Florida Medicaid 2025 — Essential facts, changes, and how to use the system
- Ask Medicaid Florida
- Sep 27, 2025
- 9 min read
Updated: Nov 9, 2025
Florida Medicaid underwent major program restructuring in 2025. The Agency for Health Care Administration implemented SMMC 3.0 on February 1, 2025, which moved most Medicaid recipients into statewide managed care, reorganized regions, and added new reporting and network requirements. The state also rolled out MyACCESS, a unified benefits portal, and kept strict provider enrollment enforcement via the Enrollment Wizard. Important political and budget pressures continue to affect program design, funding, and expansion debates in 2025.
Why this matters now
Millions of Floridians rely on Medicaid for medical, dental, behavioral, and long-term services. Policy and operational changes in 2025 affect:
how beneficiaries enroll and stay enrolled,
which clinicians are in-network,
how providers get paid and must report,
where and how members find a Medicaid doctor or dentist,
continuity of care during transitions.
These operational details impact access to appointments, out-of-pocket costs, and care continuity. Recent program redesigns aim to centralize management, increase oversight, and tie payments to quality measures.
1. Big picture changes in 2025
SMMC 3.0 launch (Feb 1, 2025). AHCA moved the majority of Medicaid recipients into a redesigned statewide managed care program. This retooling emphasizes regionally tailored plans, stronger network sufficiency standards, enhanced reporting, and quality-based incentives. Plans must meet new contract and reporting requirements.
MyACCESS portal rollout. A single portal replaces prior systems for benefits management. Members use MyACCESS to apply, upload documents, and track redetermination. The new portal aims to reduce lost paperwork and improve communications.
Provider enrollment enforcement. AHCA continued strict enforcement in 2024–2025. Providers must enroll using the Online Provider Enrollment Wizard and verify provider IDs are active to avoid termination. Audits and terminations of unregistered IDs occurred in 2024 and enforcement remains active into 2025.
2. How to locate a Medicaid doctor or dentist in Florida
Confirm your Medicaid ID and plan. Look at your Medicaid ID card or MyACCESS account for plan name and member ID.
Use your plan’s provider directory. Each managed care plan maintains a searchable online directory. Search “<Plan Name> provider directory Florida” and filter by specialty and ZIP code.
Use the statewide provider search tools. AHCA and the Florida Medicaid Managed Care portal host plan lists and contact pages that link to directories. When in doubt use AHCA plan pages to find plan phone numbers and provider lists.
Call member services. The phone number on your ID card will connect you to member services who can locate in-network primary care providers and dentists and assist with appointments.
If you need specialty care or behavioral health. Request a referral or authorization from the primary care provider (PCP) as required by the plan. If an in-network specialist is not available, ask member services about out-of-network coverage under continuity-of-care rules.
If you cannot find a dentist. Many plans maintain an oral health/best-care page. If the plan lacks a dentist in your area, file a network adequacy complaint with the plan and AHCA.
Tips:
Search by terms members use online: “Medicaid dentist near me Florida”, “find Medicaid doctor Florida”, “Medicaid pediatrician Florida”.
Keep screenshots or notes of directory searches and phone calls. These help with appeals if access is denied.
3. Eligibility and redetermination essentials
MAGI vs non-MAGI categories. Most adults and families are evaluated under Modified Adjusted Gross Income (MAGI) rules. Elderly, disabled, and long-term care applicants follow non-MAGI financial rules and may have asset and trust rules.
Redetermination continued focus. After the end of continuous coverage protections, states including Florida implemented routine redeterminations. Members must update addresses and submit documentation via MyACCESS. Failure to respond can lead to termination.
Documentation to have ready. Proof of identity, income (pay stubs, self-employment documents), SSN (if required), residency (lease, mail), and any disability documentation for SSI-related routes.
Special cases. Pregnant people, children, and people receiving Supplemental Security Income have distinct rules. For LTC and nursing home eligibility consider Qualified Income Trusts and asset-protection options.
4. MyACCESS portal: practical tips
One account to manage benefits. MyACCESS replaces older ACCESS portals. Use it to file new applications, check redetermination status, upload verification, and update contact info.
Upload quality. Scan documents clearly. Name files and include the member’s name and DOB in file names.
Use message center and alerts. MyACCESS sends notices. Check message center often and make sure your contact info is current.
If you lose access. Call the MyACCESS help line listed on the portal or visit local DCF offices for assistance.
5. Statewide Medicaid Managed Care (SMMC 3.0): implications
Automatic plan assignment for most enrollees. Beginning February 2025 many members were auto-assigned to managed care plans. Exceptions exist for small groups. Plans must meet network sufficiency and quality requirements.
