Florida ABA providers say Molina hasn't paid CMS Plan claims

Applied behavior analysis (ABA) providers in Florida say claims for children in the state's Children's Medical Services (CMS) Health Plan have gone largely unpaid since Molina Healthcare took over the plan on Oct. 1. CBS News Miami reported Oct. 23 that providers rallied outside Molina's Doral office, and that the state's Agency for Health Care Administration (AHCA) is looking into the complaints.

"The Agency is actively investigating payment concerns raised by ABA providers regarding the October 1 transition of services to Molina," an AHCA spokesperson told the station. Molina had not responded to CBS News Miami's requests for comment.

What providers are reporting

Henry Marines, a Miami attorney who works with ABA agencies, told CBS News Miami that he is in contact with almost 700 providers and "they all say the same thing. They haven't been paid." That count comes from Marines and has not been confirmed by AHCA or Molina.

The station profiled Arlene Perez, a registered behavior technician who has worked with a 12-year-old autistic boy for five years. She said she hadn't received a paycheck in the past month because most of her agency's claims had not been processed since the switch. Registered behavior technicians are the direct care staff who deliver most hands-on ABA hours under a supervising analyst. "There's gonna be a moment where I have to look for something else to pay my bills," Perez said. The boy's mother told the station she worries the delays could force his provider out of business.

Marines said Molina should already know how many children it serves because it receives state funding for each enrolled member at the start of the month. He said it was probably too early for legal action and that he planned to meet with Molina's senior leadership.

What changed on Oct. 1

The CMS Health Plan is a specialty plan for children who meet clinical eligibility rules set by the Florida Department of Health and are enrolled in Medicaid (under age 21) or Florida Healthy Kids (under 19). AHCA's transition page says Sunshine State Health Plan ran the plan through Sept. 30, 2026, and AHCA picked Molina to run it from Oct. 1. Members moved over automatically.

AHCA told families that existing appointments, prescriptions and prior authorizations would be honored. Its message to providers was: "Providers should continue delivering services as usual. Molina will accept and honor existing authorizations and process claims accordingly."

Molina's behavior analysis provider orientation, dated Sept. 30, set out the transition rules:

• Continuity of care. Children already in the plan can keep seeing their current providers for up to 240 days, or until a Molina treatment plan is final, whichever comes first. Members joining from another plan or fee-for-service get up to 180 days.
• Existing authorizations. A Sunshine authorization number stays valid while that authorization is active. Providers don't have to submit a duplicate request.
• Payment rates. Contracted providers are paid the Molina contract rate. Out-of-network providers are paid 100% of the Medicaid rate unless they prove a different prior rate or have a single-case agreement.
• Claims. Providers can bill through the Availity portal, through EDI with payer ID 51062, or on paper. Molina encourages providers to enroll with ECHO Health for electronic payment right after their first Molina payment, or within 30 days of it, to avoid being paid by Molina Visa card.
• Ongoing ABA. Most behavior analysis services need prior authorization before they start and at each reauthorization, at least every 180 days.

Sunshine Health's transition notice says its CMS Plan contracts don't carry over, so providers need a Molina contract to stay in network after continuity of care ends.

How fast plans are supposed to pay

AHCA's core contract provisions for Statewide Medicaid Managed Care plans (July 1, 2026 update) set payment deadlines for plans in the program:

A denied or contested claim has to come with a list of reasons and the documents the provider needs to send. CBS News Miami's report didn't say whether the unpaid claims had been denied, contested or simply not processed.

Background

Payment trouble adds to earlier friction over Florida ABA services. In May 2026, families and providers rallied outside AHCA's Doral offices over changes to how ABA services are approved, NBC 6 South Florida reported. DSN has also covered Florida's falling Medicaid ABA spending forecast and ABA payment changes in Georgia and Arizona.

What this means for providers and DSPs

For provider agencies serving CMS Plan children, the immediate issue is cash flow. Payroll comes due whether or not claims are paid, so a month without payment can strain even established agencies. Agencies that also employ DSPs in other Medicaid programs may feel the squeeze across their whole workforce.

Practical steps drawn from Molina's and AHCA's own materials:

• Check each claim's status in Availity and keep records of submission dates, so any late payments can be measured against the contract deadlines.
• Make sure the Sunshine authorization number is on every claim for care that started before Oct. 1, and ask for continued services before the current authorization ends.
• Confirm that the agency's NPI, tax ID, W-9 and pay-to address are on file with Molina, which the orientation lists as a requirement for out-of-network billing.
• Report unresolved problems to Molina Provider Services at (855) 322-4076. Providers can also raise them with AHCA, which says it is investigating.

For technicians, the risk is missed or late paychecks and, if agencies cut back, lost hours. For families, it is the chance of losing a long-time therapist in the middle of treatment, which the continuity-of-care rules are meant to prevent.