Medicaid Nursing Home Rates by State

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Florida

Medicaid nursing facility payment · Peer-group price · researched October 2026

Florida’s Medicaid agency and its state plan are the official source for these rules. This page summarizes them as researched in October 2026; check the state’s own documents, listed under Sources, before relying on them.

At a glance

Rate method

Peer-group price

Case-mix level

None

Classification

None

Rate updates

Once a year (Oct), often with a July update

Managed care (LTC)

Yes

Quality program

Quality Incentive Program (QIP)

Paid outside the rate

None

Bed hold

Hospital and leave

Published rates

Rates and build‑ups

Assisted living

Covered

Personal needs allowance

$160 / month

Overview

• Since Oct 1, 2018, Florida uses a prospective payment system (PPS: rates set in advance, no cost settlement).
• Each home gets a standard price for direct care, indirect care and operating costs, set as a percentage of the median cost in its peer group (North or South: 100%, 92% and 86% of median).
• Homes whose own inflated costs fall below a floor (95% of price for direct care, 92.5% for indirect care) lose the shortfall.
• The rate then adds fair rental value for property, tax and insurance pass-throughs, the Medicaid share of the provider tax, a quality incentive per diem and small add-ons.
• A budget neutrality factor then cuts the price and property parts so total spending matches the appropriation.
• About 17 pediatric, veterans and government homes stay on a cost-based rate instead.

What matters in Florida

• 17.45% budget neutrality cut on price, property and pass-through parts in Oct 2026, up from 13.16% in Oct 2025.
• $36.10 average quality add-on per Medicaid day in Oct 2026, paid from a pool of 18.1373% of 2016 payments.
• Scheduled: the quality pool falls from 18.1373% to 16.5482% of Sept 2016 non-property payments on 7/1/2027.
• Nothing is paid outside the per diem; managed care plans must pay the state-set rate, including quality and tax pass-through.
• No case mix: one per diem per home; homes spending under 95% of the direct care price lose the shortfall.
• Bed hold is unpaid when under 95% of the home's Medicaid beds were filled the previous quarter.

Frequently asked

How large is Florida's nursing home quality pool, and when does it change?

The pool is 18.1373% of 2016 payments, averaging $36.10 per Medicaid day in October 2026. It falls to 16.5482% of September 2016 non-property payments on 7/1/2027.

When does Florida Medicaid not pay for a nursing home bed hold?

Bed hold is unpaid when under 95% of the home's Medicaid beds were filled in the previous quarter. Otherwise it is paid up to 8 days per hospital stay and 16 leave days a year.

Does a Florida managed care plan pay the state's published nursing home per diem?

Yes. SMMC long-term care plans must pay the rate set by the Agency for Health Care Administration, including the quality add-on and tax pass-through.

How much is paid outside the posted rate in Florida?

None; quality, provider tax return and ventilator payments are all paid inside the per diem.

What does Florida Medicaid pay on Medicare coinsurance days?

Medicaid pays only its per diem minus Medicare's payment, capped at the coinsurance, so usually $0.

Does Florida require a minimum share of spending on care?

Yes; homes below 95% of the direct care price or 92.5% of the indirect price lose the shortfall.

How is the Florida nursing home provider tax charged?

A uniform charge per non-Medicare day; CCRC, small and hospital units exempt; Medicaid share returned at an average $19.45/day.

How the rate is set

How the method got here

Verified October 11, 2026

Cost basis

Uses cost reports

Yes

Cost report

Florida Medicaid nursing home cost report (state electronic uniform cost report on Medicare/CMS Pub. 15-1 principles, signed by a CPA, due 5 months after fiscal year end). Rate-setting cut-off is April 30 of the rate year.

Base year and rebasing

By statute, prices (and their medians and floors) are rebased 'every fourth year' from the most recently audited cost reports. The plan text says Oct 1, 2021 and every 4th year after. In practice the calculation sheets show these bases: Oct 2022 and Oct 2023 used FYE-2018 cost and Medicaid days; Oct 2024, Oct 2025, Jul 2026 and Oct 2026 use FYE-2021 audited reports (for example, 'Medicaid Days FYE 12/31/21'). Between rebases, prices only move by inflation. Pass-throughs, FRVS and Medicaid utilization use the most recent cost report each year. AHCA's Oct 2025 QIP report gives the rebase years as 2021, 2024 and 2027 (every 3 years in practice; the statute's 'every fourth year' counts inclusively), so the next rebase is Oct 1, 2027.

