Florida Medicaid Billing For Home Care and Home Health Providers
Florida’s Medicaid landscape is split between the Statewide Medicaid Managed Care (SMMC) Long-Term Care (LTC) program and the iBudget Florida waiver for individuals with developmental disabilities—each with different payers, portals, and EVV rules. Paradigm helps automate claims, prevent denials, reconcile payments, and keep EVV aligned so you get paid on time.
Electronic Visit Verification
Florida runs two parallel EVV ecosystems that home- and community-based providers encounter; due to its popularity and Paradigm’s capacity to assist with it, this information focuses on the Statewide Medicaid Managed Care LTC waiver.
SMMC / LTC (managed care): Plans require EVV for in-home services. Humana, Sunshine, and other LTC plans use HHAeXchange (HHAX) for EVV and to pass visits into claims; providers can capture visits in HHAX or integrate third-party EVV that feeds HHAX.
Managed care (LTC): No single statewide aggregator. Most LTC plans route EVV and authorizations through HHAeXchange.
Managed care (LTC): Claims go to the member’s LTC plan, often via the plan’s HHAX workflow or EDI.
Rates
How much does Medicaid pay for home care per hour in Florida?
- Fee-for-service (state schedules): Florida’s 2025 Personal Care Services schedule lists S9122 at $17.32 per hour. Home Health Visit fees are per visit (e.g., RN visit $32.07, HHA visit $18.04), and Private Duty Nursing has separate hourly rates.
Takeaway: Use fee schedules for state FFS benchmarks (e.g., some iBudget services); expect plan-specific contracted rates under LTC. When billing to the state, the fee schedule is law. However when billing to each managed care plan, providers need to reference their contract with the plan to know what to expect for reimbursement.
Payers
SMMC LTC Program — Capitated managed care with current contract awards (2024–2030) consolidated to 8 organizations. Plan availability varies by region.
- Florida Community Care
- Humana Healthy Horizons of Florida
- Simply Healthcare Plans
- Community Care Plan (South Florida Community Care Network)
- Sunshine Health (Centene)
- Aetna Better Health of Florida
- Molina Healthcare of Florida
- United Healthcare of Florida
Rates
Payers
Frequently Asked Questions
Most states operate Medicaid waiver or community-based care programs that allow reimbursement for non-skilled services such as personal care, homemaker services, respite care, and attendant care. These programs are often administered through Home and Community-Based Services (HCBS) waivers, aging programs, disability waivers, or managed long-term services and supports (MLTSS) programs. Eligibility criteria, covered services, and billing requirements vary by state.
In many states, yes. Enrolling with the state Medicaid program is typically the first step, but agencies may also need to complete separate contracts, credentialing applications, or network enrollment with individual Medicaid MCOs before claims can be submitted for reimbursement. Requirements vary by state and payer, largely depending on whether the state operates an MLTSS (Managed Long Term Services and Supports Program).
Credentialing timelines vary by state and payer, but most home care agencies can expect the Medicaid enrollment and credentialing process to take anywhere from 60 to 180 days. Delays are often caused by incomplete applications, missing ownership documentation, background check issues, or required site visits. Agencies seeking participation with Managed Care Organizations (MCOs) should also account for additional contracting and payer credentialing timelines.
How Paradigm can Help
Paradigm offers a combination of tech and highly skilled people to bridge the gaps in:
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
& Eligibility
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
Credentialling
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
We don’t stop at submission. We scrub claims, verify all documentation, manage denials, and post payments so your team can stay focused on care.
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“I’ve been using Paradigm for our home care billing for two years now. They are very helpful with my VA billing and have EXCELLENT customer service. I highly recommend them.”
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