By Stephanie Murphy

No one voted on it. No one debated it. Last year, a state agency changed a payment formula, and hundreds of millions of dollars quietly moved out of children’s primary care. Many of Florida’s pediatricians felt it right away. Florida’s children will feel it longer.

Governor DeSantis refused to expand Medicaid under the Affordable Care Act, and Florida has one of the highest rates of uninsured children in the nation. Now, his administration is defunding pediatricians.

Florida’s government is actively moving enormous sums of Medicaid money out of pediatric coverage, which provides countless children across our state with the care they need.

This is unacceptable, and it needs to stop.

The move against pediatric care began with a change in how the state pays for one set of services. Last year, the state’s Agency for Health Care Administration (AHCA) announced that “behavior analysis services” will henceforth be covered by traditional Medicaid payments.

“Behavior analysis services” are therapies relied on by children with developmental conditions such as autism. Before 2025, they were covered under a fee-for-service model; under the AHCA’s rule change, these services are now paid for through children’s regular Medicaid plans, rather than having providers bill separately for each visit.

The problem is not that Florida decided to cover these therapies. The problem is how the state chose to pay for it, and what that decision has cost children everywhere else in the system.

To pay for the cost of fully covering behavior analysis services under Medicaid, the government shifted money out of the general pediatrics fund. That fund helps pay for pediatricians’ salaries, doctors’ office upkeep, children’s medical services, and much more.

Worse, the funding formula used by the AHCA assumes that those who use behavior analysis services are spread across all age groups, even though these services are overwhelmingly used by children—and providers argue that this has resulted in an overestimation of how much money must be allocated for behavior analysis services.

The bottom line is that, thanks to a math mistake and a mismatch in priorities, Florida pediatrics is not just being defunded but massively defunded.

That may sound like an obscure disagreement over Medicaid accounting. But formulas have consequences.

Pediatric providers say Florida has lost nearly $300 million in funding for pediatric primary care in less than two years and Medicaid reimbursement rates for pediatricians were already criticized as too low, having slid by approximately 15 percent.

Remember that Florida hasn’t expanded Medicaid under the ACA, and hundreds of thousands of Florida children have been removed from its low-income healthcare rolls—in fact, the state has filed lawsuits against the federal government to let them do it.

These two factors had already combined to drive more than 647,000 Florida children off Medicaid. Medicaid coverage for children in our state was already weakening; the defunding of pediatric care will make it so much worse.

We can’t stand by while services relied on by Florida’s kids wither on the vine.

Altogether, some two million children are estimated to be at risk thanks to the pediatric care cuts. Pediatricians are taking it on the chin too, with some announcing that they’re closing their doors, an ominous trend at a time when Florida already has a doctor shortage.

A state growing as rapidly as Florida should be strengthening the health care infrastructure families depend on. It’s time for the DeSantis administration and AHCA to make this right.

AHCA should conduct a transparent review of the Medicaid rate methodology and publish the assumptions behind it. Florida has already established a task force to examine behavior analysis services, including financial sustainability and access to care. That review should consider the effect on the broader pediatric health care system as well.

If the methodology is wrong, the governor should fix it, and if more funding is necessary to adequately support both behavior analysis services and pediatric primary care, the governor and legislature should provide it.

The parents I’ve met aren’t asking government to solve every problem for them. They’re asking for a system that gives their children a fair shot at getting the care they need.

Florida can protect access to behavior analysis services and protect access to pediatricians. We should never force families to choose between the two.

Our children deserve both.