Components

Component	Method	Notes
direct care	Peer-group price = 100% of the median inflated Medicaid cost per day (North or South). Floor = 95% of price. If a home's inflated cost is below the floor, the shortfall is subtracted from the price.	Covers RN, LPN and CNA salaries and benefits, therapy, dietary, and dental/vision/hearing/podiatry. Oct 2026 prices: North $169.85, South $167.53 (from calc sheets).
indirect care	Price = 92% of peer-group median. Floor = 92.5% of price, with the same shortfall reduction as direct care.	Covers other patient care: supplies, complex medical equipment, ancillaries. Home-office costs cannot be put into direct care.
operating	Price = 86% of peer-group median, with no floor.	Covers administration, plant, laundry and housekeeping.
property (FRVS)	Fair rental value system: a standard building value, not actual cost. See capital.
pass-throughs	Real estate and personal property taxes and property insurance, at actual cost divided by total patient days from the latest cost report.	The budget neutrality factor is applied to these along with the prices and FRVS.
quality incentive	Add-on paid per quality point from a fixed pool. See quality_incentive.	Not reduced by budget neutrality.
NFQA Medicaid share	Pass-through of the Medicaid share of the provider tax.	Not reduced by budget neutrality.

Inflation

Florida Nursing Facility Cost Inflation Index, built from the IHS (S&P Global) Healthcare Cost Review SNF-without-capital market basket. It weights wage-and-salary plus benefits, food, and utilities plus other costs. Cost per diems are inflated from the midpoint of the cost report period to the midpoint of the rate period. Oct 2026 factors from FYE-2021 costs: 1.2891 for direct care and 1.2704 for indirect care and operating.

Verified October 11, 2026

Case mix

System

None

Applied at

None

How it works

No case mix: every Medicaid resident in a home is paid the same per diem.

Classification

none. The plan pays 'a single level of payment rate for all levels of nursing care' (Attachment 4.19-D, sec. VII.B).

Move to PDPM

Not applicable. Florida did not use RUG case mix in its Medicaid nursing facility rate.

Verified October 11, 2026

Low-acuity residents

None found. Florida pays one per diem per home for every Medicaid resident: the plan says 'The Florida Medicaid program shall pay a single level of payment rate for all levels of nursing care' (Attachment 4.19-D sec. VII.B). There is no custodial versus skilled split, no low case-mix group, and no reduced rate. Level of care decides whether the home is paid at all, not how much: a resident must have a nursing-facility level of care set by CARES (age 21+) or CMAT (under 21), meet Institutional Care Program eligibility, and have a pre-admission screening (PASRR) (Coverage Policy 59G-4.200 sec. 2.2). The only rate tied to an assessment goes the other way: an enhanced supplemental rate for under-21 residents whom CMAT finds medically fragile (sec. 8.6.1, Rule 59G-4.290). Checked: plan Version LII, Coverage Policy 59G-4.200, s. 409.908(2)(b), and the Oct 2026 rate files (one rate column per home).

Verified October 11, 2026

Capital

Fair rental value system (FRVS). Building value per sq ft comes from RS Means (2018 base, indexed; the Oct 2026 sheets show 'Cost per Square Foot $296.80' times the local RS Means location index). Land = 10% of gross building value. Movable equipment = $8,000 per bed. Obsolescence = 1.5% per year of adjusted age, capped at a maximum age of 40 years. Rental rate of return = 8%. Minimum occupancy = 90%. Counted square footage is between 350 and 500 sq ft per bed. Renovations of at least $500 per bed lower the adjusted age. The per diem uses actual square footage. Source: s. 409.908(2)(b)1.g., F.S. and plan sec. IV.A.

Verified October 11, 2026

Budget adjustment factor

Yes, the Budget Neutrality Factor (BNF), in place since the PPS started in Oct 2018 (Oct 2022 sheets show it on line 16). It replaced the older 'Medicaid Trend Adjustment' cut in the PPS, and rule 59G-6.010 was amended in 2021 to say so. It is a multiplier on (direct + indirect + operating prices, after floor reductions) + FRVS + tax/insurance pass-throughs. It does not apply to the QIP, NFQA share or ventilator add-on. Its purpose is to keep total spending at the General Appropriations Act level, so it is the main lever that turns appropriations into rates. Size of the cut, computed from the AHCA calculation sheets: about 14.2% (Oct 2023), 13.5% (Oct 2024), 13.16% (Oct 2025), about 15.0% (Jul 2026 revision) and 17.45% (Oct 2026). The Oct 2026 average BNF deduction is -$52.25 per day, versus -$38.22 in Oct 2025. Exempt (cost-based) homes also carry a budget neutrality reduction.

