ABA providers report unpaid claims since Molina took over Florida’s CMS Plan on October 1. AHCA cites 218,000 paid claims and 33 provider complaints.
Key Takeaways
- Providers report a month without payment. ABA agencies serving the Children’s Medical Services (CMS) Plan told CBS News Miami that most claims have gone unprocessed since Molina Healthcare took over the plan on October 1.
- The state has logged 33 complaints. The Agency for Health Care Administration (AHCA) told Acuity it has received 33 complaints from behavior analysis providers about the transition and reviews them for contract compliance.
- The transition rules promised continuity. AHCA told providers in April that the new plan would pay them promptly, and Molina must honor Sunshine Health authorizations for up to 240 days.
- Molina and the state point to progress. Molina called the $6 billion contract off to a great start on its October 22 earnings call, and AHCA says Molina has paid more than 218,000 behavior analysis claims since October 1.
For five years, Arlene Perez has worked with the same child, a 12-year-old named Isaiah who has autism and receives applied behavior analysis through Florida’s Children’s Medical Services Health Plan. Perez, a Registered Behavior Technician, has kept showing up through October. Her agency, she told CBS News Miami, has watched most of its claims sit unprocessed since the plan changed hands on October 1. Isaiah’s mother, Joyce Jackson, told the station she worries the unpaid claims could put his provider out of business.
The plan’s new operator is Molina Healthcare of Florida, which took over the CMS Plan from Sunshine State Health Plan under a contract the Agency for Health Care Administration (AHCA) awarded last year. Perez joined other providers at a rally outside Molina’s office in Doral, CBS News Miami reported on October 23, and a Miami attorney working with providers said the problem is broad. Henry Marines told the station that the nearly 700 providers he communicates with “all say the same thing. They haven’t been paid.”
AHCA confirmed to the station that it is actively investigating payment concerns that ABA providers raised about the October 1 transition. Marines’s figure has not been independently verified, and Molina did not respond to CBS News Miami’s request for comment.
In a November 2 statement to Acuity, AHCA released figures on Molina’s claims processing. Since October 1, the agency said, Molina has paid more than 218,000 behavior analysis claims and has about 79,000 more in inventory, 85 percent of them less than seven days old. By Acuity’s calculation, that leaves roughly 11,850 claims at least seven days old. AHCA said Molina had added claims validation processes and onboarded nearly 500 non-participating behavior analysis providers to support continuity of care, and had worked closely with the agency so the transition “continues to proceed in an orderly and effective manner.”
AHCA also said it has received 33 complaints from behavior analysis providers about the transition since October 1, which it reviews through its managed care oversight process for compliance with contract requirements. That count covers complaints filed with the agency, which asks providers to use a plan’s own complaint process first. AHCA did not say where the investigation it confirmed to CBS News Miami stands, or whether it has required corrective action from Molina or taken any contract enforcement steps, both of which Acuity asked about. Its statement also did not break out denied claims or dollar amounts.
How Florida’s CMS Plan Moved From Sunshine Health to Molina
The CMS Plan is a specialty plan within Florida’s Statewide Medicaid Managed Care (SMMC) program for children and young adults under 21 with serious or chronic conditions, covering both Medicaid (Title XIX) and Children’s Health Insurance Program (Title XXI) enrollees. In November 2025, Molina announced that AHCA intended to award it the statewide contract as the sole plan, with about 120,000 expected enrollees. Sunshine operated the plan through September 30. The transfer added roughly 115,000 members to a company that reported about 4.9 million members across its businesses at the end of September, according to Molina’s third-quarter earnings release.
For families, the handoff was automatic: members moved to Molina without reapplying. For providers, it was not. Sunshine told providers that their contracts would not carry over and that they would need to contract directly with Molina to keep serving CMS Plan members after the continuity-of-care period, according to Sunshine’s transition page. Claims for dates of service before October 1 stayed with Sunshine, and Sunshine stopped reviewing new network exception requests for behavior analysis services on September 4.
Families were not locked in. AHCA’s April alert said Medicaid (Title XIX) recipients who did not want to move to Molina could choose a different SMMC plan, and Molina’s FAQ set a shorter continuity period, up to 180 days, for children who join the CMS Plan from another plan or from fee-for-service after October 1. For a child in the middle of a course of ABA, changing plans would also mean finding a provider in the new plan’s network.
Behavior analysis has been part of Florida’s managed care system only since February 2025, when AHCA moved the benefit into SMMC plans and out of fee-for-service. For providers serving children with complex needs, the CMS Plan transition is the second structural change in less than two years.
