement funds.

Autism Therapy Program Review: State lawmakers and task forces are weighing changes and reviewing the costs of Florida's $2.3 billion applied behavioral analysis (ABA) program for low-income children with autism, with recommendations due by the end of the year.

Children’s Enrollment Decline: Data from mid-2026 tracks a sharp drop in Florida’s children’s Medicaid enrollment following post-pandemic program unwinding, raising concerns among health advocates regarding rising uninsured rates.

9/25/26: CMS Plan Transition from Sunshine to Molina

REMINDER: Effective October 1, 2026, the operation of the Children’s Medical Services (CMS) Plan will move from Sunshine State Health Plan, Inc. to Molina Healthcare of Florida, Inc.
The Agency previously announced (Medicaid Health Alert) that effective October 1, 2026, the operation of the Children’s Medical Services (CMS) Plan will move from Sunshine State Health Plan, Inc. (Sunshine) to Molina Healthcare of Florida, Inc. (Molina).
To ensure no disruption in current services and to support continuity of care (CoC), Molina will have a CoC period of up to 240 days (8 months). The CoC period covers services authorized by Sunshine Health and documented courses of treatment that are in effect and being delivered as of 10/1/2026 until the authorization, course of treatment, or CoC period ends, or until a new care plan is finalized and new services are authorized, whichever occurs first.
Regardless of contracting status, enrollees may continue seeing their current providers until May 31, 2027, or until their new care plan is finalized and ongoing services are authorized, whichever occurs first. Molina is required to reimburse non-participating providers at the rate they received for services rendered to enrollees prior to the transition for up to eight months, unless there is an agreement to an alternative rate.
For member questions regarding this transition, contact Molina Member Services at 1-800-262-0750. For provider questions regarding this transition, contact Molina Provider Services at 1-855-322-4076.

8/27/26: Gov. DeSantis calls grand jury report on $10M Medicaid diversion a "hoax," while Jolly pushes for new investigation

In the wake of CBS News Miami reporting that a state grand jury had found his administration misappropriated $10 million of taxpayer money into the Hope Florida Foundation, Governor Ron DeSantis angrily denounced the investigation and continued to call it all a hoax.
"The only crime that was apparent was whoever leaked the grand jury report," DeSantis said.
The grand jury found that key officials in the governor's office diverted the $10 million from a Medicaid settlement as "part of a sophisticated scheme to fund political activities," according to a copy of the sealed grand jury report obtained by CBS News Miami.
The grand jury report said the money, which was supposed to be used to provide health insurance for poor children, was instead hastily passed through multiple organizations before eventually landing in the bank accounts of two political action committees and the Republican Party of Florida. Those funds were then used in 2024 to defeat Amendment 3, the citizen initiative to legalize marijuana in Florida.

6/12/26: Governor Ron DeSantis Announces Medicaid Integrity Initiative to Crack Down on Fraud

Today, Governor Ron DeSantis announced a comprehensive Medicaid integrity initiative aimed at strengthening oversight, preventing fraud before it occurs, and ensuring taxpayer dollars are spent on care for eligible Floridians. The initiative includes enhanced provider screening, advanced fraud detection technology, enrollment controls for high-risk provider categories, and a statewide revalidation of all active Medicaid providers.

“Today, we announced major actions to strengthen the integrity of Florida’s Medicaid program and crack down on fraud,” said Governor DeSantis. “In Florida, we work to ensure that taxpayer dollars are spent responsibly and that public programs serve the people they are intended to serve.” Florida has long prioritized fiscal responsibility, reducing spending for two consecutive years, cutting debt, maintaining a AAA credit rating, and exposing wasteful government spending. “The Medicaid program exists to meet the health care needs of pregnant women, children, seniors, and some of our most vulnerable populations,” said Florida Agency for Health Care Administration Secretary Shevaun Harris. “Every dollar stolen through fraudulent schemes is one less dollar available to meet the needs of those who rely on the program most. That’s why we are working harder than ever to make sure the right people get the care they need, and everyone trying to exploit this program will be stopped.”