Verified October 11, 2026

Add-ons and money outside the rate

Paid outside the posted rate

Level

none

Estimate

None. No nursing facility UPL, IGT-funded or SMMC LTC directed payment was found; the QIP, NFQA pass-through and ventilator payment are all paid inside the per diem, and plans must pay the AHCA rate (higher only by negotiation for medically complex care).

Components

None outside the per diem.

Source

https://ahca.myflorida.com/content/download/27969/file/Florid…

Verified October 11, 2026

Payments by owner type

Applies

yes

Detail

Payment method differs by owner, not extra lump sums: government-owned homes, Florida Dept. of Veterans Affairs homes and pediatric homes (17 exempt providers in Oct 2026) stay on a cost-based prospective system (lowest of cost, peer ceiling and target, plus a Medicaid Adjustment Rate if over 50% Medicaid days) and get no QIP; all other homes are on the PPS. The dollar gap was not quantified.

Funding

No IGT-funded nursing facility payment found.

Source

https://ahca.myflorida.com/content/download/27969/file/Florid…

Verified October 11, 2026

Quality program

Program

Florida Medicaid Nursing Home Quality Incentive Program (QIP), the quality incentive component of the PPS per diem

Funding

State appropriation inside the nursing home budget (state general revenue plus federal match), partly funded by the Nursing Facility Quality Assessment (third-priority use, s. 409.9082). The statute sets the pool as a % of Sept 2016 non-property payments: 6% (2018-2022), 10% (2023-2024), 17.862% (SFY 2025-26), 18.1373% (from 7/1/2026), and 16.5482% scheduled for 7/1/2027. The QIP is not budget-neutral by itself, but the budget neutrality factor on the price and property components holds total spending to the appropriation, so in effect part of QIP growth is paid for by deeper budget neutrality cuts.

Size

Oct 2025: total quality budget of $560,639,573 per year (AHCA QIP report). Oct 2026: about $1.455 per point per Medicaid day; average QIP per diem $36.10 (range $0-$59.65); 614 of 650 PPS homes paid. Jul 2026 re-issue: about $1.76 per point per day (secondary source, Pease Bell).

Paid as

Per diem add-on built into each facility's annual Medicaid rate (calc sheet line 9). Fee-for-service pays it, and SMMC LTC plans pass it through because they must pay the AHCA rate. Not reduced by the budget neutrality factor.