Regional realignment. Counties were reorganized into nine SMMC regions for plan procurement and network oversight. This affects which plans operate in a given area and network adequacy calculations.
Performance and reporting. Plans must follow new reporting guidelines (2025–2030 plan report guide) and are subject to performance incentives and penalties tied to quality and access.
What members should do. Review plan notice, confirm PCP, check provider directory, and request continuity of care if mid-treatment.
6. Continuity of care and plan assignment rules
Continuity of care requirements. When members move to a new plan or are auto-assigned, plans are required to ensure access to medically necessary services during the transition. Many communications note a 90-day continuity window depending on service and transition details. If a current provider is not in the new network the plan must provide out-of-network coverage or arrange timely access.
What to request. If you are undergoing treatment, request a continuity-of-care exception from member services. Document clinical need and pending appointments. If necessary, file appeals and contact AHCA for enforcement.
7. Provider enrollment and the Enrollment Wizard
Mandatory online enrollment. Providers must enroll with Florida Medicaid using the Enrollment Wizard on the FLMMIS portal. The Wizard indicates required supporting documents and routes applicants to appropriate forms. AHCA’s Provider Enrollment unit manages applications, compliance, and audits.
Common enrollment issues.
Mismatch of provider taxonomy and NPI.
Missing or expired licenses.
Incomplete disclosure of ownership or managing employees.
Incorrect bank account/ACH info.
Best practices for providers.
Complete Enrollment Wizard application thoroughly.
Keep proof of submission and confirmation numbers.
Re-verify provider IDs periodically. AHCA has terminated unregistered or inactive provider IDs in enforcement actions.
Timelines and audits. Allow weeks for review. Expect post-enrollment audits and site verifications for certain specialties.
8. Telehealth, behavioral health, and pharmacy updates
Telehealth saw expanded use during and after the public health emergency. Many managed care plans continue to cover telehealth for primary care, behavioral health, and some specialty visits. Confirm with plan policies and prior authorization needs.
Behavioral health. SMMC 3.0 placed emphasis on integrating behavioral health into Medicaid managed care. Plans are expected to deliver greater access to mental health and SUD (substance use disorder) services and to meet behavioral health network requirements.
Pharmacy management. Pharmacy benefits are managed through plan contracts and PBMs. Watch for step therapy rules, formulary updates, and prior authorization policies. Plans and AHCA post formulary and pharmacy policy changes on their websites.
9. Dental services
Children’s dental. Pediatric dental remains a required benefit and plans must maintain pediatric dental networks.
Adult dental. Adult dental coverage varies by eligibility category and plan. Some managed care plans include additional dental benefits for adults. If dental access is limited in your area, file network adequacy complaints with the plan and AHCA and request interim out-of-network coverage when clinically necessary.
Finding dentists. Use the plan directory, call member services, and check statewide dental access resources.
10. Long-term services and supports (LTSS) and nursing homes
LTC eligibility. Nursing home and other long-term services follow non-MAGI rules. Income caps, asset limits, and Qualified Income Trusts are relevant for eligibility. AHCA maintains specific fact sheets and guidance for LTC applicants.
Home and community-based services (HCBS). Plans and AHCA support HCBS programs when available. SMMC 3.0 includes oversight of access to HCBS.
Care coordination. Managed care plans are required to coordinate LTSS services and house case management where applicable.
11. Billing, claims, and appeals
Claims submission. Providers must submit claims according to AHCA and plan instructions. Many plans use electronic claims portals and specific bill-type and coding rules.
Timely filing and denials. Note plan-specific timely filing windows. Keep documentation and appeal denials per plan and AHCA appeal processes.
Member appeals. Members may appeal plan decisions, denials of services, or terminations. Follow the plan’s internal appeal then external review procedures. AHCA can intervene for systemic access problems.
12. Political, fiscal, and legal developments to watch
Medicaid expansion politics. Expansion remains politically contested in Florida. Campaigns to expand Medicaid have been active, but legal and legislative barriers persist. In 2025 efforts to place expansion on the ballot faced delays related to state law changes affecting ballot initiatives. Monitor litigation and legislative bills.
Federal funding changes. Federal budget actions and federal Medicaid policy shifts can materially affect state budgets and services. In 2025 national actions and budget changes prompted scrutiny of potential state fiscal impacts.
Contract and procurement controversies. Large managed-care contractors and PBMs have been the subject of oversight and settlements. Watch AHCA contract amendments and procurement reports for transparency and financial controls.
13. Practical checklists
For members: find a Medicaid doctor or dentist
Have Medicaid ID, plan name, and member ID.
Log into MyACCESS and confirm contact info.
Check your plan’s online provider directory.