What AHCA and Molina Told Providers About Payment Before October 1
The state’s written guidance anticipated the situation providers now describe. In an April 28 Florida Medicaid Health Care Alert, AHCA said prior authorizations approved before October 1 would be honored by the new plan and that “providers will be paid promptly by the recipient’s new managed care plan.” The alert set a continuity-of-care period of up to eight months, during which recipients could keep seeing their current providers until May 31, 2027, or until their care plan was finalized and ongoing services authorized, whichever came first.
AHCA’s CMS Plan transition page carried the same assurance, telling providers to keep delivering services as usual and stating that Molina would honor existing authorizations and process claims on that basis. Molina’s own provider FAQ, dated September 25, put the continuity period at up to 240 days, through May 29, 2027, for members coming from Sunshine. The FAQ reminded providers that Sunshine contracts would not transfer, said Molina was actively contacting providers about joining its CMS Plan network, and said the company would follow AHCA’s continuity-of-care provisions after the transition.
A further protection applies to agencies that have not yet signed with Molina. Under AHCA’s September 25 reminder, Molina must pay non-participating providers the rate they received before the transition for up to eight months unless the two sides agree on a different rate, according to a summary by the Home Care Association of Florida.
The contracts also set payment deadlines. Asked what claims payment timelines Molina’s CMS Plan contract requires, AHCA pointed to Attachment II, Section VII.E.2 of the SMMC contracts. The agency’s summary of those contracts says health plans must pay 85 percent of clean claims within seven days, 95 percent within 10 days, and 98 percent within 20 days, and that falling short can bring liquidated damages of $10,000 per month. The inventory figures AHCA provided measure how long unprocessed claims have been waiting, not how quickly clean claims are paid, and the agency did not say whether Molina is meeting the contract standards for behavior analysis claims.
Read together, the documents describe a transition in which an ABA agency without a Molina contract could keep treating a CMS Plan child under an existing Sunshine authorization and expect prompt payment at its prior rate. What they do not settle is whether that is happening. AHCA’s statement points to one variable, the additional claims validation processes Molina put in place, but neither AHCA nor Molina has said whether the delays providers describe trace to that step or to contracting, credentialing, transferred authorizations, or claims configuration.
Molina’s Account of the Launch on Its Third-Quarter Call
Molina’s executives discussed the contract with investors on October 22, the day before the CBS News Miami report aired. Chief Executive Joe Zubretsky described the plan as a $6 billion annual contract that was “off to a great start,” according to a transcript of the call. Asked about the first 22 days, he said Molina had taken on 115,000 members, children he described as having complex medical and behavioral conditions, and characterized the operational and clinical rollout as close to flawless.
The company has been explicit that the contract is costly at the outset. Chief Financial Officer Mark Keim said Molina expected the plan to run at a medical care ratio of about 99 percent in the fourth quarter, with a pre-tax loss of about 5 percent, and that roughly two percentage points of that ratio reflect one-time reserves a company must set aside when it takes on new revenue. He told analysts the company expected about $100 million in fourth-quarter administrative expense on the contract and described a roughly linear path to break-even through 2027 as operations settle. Molina’s 2026 guidance includes a $1.50-per-share loss tied to implementing the new Florida contract, according to the same earnings release, and the company told investors it expects the plan to reach break-even or better in 2027.
None of the remarks on the call addressed provider payment timing or ABA specifically. A high medical care ratio means a larger share of premium is going to the cost of care, which is a separate question from whether individual claims are being adjudicated on time.
What Florida ABA Providers Serving CMS Plan Children Should Watch
Marines told CBS News Miami that it was likely too early for legal action and that he planned to meet with senior Molina leadership. For agencies, the more immediate questions are mechanical: whether claims are pending or denied, whether denials cite network status or authorization mismatches carried over from Sunshine, and whether Molina is paying non-participating providers at the prior rate AHCA described for the continuity period. AHCA’s guidance for providers says agencies should take claims disputes through Molina’s own complaint process first and, if that does not resolve them, file with the agency online or through the Medicaid Helpline at 1-877-254-1055.
The dispute sits within a broader effort by the state to restrain ABA spending, much of it routed through the same managed care plans now responsible for paying claims. Florida officials said this month that managed care, utilization controls, and enforcement had lowered projected ABA spending for fiscal 2026-27 to $2.88 billion, nearly $1 billion below an earlier forecast, as Acuity reported. The CMS Plan serves a small, high-need slice of that population, and the plan’s new operator has told investors it expects to manage its costs down over the coming year.
For families, continuity-of-care protections extend into late May 2027. For the agencies treating their children, the ability to keep doing so through that window depends on how quickly their claims clear.
Acuity requested comment from Molina Healthcare.