Measures

Measure	Source	Weight	How points are earned
Flu vaccine: % of long-stay residents assessed and given the seasonal influenza vaccine	CMS MDS long-stay QM (Care Compare, 4-quarter avg as of May 31)	3 pts max	Higher is better: above the Florida 50th/75th/90th percentile = 1/2/3 pts; 0.5 pt for 20% year-over-year improvement. Oct 2024 cut points were all 100.00%.
Antipsychotic medication: % of long-stay residents	CMS MDS long-stay QM (Care Compare, 4-quarter avg as of May 31)	3 pts max	Below the 50th/25th/10th percentile = 1/2/3 pts (Oct 2024: 8.27% / 4.68% / 2.36%); 0.5 pt for 20% year-over-year improvement.
Physical restraints: % of long-stay residents	CMS MDS long-stay QM (Care Compare, 4-quarter avg as of May 31)	3 pts max	Below the 50th/25th/10th percentile (Oct 2024: 0.00% at all three cut points); 0.5 pt for improvement.
Antianxiety or hypnotic medication: % of long-stay residents	CMS MDS long-stay QM (Care Compare, 4-quarter avg as of May 31)	3 pts max	Below the 50th/25th/10th percentile (Oct 2024: 20.70% / 16.06% / 12.03%); 0.5 pt for improvement.
Urinary tract infection: % of long-stay residents	CMS MDS long-stay QM (Care Compare, 4-quarter avg as of May 31)	3 pts max	Below the 50th/25th/10th percentile (Oct 2024: 0.72% / 0.12% / 0.00%); 0.5 pt for improvement.
Pressure ulcers: % of high-risk long-stay residents (CMS measure 453 since 10/2018)	CMS MDS long-stay QM (Care Compare, 4-quarter avg as of May 31)	3 pts max	Below the 50th/25th/10th percentile (Oct 2024: 8.02% / 5.87% / 3.84%); 0.5 pt for improvement.
Falls with major injury: % of long-stay residents	CMS MDS long-stay QM (Care Compare, 4-quarter avg as of May 31)	3 pts max	Below the 50th/25th/10th percentile (Oct 2024: 2.41% / 1.30% / 0.59%); 0.5 pt for improvement.
New or worsened bowel or bladder incontinence (low-risk long-stay residents)	CMS MDS long-stay QM (Care Compare, 4-quarter avg as of May 31)	3 pts max	Below the 50th/25th/10th percentile (Oct 2024: 50.61% / 38.50% / 29.87%); 0.5 pt for improvement.
Increased need for help with daily activities (ADLs): % of long-stay residents	CMS MDS long-stay QM (Care Compare, 4-quarter avg as of May 31)	3 pts max	Below the 50th/25th/10th percentile (Oct 2024: 9.69% / 6.35% / 4.42%); 0.5 pt for improvement.
Hospitalizations per 1,000 long-stay resident days	CMS Care Compare claims-based long-stay measure (assumed; see open_questions)	3 pts max	Below the 50th/25th/10th percentile (Oct 2024: 2.1786 / 1.7051 / 1.2716); 0.5 pt for improvement.
RN turnover	CMS PBJ-based staffing data on Care Compare (assumed; see open_questions)	3 pts max	Below the 50th/25th/10th percentile (Oct 2024: 52.40% / 39.55% / 27.80%); 0.5 pt for improvement.
Combined direct care staffing: RN+LPN+CNA productive hours per patient day	State Medicaid cost report (most recent one received by the Apr 30 cut-off)	3 pts max	Above the 50th/75th/90th percentile = 1/2/3 pts (Oct 2024: 3.6360 / 3.9878 / 4.6014 hours per patient day); recalculated every year; no improvement points.
Social work and activities staff per resident day	CMS PBJ (1-year average as of May 31)	3 pts max	Above the 50th/75th/90th percentile = 1/2/3 pts (Oct 2024: 0.1047 / 0.1385 / 0.1866); recalculated every year.
CMS Five-Star overall rating	CMS Star Ratings (as of May 31)	5 pts max	3 stars = 1 pt, 4 stars = 3 pts, 5 stars = 5 pts.
Credential: Florida Gold Seal, Joint Commission accreditation, or AHCA/NCAL National Quality Award (Silver or Gold)	State Gold Seal list / Joint Commission / AHCA-NCAL (as of May 31)	5 pts max	5 pts if the home holds any one of the three; holding more than one adds nothing.

Scoring period

All data is taken as of May 31 of the year the Oct 1 rate period starts: the latest 4-quarter MDS quality-measure average, PBJ, star rating and credentials. Staffing hours come from the latest cost report received by Apr 30. So Oct 2026 rates mostly reflect CY2025 MDS quarters, a lag of roughly 9-18 months. Percentile cut points for process and outcome measures are reset only in rebase years (2021, 2024, next 2027) and frozen in between; structural percentiles are recalculated every year. If a measure has no current data, the prior year's CMS data is used. A home with no data at all counts as 'new' and gets the 50th-percentile score.

Payment formula

Maximum 49 points: 4 process measures x 3 = 12, 7 outcome x 3 = 21, 2 structural x 3 = 6, star rating 5, credential 5. Homes below the eligibility threshold get $0. Each home's weighted score = points x annualized Medicaid days, scaled by the statewide average Medicaid days. Facility share = weighted score / sum of all weighted scores. Annual funding = share x total quality budget. Per diem = annual funding / annualized Medicaid days. The net effect is one statewide $ per point per Medicaid day (Oct 2026: about $1.455). Worked example (Oct 2025): Surrey Place, 26 points, 9,034 Medicaid days -> $406,813 per year -> $45.03 per day.

