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Florida Medicaid Providers: New $15 Minimum Wage Requirements

Effective October 1, 2022, certain providers participating in the Florida Medicaid program will be required to pay direct care workers a minimum of $15 per hour. Below we’ve outlined which organizations are subject to this new requirement and other relevant implementation details.

What is the new requirement?

Starting on October 1, 2022, Florida Medicaid providers will be required to pay certain of their staff a minimum wage of $15 per hour. The minimum wage requirement applies to the following groups:

  • Direct care workers, whether employees or independent contractors, of non-nursing home entities paid under the fee schedules discussed below.
  • All nursing home workers, whether employees or independent contractors.

A “direct care worker” means an individual who has direct contact with a Medicaid recipient to provide a Medicaid reimbursable service. Direct care workers do not include individuals who do not provide a Medicaid reimbursable service, such as maintenance or administrative staff.

Which providers are covered by this new requirement?

The new rule covers all Medicaid providers that receive reimbursement under one of the impacted fee-for-service schedules. The Florida Agency for Health Care Administration (AHCA) published a list of impacted fee schedules on its website, which includes but is not limited to, the Practitioner Fee Schedule, Radiology Fee Schedule, Hospital and ASC Inpatient and Outpatient Services Fee-For-Service Rates, Home Health Visit Services Fee Schedule, and Nursing Home Fee-for-Service Rates. Providers that bill under an impacted fee schedule must implement the minimum wage increase. A provider cannot “opt-out” of this requirement.

Are there any exceptions?

Providers who exclusively bill under the following fee schedules will not be required to comply with the new minimum wage requirement:

  • Behavior Analysis
  • Community-Based Substance Abuse County Match
  • County Health Department Certified Match Program
  • Durable Medical Equipment and Medical Supply Services Provider Fee Schedule for all Medicaid Recipients
  • Early Intervention Services
  • Medicaid Certified School Match Program
  • Physician Pediatric Surgery
  • Prescribed Drugs Immunization
  • Prescribed Drugs Physician Administered Billing Codes
  • Regional Perinatal Intensive Care Center Neonatal Services
  • Regional Perinatal Intensive Care Center Obstetrical Services
  • Targeted Case Management for Children at Risk of Abuse and Neglect

How will the wage increase be paid for?

Funding to support the $15 minimum wage will be distributed to Medicaid providers through increased fee-for-service reimbursement fee schedules and managed care rates.

AHCA is currently finalizing the impacted fee schedule increases and anticipates completion of all fee schedule increases by October 1, 2022. The increased rates for Nursing Homes, Federally Qualified Health Centers, and Rural Health Clinics will be effective October 1, 2022. All other fee schedule increases will be retroactively effective as of July 1, 2022.

What must a Medicaid Provider do before October 1, 2022?

Before October 1, 2022, each Medicaid provider who is required to implement the $15 minimum wage must sign a supplemental wage agreement located at the Medicaid Provider Secure Web Portal,  attesting that every direct care worker of the provider (and all workers for nursing homes), will be paid at least $15 per hour, as of October 1.

What are the penalties for non-compliance?

Providers who fail to sign the supplemental wage agreement will be subject to recoupment of funds associated with the minimum wage requirement. Additionally, beginning January 1, 2023, providers will be subject to an increased risk of litigation if they fail to comply with the requirement to pay workers at least $15 per hour. Any staff member of a provider who should be paid at least $15 per hour but is not will be able to file a civil action against the allegedly non-complying provider as of that date.

Next steps?

Providers should consider the following next steps:

  1. Determine whether the new minimum wage requirements apply to the provider.
  2. Determine which workers are subject to the minimum wage increase.
  3. Submit the supplemental wage agreement attesting all eligible workers will be paid at least $15 per hour as of October 1, 2022, and implement all necessary internal changes needed to comply with the requirements by the October 1 deadline.
  4. Implement the new increased minimum wage for eligible workers by October 1, 2022.
  5. Ensure that the increased rates are being reflected in reimbursement received from Medicaid.

The AHCA’s portal contains an FAQ page with helpful information.  Please contact the authors with questions regarding this new minimum wage increase requirement.

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