Bill Summary

by Snyder

State Medicaid Program: Authorizes AHCA to conduct retrospective reviews & audits of certain claims under state Medicaid program for specified purpose; requires agency, in coordination with DCF, to implement mandatory work & community engagement requirements for able-bodied adults as condition of obtaining & maintaining Medicaid coverage; specifies types of activities which may satisfy work & community engagement requirements; provides that certain population is required to engage in work or community engagement activities only during standard school hours; requires persons eligible for Medicaid to demonstrate compliance with work & community engagement requirements at specified times as condition of maintaining Medicaid coverage; revises components of Medicaid prescribed-drug spending-control program to include preferred physician-administered drug list, preferred product list, & high-cost drug list; provides that determinations of overpayment under Medicaid program may be based upon retrospective reviews, investigations, analyses, or audits conducted by agency to determine possible fraud, abuse, overpayment, or recipient neglect; requires agency to implement Integrated Managed Care Pilot Program in designated regions by specified date. Effective Date: July 1, 2026

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