Eligibility

PPS homes only; exempt pediatric, state veterans and government-owned homes get $0 QIP. A home must score at least 33% of available points (s. 409.908(2)(b)1.f.): 16 points in Oct 2024, about 16.5 cited for 2026. No current rule disqualifies homes for immediate jeopardy, Special Focus Facility status or abuse citations; an abuse-icon reduction is only a study recommendation. New homes get the 50th-percentile score. After a change of ownership, the prior owner's data is used.

Cadence

Scored once a year for the Oct 1 rate period and paid daily as part of the per diem. Re-issued mid-year when the pool % changes (for example, Jul 1, 2026).

Scores published

Yes. Each home's points and QIP per diem appear on every calculation sheet (line 9) and in the Final Rates - Detail xlsx. AHCA's annual 'Florida Medicaid Nursing Home Quality Incentive Report and Trends' to the Legislature (first issued Oct 2025, required by s. 409.908(2)(b)9.) lists each home's points by measure and its per diem: https://ahca.myflorida.com/content/download/27201/file/FL%20M…

Notes

The point table in the posted plan (Version LII) totals 49 points. The consumer satisfaction survey measure named in the statute (s. 400.0225) has not been added. A 2026 law tells AHCA to consider the Guidehouse study recommendations at the next QIP rebase: national benchmarks, an abuse-icon reduction, weight-loss and short-stay rehospitalization measures, cumulative credential points, and leaving credential points out of the eligibility threshold. Any scoring change must wait 1 year after the rescored results are made public.

Verified October 11, 2026

Provider tax

Charged

per non-Medicare day

Standard amount

Uniform charge per non-Medicare resident day (Medicare and Medicare Advantage days excluded), capped at the federal maximum share of net patient revenue; in place since 4/1/2009. Current per-day amount not found.

Tiers

Who	Test	Amount
CCRC homes	ccrc	exempt
<= 45 beds	size	exempt
hospital SNF units	hospital_based	exempt

Lower for high-Medicaid homes

no

Returned in the rate

Medicaid share passed back as a per diem ('Quality Assess-Medicaid Share', averaged $19.45/day in Oct 2026); the rest restores rate cuts since Jan 2008 and partly funds the QIP.

Source

https://www.flsenate.gov/Laws/Statutes/2025/409.9082

Verified October 11, 2026

Provider tax notes

Nursing Facility Quality Assessment (NFQA), s. 409.9082, F.S., in place since Apr 1, 2009. It is a uniform charge per non-Medicare resident day (Medicare and Medicare Advantage days are excluded), capped at the federal maximum share of net patient revenue. Exempt from it: CCRC homes, homes with 45 or fewer beds, and hospital SNF units. The money is used in this order: (1) pass the Medicaid share back as a per diem ('Quality Assess-Medicaid Share', which averaged $19.45 per day in Oct 2026); (2) restore rate cuts made since Jan 2008; (3) partly fund the QIP. The current per-day assessment amount was not found.

Verified October 11, 2026

Supplemental payments

None identified for nursing facilities. AHCA's rate pages, the plan and the statute show no nursing facility UPL, IGT-funded payment or SMMC LTC directed payment. Florida's directed payment programs that we know of are hospital and physician programs. The QIP and the NFQA pass-through are paid inside the per diem, not as separate lump sums.

Verified October 11, 2026

Other add-ons

Ventilator supplemental payment: $200 per Medicaid ventilator day, counted from claims with ICD-10 Z99.11 in the prior calendar year and spread over Medicaid days, with a statewide cap of 40,000 vent days per year. In Oct 2026 the average is $0.14 per day and the maximum $25.97. High Medicaid Utilization / High Direct Patient Care add-on (the 'Direct Care Staffing Add-On' line): applies only if the PPS rate is below the home's Sept 1, 2016 rate, and pays the lesser of $20 per day or the gap; $0 for every home in Oct 2026. A '$15 minimum wage increase' has been built into rates since 2022: in Oct 2022 it was a separate 8.2852% line, and since Oct 2023 the sheets note that the final rate 'includes' it. Exempt pediatric homes have a 'Level U: Fragile Under 21' rate. Exempt homes can get a special-care supplemental flat rate above their ceilings.