6/1/26: Medicaid Community Engagement Requirement for Certain Individuals Interim Final Rule with Comment Period (CMS-2454-IFC)

As required by law, on June 1, 2026, the Centers for Medicare & Medicaid Services (CMS) issued an interim final rule implementing a new statutory requirement for certain adults in Medicaid to meet an 80 hours per month work requirement (sometimes referred to as Medicaid community engagement) as a condition of eligibility. States must generally implement this requirement no later than January 1, 2027. This fact sheet discusses the provisions of the Interim Final Rule with Comment Period.

Who is Affected?

The work requirement applies to non-pregnant adults between the ages of 19 and 64 who are not entitled to or enrolled in Medicare and are eligible for or enrolled in the Medicaid adult group or in certain section 1115 demonstrations that provide minimum essential coverage to adult beneficiaries. To date, 43 states and the District of Columbia provide coverage to these populations and will be required to implement the new requirement; U.S. territories are not subject to this law.

Certain individuals are exempt from the requirement, including those who are pregnant or in a postpartum period, disabled or medically frail, parents and caretakers of children under 14 years of age or people with disabilities, American Indians and Alaska Natives, and certain others.

States may also elect to offer short-term hardship exceptions for individuals subject to the work requirement under specific circumstances—for example, those receiving inpatient or certain other medical services, individuals who need (or whose dependent needs) to travel outside their community for certain medical care not available in their home community, those in a county with an unemployment rate at or above 8% or 1.5 times the national average, and those who reside in a county where certain national emergencies or disasters exist.

What the Requirement Means

Under the rule, affected Medicaid applicants and enrollees (referred to as “applicable individuals”) will be required to demonstrate 80 hours per month of qualifying activities, such as employment, participation in certain work programs, or community service, or be enrolled in educational program at least half time. Individuals may combine activities to meet the 80-hour requirement. or meet it by earning at least 80 times the Federal hourly minimum wage ($580 per month in 2026); for seasonal workers, there is a different calculation. Certain new Medicaid applicants will need to meet the requirement for at least one month before the month in which the applicant applies, and existing Medicaid beneficiaries will need to meet the requirement for one or more months between renewals.

States must verify compliance of applicable individuals at application, at renewal, and—at state option—at more frequent periodic intervals. If a state cannot verify that an individual has met the requirement, it must send a notice of noncompliance and provide the individual with 30 calendar days to demonstrate compliance or that the requirement does not apply to them. If the individual fails to do so, their application might be denied or they might be disenrolled from Medicaid. Individuals who are disenrolled may reapply at any time and will be assessed for compliance upon reapplication.

States are responsible for implementing and administering the work requirement. This includes:

Identifying who is and is not subject to the work requirement, including who meets an exception;
Verifying that applicable individuals meet the requirement at application and renewal
Providing outreach and notice to affected populations;
Taking defined steps when individuals are found noncompliant or compliance cannot be verified;
Submitting data to CMS to support monitoring and program integrity.

CMS is issuing new reporting requirements and will use existing data reporting systems to monitor state implementation. States that fail to submit required data or show compliance issues may be subject to corrective action.

5/26/26: Temporary Moratorium on Enrollment of New Medicaid Providers for Durable Medical Equipment

Today, the Agency for Health Care Administration announced that a temporary moratorium has been issued for enrollment of new Durable Medical Equipment (DME) providers in the Florida Medicaid program. The temporary moratorium is being implemented to combat fraud and safeguard taxpayer dollars, while ensuring quality access to care.

“The Agency is continually looking at ways to strengthen fraud detection and prevention strategies and over the last year, we have taken intentional enforcement action to hold providers accountable and safeguard taxpayer dollars,” said Agency for Health Care Administration Secretary Shevaun Harris. “This moratorium is just one example of the many efforts being put in place to curb fraud, waste, and abuse in the Medicaid program and to ensure Medicaid recipients are able to receive care from high quality providers.”