March 5, 2025
If you’ve been involved in Medicaid provider enrollment for any length of time, you know that policy updates are nothing new. However, that doesn’t make it any easier when major changes—like those in the Florida Medicaid Provider Enrollment Policy —are rolled out. With these new updates, providers now face increased requirements related to eligibility, application procedures, screening, and revalidation. If you’re unsure how these changes will impact you or what you should do next, this post will break it down. Today, we’ll cover what has changed, how these updates may affect your ability to enroll or remain enrolled, and four critical steps you should take now to avoid delays or compliance issues. Let’s take a closer look at these changes. What is the Florida Medicaid Provider Enrollment Update All About? In case you haven't heard, the Florida Medicaid Provider Enrollment Policy, outlined in Rule 59G-1.060, F.A.C., has been updated. These changes introduce new requirements for providers seeking to enroll in or maintain their enrollment in the Medicaid program. The updated policy includes: More Stringent Eligibility Criteria – Providers must meet additional qualifications, including professional licensure, certifications, and stricter compliance with state and federal regulations. Changes to the Application Process – A revised process now requires updated documentation and compliance with new deadlines. Stronger Screening Requirements – Providers may face more comprehensive background checks, additional site visits, and other verification processes depending on their risk category. Mandatory Revalidation – Periodic revalidation is required for continued participation in Medicaid, with specific steps that must be followed. Expanded Provider Responsibilities – Providers must ensure accurate record-keeping, notify Medicaid of any significant practice changes, and adhere to Medicaid billing and compliance policies. How These Changes May Affect You These updates create additional administrative burdens for providers. Some key impacts include: Longer Processing Times – The increased documentation and screening requirements may cause delays in approval for both new applicants and providers undergoing revalidation. Higher Compliance Risks – Failure to meet the new documentation and screening requirements could result in enrollment delays, suspension, or loss of Medicaid eligibility. Increased Scrutiny – The introduction of more frequent site visits and background checks means providers will need to be prepared for unexpected compliance audits. Given these changes, it’s important to take proactive steps to ensure your Medicaid enrollment remains intact. 4 Things You Should Do Now While Medicaid enrollment has never been a simple process, these new updates introduce additional challenges that providers must be prepared for. Here are four key steps to take right away: #1. Review the Updated Policy and Identify What Applies to You One of the biggest mistakes providers make is assuming that previous requirements still apply. The updated policy includes more detailed eligibility criteria and stricter compliance requirements. Take time to review the updated enrollment rules and determine what specific changes apply to your provider type. This includes checking for: New documentation requirements Changes in ownership reporting Additional background screening measures Not staying ahead of these changes could result in delays or disruptions in your Medicaid enrollment status. #2. Ensure Your Documentation is Up-to-Date and Accurate With the increased scrutiny on eligibility and provider compliance, it is critical to ensure all required documents are current. This includes: Licenses and certifications Ownership and control disclosures Background screening records If there are any discrepancies or missing documents in your Medicaid file, this could lead to application denials or delays in revalidation. Avoid last-minute scrambling by reviewing your records now. #3. Prepare for More Frequent Screenings and Compliance Checks Medicaid is increasing its use of background checks, risk assessments, and site visits to verify provider compliance. This means: Providers in high-risk categories may face unannounced site visits. Background screenings will be expanded for individuals with ownership interests in a Medicaid-enrolled entity. Failure to meet compliance expectations during a site visit could result in enrollment suspension. If you have never undergone a Medicaid site visit before, familiarize yourself with what to expect and ensure your practice is prepared for compliance checks. #4. Monitor Deadlines for Revalidation and Policy Changes Medicaid providers are required to revalidate their enrollment at regular intervals. Missing a revalidation deadline can result in termination from the program, requiring a full re-enrollment process. Steps to take now: Confirm your revalidation date and mark it on your calendar. Set reminders for document updates well before the deadline. Regularly check AHCA and Medicaid provider bulletins for policy changes that could impact revalidation. Keeping track of Medicaid enrollment deadlines is crucial—failure to revalidate on time may mean loss of Medicaid payments and provider status. Conclusion Medicaid enrollment is becoming increasingly complex, and these updates only add to the administrative burden for providers. The increased documentation requirements, stricter screening processes, and more frequent compliance checks mean that staying proactive is essential. By taking these four steps now—reviewing the new policy, ensuring documentation accuracy, preparing for site visits, and tracking revalidation deadlines—you can avoid unnecessary delays and disruptions in your Medicaid enrollment. If you have further questions or need assistance navigating the updated Medicaid provider enrollment process, be sure to consult with a healthcare compliance expert or visit AHCA’s website . For more insights on Medicaid enrollment and compliance, check out their training resources. Remember, staying informed and proactive is the best way to ensure continued Medicaid participation while minimizing disruptions to your practice.