Verified October 11, 2026

Units paid separately

(1) Exempt providers: pediatric, Florida Dept. of Veterans Affairs and government-owned homes (17 in Oct 2026) stay on a cost-based prospective system (plan sec. VI). Operating, direct and indirect care are each paid at the lowest of cost, the peer-group ceiling and the provider target. Homes with more than 50% Medicaid days also get a Medicaid Adjustment Rate (MAR) add-on, plus FRVS, pass-throughs and the NFQA share, less a budget-neutrality reduction. They get no QIP. Pediatric exempt homes also have a separate 'Level U: Fragile Under 21' rate. (2) Ventilator residents: there is no separate unit rate. Instead the home gets $200 per vent Medicaid day, spread across its per diem (statewide cap of 40,000 vent days per year). (3) Special-care supplement: exempt homes may receive a flat per-patient rate above their ceilings for extraordinary care, for up to 12 months, with notice to CMS (plan sec. VI.H). (4) Hospital-based skilled nursing units (SNU) have their own AHCA rate page and are outside the nursing home PPS. No separate brain-injury, behavioral or IMD nursing-facility rate was found.

Verified October 11, 2026

Payment rules

Managed care for long-term care

Status

yes

Detail

SMMC Long-Term Care plans; AHCA still sets each home's rate

Verified October 11, 2026

Who pays

mixed: overwhelmingly managed_ltss through the Statewide Medicaid Managed Care Long-Term Care program (SMMC LTC). AHCA still sets every facility's per diem, and fee-for-service pays it directly for the residents not in a plan.

Verified October 11, 2026

Managed care rate floor

Yes. Plans must pay the AHCA rate, which works as both a floor and the default price. s. 409.982(5)(a), F.S.: 'Plans shall pay nursing homes an amount equal to the nursing facility-specific payment rates set by the agency; however, mutually acceptable higher rates may be negotiated for medically complex care.' Under s. 409.982(5)(c), clean electronic nursing home claims must be paid within 10 business days. Under s. 409.983(6), AHCA reconciles plan payments when nursing home per diems change, but does not reconcile for actual days. Because the AHCA rate already contains the quality incentive and the provider-tax pass-through, plans pay those through as well.

Verified October 11, 2026

Included in the daily rate

The per diem is all-inclusive (Coverage Policy 59G-4.200 sec. 4.2). It covers room and board; all nursing, including restorative; on-site physician services; care planning; personal hygiene items, including incontinence supplies; laundry; dressing and skin care items; medical supplies and equipment; over-the-counter drugs, biologicals and emergency drugs; dietary, including tube-feeding supplements; physical, occupational and speech therapy; social services; and activities. Under cost-report rules, dental, vision, hearing and podiatry costs sit in the direct care component and complex medical equipment in indirect care. Probably paid separately (inferred from the inclusion list; no exclusion list was found): prescription drugs (pharmacy benefit), services billed by outside physicians, hospital care, and lab, x-ray and transport billed by their own providers.

Verified October 11, 2026

Bed hold

Hospital stays

Paid. Up to 8 days per hospital stay, with no annual maximum (residents approved for the Institutional Care Program, including hospice residents). The plan does not state the percentage of the per diem paid.

Leave days

Paid. Up to 16 days per state fiscal year (Jul 1 to Jun 30), for overnight visits to a family-type setting. Must be in the plan of care and approved by a physician.

Occupancy rule

Not paid when fewer than 95% of the home's Medicaid-certified beds were filled in the previous quarter (raw number, no rounding; any calendar, fiscal or rolling quarter may be used). Not paid once the home knows the resident will not return.

Notes

SMMC plans may not impose stricter coverage limits than the Medicaid coverage policy.

Source

https://ahca.myflorida.com/content/download/4954/file/attachm… ; https://ahca.myflorida.com/content/download/27067/file/59G-4.…

Verified October 11, 2026

Personal needs allowance

Per month

160

Effective

In force per DCF ESS Policy Manual Appendix A-9 (July 2026 standards). Raised from $130 (the amount in rule 65A-1.7141 text) in the FY2023-24 budget per secondary sources; the 2023-07-01 start date was not confirmed from a primary source.

Notes

DCF ESS Program Policy Manual Appendix A-9, 'SSI-Related Medicaid Coverage Groups Financial Eligibility Standards July 2026': Personal Needs Allowance NH-ICP/HCBS/Hospice/PACE $160. s.409.904(3)(a) sets the amount by appropriation. Additional PNA = half of therapeutic wages up to $111. Not COLA-indexed.

