March 13, 2025  – Florida has launched a Medicaid pilot program that transitions waiver services for individuals with intellectual and developmental disabilities (IDD) to managed care. The Florida Agency for Health Care Administration (AHCA) is overseeing the initiative, which is currently limited to two regions in the state.

The program, operated under a contract with Florida Community Care (FCC), covers beneficiaries in Region 6—encompassing Hillsborough, Polk, Manatee, Hardee, and Highlands counties—as well as Region 11, which includes Miami-Dade and Monroe counties. Over the course of the pilot, 600 individuals with IDD will receive comprehensive care, including medical, long-term care, and home- and community-based services (HCBS) under the FCC agreement.

Historically, individuals receiving IDD waiver services were exempt from Medicaid managed care enrollment. This pilot marks a shift in the state’s approach, with the program set to continue through September 30, 2030.

Enrollment and Implementation Progress

Enrollment for the pilot program officially began on October 1, 2024. By January 31, 2025, AHCA reported that 281 participants had enrolled. Provider organizations participating in the program also began billing Medicaid as part of the transition.

The process leading to the selection of Florida Community Care as the pilot’s operator involved a competitive bidding procedure. In November 2023, AHCA issued an invitation to negotiate (ITN 009-23/24), receiving two responses by the December 8 deadline. The evaluation process assigned scores based on five main criteria, with a maximum possible score of 1,000 points. Florida Community Care received the highest score, 983.94 points, while Simply Healthcare Plans, Inc., the other bidder, scored 939.82 points.

Regulatory Framework and Waiver Approval

The pilot is part of Florida’s amended 1115 Medicaid waiver that grants AHCA the authority to implement the Statewide Medicaid Managed Care (SMMC) 3.0 program.

Beyond the pilot regions, CMS has also approved Florida’s plan to assign individuals with IDD to a Medicaid managed care plan that provides state plan services and long-term care. However, individuals outside the pilot regions will have the option to opt out of managed care at a later stage.

As the pilot progresses, state officials and advocacy groups will closely monitor its impact on access to care, service quality, and participant outcomes. The results may influence future decisions on expanding managed care for IDD services across Florida.