Florida Medicaid Medical Foster Care (MFC) reimbursement depends on the child’s assigned level of care, the correct HCPCS code and modifier, provider eligibility, supporting documentation, and the applicable payer’s billing requirements. For 2026, the Florida Agency for Health Care Administration (AHCA) lists three Medical Foster Care per-diem rates under HCPCS code S5145: $48.47 for Level I, $60.59 for Level II, and $84.81 for Level III. A separate Child Health Targeted Case Management (TCM) fee schedule lists $11.42 per unit for T1017 with modifier SE, subject to a maximum of 32 units per day.
This guide explains the published rates, the distinction between Medical Foster Care and Targeted Case Management, and the checks providers and billing teams should perform before submitting claims.
Florida Medicaid Medical Foster Care Fee Schedule 2026
The following amounts appear in AHCA’s posted 2026 Medical Foster Care Services Fee Schedule.
| HCPCS Code | Modifier | Description of Service | Maximum Fee |
|---|---|---|---|
| S5145 | HA | Level I Medical Foster Care Service | $48.47 per day |
| S5145 | TF | Level II Medical Foster Care Service | $60.59 per day |
| S5145 | TG | Level III Medical Foster Care Service | $84.81 per day |
| T1017 | SE | Targeted Case Management for Children’s Medical Services Medical Foster Care Contractors | $11.42 per 15-minute unit; maximum 32 units per day |
Important: S5145 and T1017-SE represent different services and use different billing units. The S5145 fee schedule expresses reimbursement as a daily maximum. T1017-SE is reported in 15-minute units under the separate Child Health Targeted Case Management schedule.
Always check the current official schedule before billing and verify whether the applicable fee-for-service or managed-care payer follows the published amount.
What Is Florida Medicaid Foster Care?
Florida’s Medical Foster Care Program serves Medicaid-eligible children under age 21 who have complex medical needs and cannot receive the necessary care in their own homes. The program enables eligible children to live in foster homes with trained caregivers instead of remaining in hospitals or other institutional settings when a foster-home placement can safely meet their needs.
The program involves coordination among Florida Medicaid, the Department of Health’s Children’s Medical Services (CMS), the Department of Children and Families (DCF), medical professionals, and qualified foster caregivers.
Medical Foster Care is not the same as ordinary foster-care room-and-board support. It is a specialized Medicaid service with its own eligibility criteria, care requirements, provider qualifications, reimbursement schedule, and documentation rules.
Providers should use AHCA’s Medical Foster Care program information and Medical Foster Care Services Coverage Policy as starting points for their compliance workflow.
Understanding the S5145 Modifiers
The code alone does not identify the correct Medical Foster Care reimbursement level. The modifier must correspond to the applicable level-of-care determination and supporting billing information.
Level I: S5145-HA
The published maximum fee is $48.47 per day.
The HA modifier identifies Level I Medical Foster Care Service in Florida’s MFC fee schedule. Billing teams should confirm that the child’s assigned level and the applicable authorization or plan records support this combination for the date of service.
Level II: S5145-TF
The published maximum fee is $60.59 per day.
Before submitting a Level II claim, verify the applicable level-of-care documentation and check that the procedure code and modifier match the child’s current records.
Level III: S5145-TG
The published maximum fee is $84.81 per day.
This combination identifies Level III Medical Foster Care Service. Do not select TG solely because a child has a particular diagnosis, equipment need, or medical condition. Use the documented level-of-care determination and applicable payer requirements.
Why the Distinction Matters
A claim with the right HCPCS code but the wrong modifier may not accurately represent the covered service. It can result in a denial, payment discrepancy, or documentation review.
Florida’s Department of Health explains that the Children’s Multidisciplinary Assessment Team (CMAT) reviews medical and psychosocial assessments to determine eligibility for Medicaid-funded long-term care services. Its level-of-care recommendations are valid for a maximum of 180 days and must be reconsidered when the child’s condition changes.
T1017-SE: Medical Foster Care Targeted Case Management Rate
Medical Foster Care contractors should not confuse the daily S5145 reimbursement with Child Health Targeted Case Management.
For 2026, the AHCA Targeted Case Management Fee Schedule lists:
| Procedure Code | Modifier | Service | Maximum Fee | Maximum Units |
|---|---|---|---|---|
| T1017 | SE | TCM for Children’s Medical Services Medical Foster Care Contractors | $11.42 per unit | 32 per day |
| T1017 | TL | TCM for Children’s Medical Services Early Steps Providers | $11.42 per unit | 32 per day |
T1017-SE is a separate case-management service, not another way to bill the daily Medical Foster Care rate. Targeted case management can help eligible children access medical, social, educational, and other support services.
The T1017-SE maximum of 32 units equals eight hours of 15-minute units. It is a billing limit, not automatic permission to submit eight hours every day. The documentation must support the actual covered service and the units claimed.