Call member services for help locating providers and booking appointments.
If mid-treatment, request continuity of care and document requests.
For providers: onboarding and compliance
Enroll using Enrollment Wizard and keep confirmation records.
Verify NPI, taxonomy, licenses, and bank info.
Review SMMC 3.0 network adequacy and reporting requirements.
Prepare for audits and timely claim submission.
Keep clear referral and authorization workflows for members in managed care.
For advocates and case managers
Track redetermination deadlines in MyACCESS for clients.
Help clients upload documents and check messages.
Keep appeal templates ready and document all communications.
Monitor plan directories and file network adequacy complaints where necessary.
14. Top 10 questions members ask and simple answers
How do I find a doctor? Use your plan directory, call member services, or use AHCA plan pages to locate in-network providers.
What is MyACCESS? The unified online portal to manage benefits, apply for Medicaid, and submit redetermination materials.
Why was my plan assignment changed? SMMC 3.0 includes auto-assignment. Plans and AHCA notify members and continuity rules apply for ongoing care.
How do I keep Medicaid during redetermination? Respond to MyACCESS notices, upload required documents, and confirm contact info.
Can I see a specialist out of network? Only under certain continuity or prior authorization rules. Ask member services and file appeals if denied.
How do providers enroll? Via the AHCA Online Provider Enrollment Wizard on FLMMIS. Keep proof of enrollment.
Is adult dental covered? It depends on eligibility and plan. Check plan benefits and file complaints if access is insufficient.
Is telehealth covered? Often yes, but check plan policy and prior authorization rules.
What if my provider ID is deactivated? Contact AHCA Provider Enrollment and your plan immediately. AHCA has terminated unregistered provider IDs in prior enforcement.
Will Medicaid expand in Florida? Expansion remains debated and faced ballot and legislative barriers in 2025. Watch litigation and legislative updates.
15. Where to get official help (quick links and contacts)
AHCA Florida Medicaid pages — plan info, SMMC 3.0, provider enrollment guidance.
MyACCESS portal — applications, redetermination, document upload.
FLMMIS Provider Enrollment — Enrollment Wizard and enrollment resources.
Plan member services — phone number on your ID card.
Local legal aid and advocacy groups — for appeals and access complaints.
16. Strategic takeaways for 2025
SMMC 3.0 centralizes managed care in Florida. Prepare for plan assignment and network changes.
Use MyACCESS proactively to stay enrolled.
Providers must be enrolled and compliant via the Enrollment Wizard. Noncompliance risks termination.
Dental and behavioral health access remain priorities. If access is poor, escalate to plan complaints and AHCA.
Monitor political developments on expansion and federal funding. These will alter coverage and budgets.
Appendix A — Sample scripts (member and provider)
Member calling member services: “My name is [X], DOB [MM/DD/YYYY], member ID [####]. I need a primary care provider in ZIP [#####] who accepts new Medicaid patients. Please confirm in-network status and next available appointment.”
Provider contacting AHCA enrollment: “This is [Provider Name], NPI [#####]. I completed the Enrollment Wizard on [date] and received confirmation number [#####]. I need status and whether additional documents are required.”
Appendix B — Glossary
AHCA. Agency for Health Care Administration. State Medicaid agency for Florida.
SMMC 3.0. Statewide Medicaid Managed Care version launched Feb 1, 2025.
MyACCESS. Florida’s unified benefits portal.
FLMMIS. Florida Medicaid Management Information System. Provider enrollment platform hosts the Enrollment Wizard.
Other Important Medicaid Florida Websites
AHCA
Medicaid is a medical assistance program that provides access to health care for low-income families and individuals. Medicaid also assists the elderly and people with disabilities with the costs of nursing facility care and other medical and long-term care expenses. Go to AHCA
MyACCESS
Here you can apply for Medicaid, Food Assistance (SNAP), Temporary Cash Assistance (TCA), Optional State Supplementation (OSS), and more. Go to MyACCESS
Sources and further reading (key citations)
About the Author
Ask Medicaid Florida is a trusted independent author focused on simplifying Medicaid news, policy updates, and healthcare resources for Florida residents. With a mission to make complex Medicaid issues understandable, Ask Medicaid Florida provides clear, factual, and timely insights that help readers stay informed and empowered. "You are valued, thank you for visiting our website".
Disclaimer
The content on the Ask Medicaid Florida (AMF's) website is for informational purposes only and does not constitute advice for your Healthcare decisions or any other type of advice. All content, materials, and resources made available are solely for educational purposes and should not be relied upon for making Healthcare decisions. Ask Medicaid Florida (AMF) makes no claims to be associated with any state agencies including Medicaid of Florida.
Comments