Florida Lowers ABA Forecast by Nearly $1 Billion

WEST PALM BEACH, FLORIDA – Florida’s Medicaid program now expects to spend $2.88 billion on applied behavior analysis in fiscal year 2026–27, nearly $1 billion below its earlier $3.86 billion forecast, the governor’s office said Oct. 6 as Gov. Ron DeSantis announced results of his Medicaid crackdown.

The governor’s office credits managed care, “utilization management,” and efforts against fraud, waste, and abuse. Most ABA services moved into managed care in 2025, putting health plans in charge of approvals and payments for their enrollees. Utilization management includes the plans’ reviews of which services to approve. The announcement does not quantify each factor’s contribution.

The roughly $980 million gap is a change in projected spending, not a recovery of that amount. DeSantis said economists made the earlier forecast before the managed care switch, according to the Florida Phoenix.

The state had been projecting 30% annual growth in ABA spending, said Shevaun Harris, secretary of the Agency for Health Care Administration (AHCA), Florida’s Medicaid agency. Officials say growth has slowed to less than 10% a year since the switch, WPTV reported. They described spending as still rising, but more slowly than previously projected.

Florida recorded about $6.6 billion in Medicaid and Children’s Health Insurance Program payments for ABA from 2023 through 2025, nearly four times the next-highest state, according to federal data AHCA presented in August.

The Crackdown’s Tally

The governor’s office reported more than 220 Medicaid provider terminations for what it called fraud, waste, or abuse, and payment restrictions or suspensions for more than 260 providers. It also reported more than 150 fraud-related referrals to the attorney general’s office over the past year and more than 400 site visits since January, focused on ABA, medical equipment suppliers, and adult day care. The release did not identify criminal convictions arising from those referrals.

The governor’s office said AHCA found billing for months of daily services through weekends and holidays, sometimes for “more than 24 hours of services in a single day.” It did not identify the providers involved or say how many of those terminated provided ABA. When WPTV asked for a list, Harris said she would provide what she could without jeopardizing ongoing, potentially criminal investigations.

The terminated providers billed Medicaid more than $230 million in 2025, the release said. That is total billing across unspecified provider types, not a measure of proven fraud or ABA savings. The release gave no billing total for providers whose payments were restricted or suspended. DeSantis called the results “kind of just the opening salvo.”

Managed Care’s First Eight Months

An Oct. 1 report that the actuarial firm Milliman prepared for AHCA found ABA service use 16.1% below projections from February through September 2025, the first eight months of managed care coverage. The payment rates initially assumed no ABA savings from managed care. Plans reported $1.73 billion in incurred ABA costs, about $198.2 million below their combined $1.93 billion risk-adjusted cost target.

AHCA’s summary attributes lower use to “managed care efficiencies” and the concentration of ABA recipients in the Children’s Medical Services Plan. The period ended before the June 12, 2026, launch of the integrity initiative. Florida had pursued ABA fraud controls before that initiative.

“We were projecting 30% year-over-year growth in expenditures to this service. That kind of growth is unsustainable.” – Shevaun Harris, Secretary, Florida Agency for Health Care Administration, Oct. 6, 2026

Under AHCA’s risk-sharing arrangement, applied plan by plan, a plan keeps savings up to 5% below its target, splits the next 5% equally with the state, and returns the rest. The report allocates $134.5 million, about two-thirds of the $198.2 million, to the plans and $63.6 million to AHCA. The agency’s share includes federal funds. These amounts precede the separate 2025 profit-sharing calculation, which was not complete when the report was written.

Neither the governor’s release nor the Milliman report quantifies how much of the savings came from fraud controls, authorization decisions, or barriers to care. Lower use alone does not establish that necessary therapy was denied. Milliman assessed the plan and agency data for reasonableness but did not audit them.

Families Report Interruptions

AHCA identified 55,226 recipients in a recent six-month period of ABA encounter data, according to its August task force presentation using data as of June 26. Families and providers have complained about therapy interruptions since the managed care switch, the Florida Phoenix reported. Some providers were dropped from plan networks, while others stopped treating Medicaid patients.

DeSantis blamed providers who bill fraudulently. “If you have a provider that is doing some legitimate services and much fraudulent,” he said, “to the extent that those services get interrupted, that’s not AHCA’s fault.” Harris said the plans have care coordinators to help families find new providers and that parents can contact the agency directly.

Task Force Report Due Dec. 31

The Legislature directed the task force to evaluate authorization limits, potential caps on months of ABA services, and stronger provider enrollment and billing standards. These are subjects for review, not enacted caps. BreakingNewsABA previewed the panel’s options Oct. 2. As of Oct. 12, AHCA listed a fifth meeting as forthcoming, with no date posted. Recommendations are due to the governor and legislative leaders by Dec. 31, 2026.

AT A GLANCE

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