SESSION WATCH
THE BILL ITSELF

SB 1026

Community Health Worker Services

VERSION S 1026 Filed · BACK TO THE SUMMARY · OFFICIAL RECORD

underlined language is being added; struck language is being deleted. Line numbers are the Legislature's own — the same ones amendments cite.

Florida Senate - 2026 SB 1026 By Senator Rodriguez 40-01390-26 20261026__
1 A bill to be entitled
2 An act relating to community health worker services;
3 amending s. 409.906, F.S.; authorizing the Agency for
4 Health Care Administration to pay for specified
5 community health worker services as an optional
6 Medicaid service, subject to certain coverage
7 requirements; defining the term “community health
8 worker”; requiring the agency to adopt rules;
9 authorizing the agency to seek federal approval;
10 amending s. 409.908, F.S.; adding community health
11 worker services to the list of Medicaid services
12 authorized for reimbursement on a fee-for-service
13 basis; amending s. 409.973, F.S.; adding community
14 health worker services to the list of minimum benefits
15 required to be covered by Medicaid managed care plans;
16 providing an effective date.
18 Be It Enacted by the Legislature of the State of Florida:
20 Section 1. Subsection (30) is added to section 409.906,
21 Florida Statutes, to read:
22 409.906 Optional Medicaid services.—Subject to specific
23 appropriations, the agency may make payments for services which
24 are optional to the state under Title XIX of the Social Security
25 Act and are furnished by Medicaid providers to recipients who
26 are determined to be eligible on the dates on which the services
27 were provided. Any optional service that is provided shall be
28 provided only when medically necessary and in accordance with
29 state and federal law. Optional services rendered by providers
30 in mobile units to Medicaid recipients may be restricted or
31 prohibited by the agency. Nothing in this section shall be
32 construed to prevent or limit the agency from adjusting fees,
33 reimbursement rates, lengths of stay, number of visits, or
34 number of services, or making any other adjustments necessary to
35 comply with the availability of moneys and any limitations or
36 directions provided for in the General Appropriations Act or
37 chapter 216. If necessary to safeguard the state’s systems of
38 providing services to elderly and disabled persons and subject
39 to the notice and review provisions of s. 216.177, the Governor
40 may direct the Agency for Health Care Administration to amend
41 the Medicaid state plan to delete the optional Medicaid service
42 known as “Intermediate Care Facilities for the Developmentally
43 Disabled.” Optional services may include:
44 (30) COMMUNITY HEALTH WORKERS.—The agency may pay for the
45 provision of community health worker services including, but not
46 limited to, health promotion, wellness coaching, and self
47 management education; cultural mediation; interpretation or
48 translation services; health system navigation; patient and
49 family advocacy; outreach before appointments, including
50 appointment reminders; outreach to ensure adherence to
51 treatments and medications; home visits; individual, community,
52 and environmental assessments; arranging transportation; making
53 connections to community resources or social services; and
54 providing care coordination and case management.
55 (a) As used in this subsection, the term “community health
56 worker” means a frontline public health worker who provides a
57 range of services addressing the health and social needs of the
58 community and is a trusted member of or has a close
59 understanding of the community he or she serves. The term
60 includes community health representatives, promotores de salud,
61 and workers of public or private community-based organizations.
62 (b) The agency shall adopt rules to implement this
63 subsection, including, but not limited to, rules establishing
64 eligible services provided by community health workers.
65 (c) The agency may seek federal approval necessary to
66 implement this subsection.
67 Section 2. Present paragraphs (c) through (u) of subsection
68 (3) of section 409.908, Florida Statutes, are redesignated as
69 paragraphs (d) through (v), respectively, and a new paragraph
70 (c) is added to that subsection, to read:
71 409.908 Reimbursement of Medicaid providers.—Subject to
72 specific appropriations, the agency shall reimburse Medicaid
73 providers, in accordance with state and federal law, according
74 to methodologies set forth in the rules of the agency and in
75 policy manuals and handbooks incorporated by reference therein.
76 These methodologies may include fee schedules, reimbursement
77 methods based on cost reporting, negotiated fees, competitive
78 bidding pursuant to s. 287.057, and other mechanisms the agency
79 considers efficient and effective for purchasing services or
80 goods on behalf of recipients. If a provider is reimbursed based
81 on cost reporting and submits a cost report late and that cost
82 report would have been used to set a lower reimbursement rate
83 for a rate semester, then the provider’s rate for that semester
84 shall be retroactively calculated using the new cost report, and
85 full payment at the recalculated rate shall be effected
86 retroactively. Medicare-granted extensions for filing cost
87 reports, if applicable, shall also apply to Medicaid cost
88 reports. Payment for Medicaid compensable services made on
89 behalf of Medicaid-eligible persons is subject to the
90 availability of moneys and any limitations or directions
91 provided for in the General Appropriations Act or chapter 216.
92 Further, nothing in this section shall be construed to prevent
93 or limit the agency from adjusting fees, reimbursement rates,
94 lengths of stay, number of visits, or number of services, or
95 making any other adjustments necessary to comply with the
96 availability of moneys and any limitations or directions
97 provided for in the General Appropriations Act, provided the
98 adjustment is consistent with legislative intent.
99 (3) Subject to any limitations or directions provided for
100 in the General Appropriations Act, the following Medicaid
101 services and goods may be reimbursed on a fee-for-service basis.
102 For each allowable service or goods furnished in accordance with
103 Medicaid rules, policy manuals, handbooks, and state and federal
104 law, the payment shall be the amount billed by the provider, the
105 provider’s usual and customary charge, or the maximum allowable
106 fee established by the agency, whichever amount is less, with
107 the exception of those services or goods for which the agency
108 makes payment using a methodology based on capitation rates,
109 average costs, or negotiated fees.
110 (c) Community health worker services.
111 Section 3. Present paragraphs (e) through (cc) of
112 subsection (1) of section 409.973, Florida Statutes, are
113 redesignated as paragraphs (f) through (dd), respectively, and a
114 new paragraph (e) is added to that subsection, to read:
115 409.973 Benefits.—
116 (1) MINIMUM BENEFITS.—Managed care plans shall cover, at a
117 minimum, the following services:
118 (e) Community health worker services.
119 Section 4. This act shall take effect July 1, 2026.