SMMC 3.0 Changes That Could Cost Florida Medicaid Recipients in 2026
- Ask Medicaid Florida
- Jun 1, 2025
- 4 min read
Updated: Feb 22
The Agency for Health Care Administration (Agency) reminds providers that effective February 1, 2025, the new SMMC 3.0 program, which includes the delivery of behavior analysis (BA) services through the managed care delivery system, goes into effect. As part of the transition to the new SMMC 3.0 program, the Agency is requiring health plans to adhere to a continuity of care period (COC) for all services, with special COC requirements specific to BA.
The purpose of the COC period is to ensure no recipient misses a medically necessary service and providers are paid for the services they provide. As such, the Agency will ensure reimbursement for BA services to eligible recipients enrolled with a health plan.
To be reimbursed by SMMC health plans for BA services delivered during the COC period, providers must continue serving clients. The Agency has enacted the following plan requirements to ensure uninterrupted access and delivery of BA services:
· Providers will be paid for delivering BA services during the COC period to their clients enrolled in a health plan.
· During the COC period, health plans are required to:
Pay Medicaid enrolled BA providers for services rendered to recipients on and after 2/1/2025 who are enrolled in their plan.
The health plans shall reimburse non-participating providers at the rate they received for services rendered immediately prior to the enrollee transitioning to the health plan for a minimum of 60 days unless negotiated otherwise. Some health plans may offer a longer period of time.
Honor existing prior authorizations and level of service for a minimum of 90 days. Some health plans may offer a longer time period.
Extend authorizations that expire prior to the end of the 90-day COC period for the remainder of the COC period.
· Updated links to each health plan’s updated behavior analysis information can be found here.
Note: There are a small number of Florida Medicaid recipients enrolled with a managed care plan as a voluntary SMMC population; these recipients may opt to remain in the fee-for-service program at any time by opting out of managed care. Reimbursement for voluntary recipients who choose to “opt-out” of managed care will continue through the fee-for-service delivery service. More information can be found here. There are several ways that a voluntary recipient can disenroll (or opt-out) of an MMA plan:
Phone: Medicaid Helpline at 1-877-254-1055 or Medicaid Choice Counselor at 1-877-711-3662
Online: Beginning February 1st, 2025, you can also disenroll by visiting www.flsmmc.com
Complaints:
· Providers having difficulty receiving reimbursement from a health plan can file a complaint at: File a Complaint
· Providers who wish to know more about the Grievance and Appeals process can find more information at the following highlight document: Grievance and Appeal Process Snapshot
· Additional information on the SMMC 3.0 program beginning on 2/1/25 can be found at: New SMMC Program
Who Should Be Concerned About SMMC 3.0?
Florida’s Statewide Medicaid Managed Care (SMMC) 3.0 transition impacts specific groups more than others. If you fall into any of the categories below, pay close attention.
1. Seniors Receiving Long-Term Care (LTC)
If you rely on:
Nursing home coverage
Assisted living support
Home and community-based services
Changes to managed care contracts could mean:
New plan assignments
Provider network changes
Care coordinator reassignment
Oversight comes from the Florida Agency for Health Care Administration.
2. Medicaid Recipients With Chronic Conditions
Those managing:
Diabetes
Heart disease
Cancer treatment
Dialysis
Mental health services
Risk: Your current specialist may not be in your new plan’s network.
3. Families With Children on Medicaid
Especially those with:
Special healthcare needs
Behavioral therapy
Autism services
Ongoing specialist care
Network or authorization changes can disrupt continuity of care.
4. Dual-Eligible (Medicare + Medicaid) Beneficiaries
If you receive both Medicare and Medicaid:
Coordination rules may shift
Managed care alignment may change
Supplemental benefits may vary
Federal oversight involves the Centers for Medicare & Medicaid Services.
5. Individuals Assigned to Plans Automatically
If you do not actively choose a plan:
You may be auto-assigned
Your current providers may not participate
You may need to switch during open enrollment
Passive enrollment increases the risk of disruption.
6. Medicaid Recipients Who Recently Moved Counties
Plan availability and provider networks vary by region. Moving counties may trigger a different plan selection pool.
7. Caregivers Managing Coverage for Others
If you manage Medicaid for:
A parent
A disabled adult child
A medically fragile family member
You should monitor:
Plan transition notices
Provider participation
Service authorization timelines
Other Facts about SMMC 3.0
What is SMMC in Florida?
Statewide Medicaid Managed Care (SMMC) is the program where most Medicaid recipients receive their Medicaid services.
What does SMMC stand for?
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