Confidence

confirmed

Source

https://ffic.myflfamilies.com/manual/essfiles/30451.pdf

Verified October 11, 2026

Medicare coinsurance days

Method

lesser_of

Rule

Lesser-of by statute. s. 409.908(13)(c)1., F.S.: Medicaid payments for nursing home Medicare Part A coinsurance are limited to the Medicaid nursing home per diem rate less any amounts Medicare paid, but only up to the Medicare coinsurance. The per diem is the rate in effect on the dates of service and is not adjusted later. s. 409.908(13)(b): no payment when Medicare's payment equals or exceeds what Medicaid would have paid. The 4.19-D plan says FL reimburses Medicare Parts A, B and C cost-sharing on a lesser-of basis. MA SNF cost-sharing is therefore likely capped the same way.

Effect

The home gets the Medicaid per diem minus Medicare's payment, which is usually negative, so it usually gets $0.

Confidence

confirmed

Source

https://www.flsenate.gov/Laws/Statutes/2025/409.908

Medicare Advantage

not addressed: s. 409.908(13), F.S. has no Medicare Advantage or Part C text. The general rule in (13)(b) covers all 'Medicare services rendered to Medicaid-eligible persons': no payment when Medicare's payment equals or exceeds what Medicaid would have paid, and Medicare plus Medicaid may not exceed the Medicaid sole-payor amount. That rule would cap MA cost-sharing at lesser-of if applied, but (13)(c)1 (NF-specific) names only 'Medicare part A coinsurance'. The SMMC contract was not checked.

Medicare Advantage source

https://www.flsenate.gov/Laws/Statutes/2025/409.908

Verified October 11, 2026

Required care spending

Applies

yes

Rule

Direct care floor = 95% of the peer-group direct care price; indirect care floor = 92.5% of the indirect price. A home whose inflated cost is below the floor has the shortfall subtracted from the price. No floor on the operating component. Applies to PPS homes; exempt (cost-based) homes are paid at cost limits instead.

Source

https://www.flsenate.gov/Laws/Statutes/2026/409.908

Verified October 11, 2026

Occupancy rules

Applies

yes

Rule

(1) The FRVS property per diem uses a 90% minimum occupancy. (2) Bed-hold days are not paid when fewer than 95% of the home's Medicaid-certified beds were filled in the previous quarter.

Source

https://www.flsenate.gov/Laws/Statutes/2026/409.908

Verified October 11, 2026

MDS accuracy penalties

None. Florida's per diem has no case-mix (MDS-driven) part, so there are no MDS accuracy audits or case-mix recoupments tied to the rate. MDS data affects only QIP points, through the CMS long-stay quality measures.

Verified October 11, 2026

Published rates and changes

How often rates change

A home's rate changes

annual

When

Rate year starts October 1. Mid-year July updates are common when the appropriation changes (7/1/2019, 7/1/2020, 7/1/2021, 7/1/2026) plus a 1/1/2022 re-issue. Before the October 2018 PPS, rates changed every January 1 and July 1 (semesters, 2010 to 1/2015), then September 1 (2015-2017).

Table note

Once a year (Oct), often with a July update

Verified October 11, 2026

When rates change

Annual rate period runs Oct 1 to Sep 30 (the state fiscal year starts Jul 1). AHCA republishes mid-year when appropriations change; the most recent example is a Jul 1, 2026 rate set effective 07/01/2026-09/30/2026. Retroactive per-facility changes, such as from amended or audited cost reports, are posted on a separate retroactive-adjustment page.

Verified October 11, 2026

Posted rates

Home-level rates published

Yes

Where

https://ahca.myflorida.com/medicaid/cost-reimbursement/nursin…

Format

xlsx (NH Final Rates; NH Final Rates - Detail with component columns) plus pdf (rate letters and calculation sheets)

Cadence

Annual (Oct 1), plus mid-year re-issues when the budget changes (Jul 2019, Jul 2020, Jul 2021, Jan 2022, Jul 2026)

History

The main page has every rate period from Jan 2015 through Oct 2026. From Oct 2018 on, each period has Final Rates and Final Rates - Detail xlsx. 2015-2017 have 'Rate Semester Initial Per Diem' xlsx/pdf. An archive page has 2010-2014: https://ahca.myflorida.com/medicaid/cost-reimbursement/archiv…

Home identifier

Florida Medicaid provider number, formatted as '0 001135-00', plus the provider name. No NPI, CCN or license number. The detail xlsx also has 'Region Grouping' (North/South).

