Florida Medicaid Managed Care: What Health Centers Need to Know About SMMC 3.0

Florida’s Statewide Medicaid Managed Care (SMMC) 3.0 program took effect February 1, 2025, opening the next chapter of the state’s Medicaid managed care system through 2030. Administered by the Agency for Health Care Administration (AHCA), SMMC 3.0 covers the majority of Florida’s Medicaid recipients across three core components: Long-Term Care (LTC), Managed Medical Assistance (MMA), and the Dental Program. The update brings together several changes including new family-focused programs, revised quality requirements, and changes to plan structures and regional coverage that providers will need to understand as they prepare.

Several updates define this new phase. New family-focused plans and programs are designed to improve care coordination and outcomes for families, while a set of health improvement initiatives asks new contracts to expand integration and support for enrollees. AHCA is also raising the bar on quality, holding plans to stricter performance standards backed by incentive measures, and revising regional coverage and plan structures to widen access and encourage competition.

How should health centers prepare for SMMC 3.0?

Review New Contracts and Plan Offerings. Examine which managed care plans and dental plans have new or renewed contracts in your service regions, as participation and reimbursement requirements may change.

Update Billing and Credentialing Processes. Make sure all billing systems are updated to align with new plan participation requirements, rates, and documentation standards, and verify that all providers are credentialed with the health plans they will be billing under SMMC 3.0.

Monitor Quality Performance Metrics. Health centers may see changes in incentive payments based on new quality performance measures. Track these closely, as they may affect revenue and compliance obligations.

Train Staff on Referral and Authorization Changes. Ensure front desk, medical, and billing staff are trained on revised referral and authorization processes and familiarize your team with the new regional structures and care coordination expectations.

Communicate Plan Changes to Patients. Inform patients about plan changes that may affect their provider choices and care continuity, especially during the initial transition period.

Monitor AHCA Guidance and Update Compliance Protocols. Regularly check AHCA updates for any additional guidance or program adjustments and maintain accurate records while updating internal compliance protocols to reflect procedural changes under SMMC 3.0.

Assess Financial Impact. Adjust financial projections for any anticipated changes in reimbursement or patient volume tied to new plans and regions and revisit contracts with subcontractors or partners who may also be affected by the new plan structures.

Ultimately, preparation is an opportunity to strengthen operational readiness, protect revenue, and reduce disruption for both patients and staff as SMMC 3.0 takes full effect.

Putting This Into Practice: Healthcare Finance & Compliance

AAFCPAs has supported healthcare providers and private practices for more than 50 years, bringing audit, tax, and advisory expertise to an industry defined by regulatory complexity and financial pressure. Our Healthcare team, which includes financial statement auditors, tax attorneys, consulting CFOs and controllers, business process and systems architects, data analysts, and IT security professionals, helps organizations navigate compliance with federal, state, and local funding requirements, strengthen internal controls, and meet the financial statement audit standards required by lenders and regulators. We also work closely with clients on reimbursement optimization, including changes in reimbursement methodology, as well as revenue cycle performance, 340B program compliance, and the consolidation and coordination of care that often accompanies growth. Whether the organization is a federally qualified health center, behavioral health provider, nursing home, home care or hospice agency, or physician practice, our specialists bring the same depth of experience to help protect revenue, maintain compliance, and support long-term financial stability.

These insights were contributed by Sorie M. Kaba, CPA, Partner and Thomas Perruna, MPAc, Director.

Questions? Reach out to our authors directly or your AAFCPAs partner.

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