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
MCOs
Frequently Asked Questions
Yes—if your state contracts with multiple Medicaid managed care organizations, you generally need to credential with each one individually to bill for services.
In most states, the same Medicaid provider ID is used for both state plan and waiver services, but some states may assign a separate ID or require an additional enrollment step.
A common timeframe is 60–120 days, though the exact timeframe varies by state and can be longer if applications are incomplete or require corrections.
You must apply through your state Medicaid agency, typically by completing a provider enrollment application and submitting required documentation such as licenses, background checks, and insurance. Some states also require training or orientation specific to HCBS waivers.
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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