Verified October 11, 2026

Rate build-ups

Published

Yes

Where

https://ahca.myflorida.com/medicaid/cost-reimbursement/nursin… (a 'Rate Calculations' and an 'Exempt Provider Rate Calculations' PDF for each rate period, back to 2015)

What they show

One page per facility (650 PPS pages in Oct 2026), showing the full build-up. Header: provider number, final rate, zip, peer group, beds, price % / floor % / inflation factor for each component, Medicaid days and total days by cost-report FYE, Medicaid utilization %, and the RS Means cost per sq ft. Lines 1-8 for direct care, indirect care and operating: total cost, cost per diem, inflated cost per diem, peer median, price, floor, floor adjustment and resulting rate. Line 9: quality points and QIP per diem. Line 10: FRVS actual age, adjusted age, RS Means index, square footage and per diem. Lines 11-12: tax and insurance dollars and per diems. Lines 13-16: direct care staffing add-on, ventilator days and per diem, NFQA Medicaid share, and the budget neutrality adjustment. Line 17: final rate. The Oct 2022 sheets also show the hold-harmless rate, the cap on gains (115.65%) and the minimum-wage line.

Format

pdf (text-extractable with pdfplumber; consistent fixed layout). The same component values are also in the 'NH Final Rates - Detail' xlsx, which is easier to ingest.

Example file

https://ahca.myflorida.com/file/medicaid/10.01.2026_Rate_Calc…

Verified October 11, 2026

Recent changes

Verified October 11, 2026

Assisted living

Medicaid assisted living

Covered

yes

Program

Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) program; assisted living services delivered through LTC plans (1915(b)/(c) authority)

What is paid

Services only in the ALF (and in adult family care homes); room and board is not covered.

Rate

Not published; negotiated between LTC plans and ALFs

Limits

Fixed number of HCBS slots; statewide waitlist (reported at ~48,000-59,000) prioritized by CARES priority score 1-5; no waitlist for NF services

Source

https://www.payingforseniorcare.com/florida/medicaid-waivers/…

Verified October 11, 2026

Sources

1. s. 409.908 F.S. (2026) - Reimbursement of Medicaid providers (PPS parameters, QIP pool, FRVS) · statute
2. s. 409.982 F.S. (2026) - LTC managed care plan provider payment (plans pay facility-specific rates) · statute
3. s. 409.983 F.S. (2026) - LTC plan payment; nursing-facility-specific rates and reconciliation · statute
4. s. 409.9082 F.S. - Nursing home facility quality assessment · statute
5. Florida Title XIX Long-Term Care Reimbursement Plan, Version LII (Attachment 4.19-D Part I, SPA FL-24-0010) · state plan
6. Attachment 4.19-C Paid Bed Reservation Policy · state plan
7. Rule 59G-6.010 F.A.C. - Payment Methodology for Nursing Home Services · regulation
8. Florida Medicaid Nursing Facility Services Coverage Policy (Rule 59G-4.200) · regulation
9. AHCA Nursing Home Rates page (rates, details, letters, calculation sheets 2015-2026) · agency page
10. Oct 1, 2026 PPS Rate Calculations (per-facility sheets) · rate file
11. Oct 1, 2026 NH Final Rates - Detail (xlsx) · rate file
12. Jul 1, 2026 Rate Calculations · rate file
13. Oct 1, 2022 Calc Sheets (hold harmless / cap on gains era) · rate file
14. Nursing Home Retroactive Rate Adjustments · agency page
15. Study of Nursing Home Quality Incentive Programs - Final Report (Guidehouse for AHCA, Dec 2025) · agency page
16. Senate bill analysis HB 5301 (2026) - QIP pool history (10% to 17.862% for SFY 25-26) · statute
17. House staff analysis HB 5305 (2023) - QIP pool increase from 6% · statute
18. Florida Medicaid Nursing Home Quality Incentive Report and Trends (AHCA report to the Legislature, Oct 2025) · agency page
19. Medicare crossover / coinsurance rule · regulation
20. Pease Bell - Florida Finalizes October 2026 Medicaid Nursing Home Rates (BNF 13.16% to 17.45%; $1.454/point) · secondary
21. PayingForSeniorCare: Florida SMMC LTC program · secondary
22. Personal needs allowance · secondary

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