Another common source of confusion is the standard mental-health TCM rate. The 2026 fee schedule lists $14.82 per unit for specified mental-health TCM categories, while Child Health TCM for Medical Foster Care contractors uses $11.42 per unit under modifier SE. The applicable target group and program, not just the T1017 code, determine which schedule to consult.
What Case Management Documentation Should Support
Documentation should establish that the service was actually provided, was within the provider’s authorized scope, and met the applicable coverage and billing requirements.
Depending on the service and governing policy, relevant records may include:
- Recipient identification and date of service.
- The case management activity performed.
- The purpose of the activity and its connection to the child’s care needs.
- The individuals or organizations involved in the coordination.
- The time spent, where required by the applicable billing instructions.
- The corresponding care plan or other required supporting records.
- The number of units billed and the calculation supporting those units.
Scheduling an appointment, copying a record, or documenting an administrative task does not automatically make the activity reimbursable. The provider must establish that the activity qualifies as the covered case management service.
Do Not Confuse Medical Foster Care with Other Foster Care Services
One of the most important fee schedule checks is confirming that the correct service category is being used.
Medical Foster Care
Medical foster care supports eligible children with complex medical needs in an approved foster care setting. S5145 and its applicable modifiers should be reviewed against the Medical Foster Care Services Fee Schedule.
Specialized Therapeutic Foster Care
Specialized therapeutic foster care is a distinct service category. It has its own reimbursement reference and should not be assigned medical foster care rates merely because both services involve foster homes.
Targeted Case Management
Targeted case management covers qualifying coordination services under the applicable program rules. Its code, modifier, unit limits, and reimbursement amount should be verified in the appropriate targeted case management schedule.
Foster Care Room and Board
Room-and-board payments are foster caregiver maintenance payments, not automatically Medicaid claims for medical foster care services.
Florida law establishes separate foster care room-and-board payment provisions. Effective July 1, 2026, section 409.145 of the Florida Statutes specifies monthly rates of $663.03 for ages 0–5, $680.01 for ages 6–12, and $795.94 for ages 13–21 under the provisions described in the statute.
These caregiver payment amounts should not be added to medical foster care fee schedule rates or treated as reimbursement for HCPCS S5145.
Florida Medicaid Medical Foster Care Billing Errors to Avoid
Accurate code selection is only one part of compliant billing. The following operational checks can help reduce preventable claim errors.
1. Using an Outdated Reimbursement Amount
Why it matters: A previously published fee may not reflect the schedule applicable to a 2026 date of service.
What to do: Maintain a dated fee schedule reference and review AHCA updates before changing rates in the billing system. Verify the actual rate rather than calculating a replacement amount from a percentage increase.
2. Reporting the Wrong Modifier
Why it matters: An incorrect modifier can misrepresent the service level and lead to a denial, payment discrepancy, or compliance concern.
What to do: Compare the submitted modifier with the current medical foster care assessment and applicable program records for the date of service.
3. Mixing Medical Foster Care and Case Management Claims
Why it matters: These services are listed in different fee schedules and may have different units, limits, and documentation requirements.
What to do: Maintain separate billing checks for S5145 medical foster care and T1017 targeted case management. Do not assume that a rule applicable to one code also applies to the other.
4. Billing Without Sufficient Supporting Records
Why it matters: A claim may be difficult to defend if the medical record does not establish the service, date, applicable level, or required supporting information.
What to do: Check the documentation against the applicable Medicaid policy and payer requirements. Use individualized records that accurately reflect the services provided rather than relying on copied notes.
5. Assuming Every Managed Care Plan Pays the Same Amount
Why it matters: A published AHCA fee schedule and a managed care provider contract are not necessarily interchangeable.
What to do: Verify the recipient’s plan, provider participation, applicable reimbursement terms, claims instructions, and any required authorization or program approval. Do not assume that the statewide fee schedule guarantees a specific managed care payment.
6. Overlooking Hospitalization or Placement Changes
Why it matters: A child’s hospitalization, placement change, or change in medical foster care level can affect whether a service is billable on a particular date.
What to do: Review the governing program policy and payer guidance for the exact circumstances. Confirm any applicable leave-day provision, continued-service requirement, or documentation condition before billing. Do not assume that hospitalization automatically permits or prohibits payment.
Medical Foster Care Documentation and Audit Readiness
An effective compliance process links every claim to the records that establish the provider’s right to bill.
A practical internal audit should check:
- Provider status: Is the billing provider eligible and properly enrolled for the service?
- Recipient eligibility: Was the child eligible for the applicable Medicaid service on the date of service?
- Service-level support: Does the current assessment support the billed medical foster care level and modifier?
- Code accuracy: Does the code and modifier match the service actually provided?
- Fee schedule: Was the correct schedule and effective date used?
- Units and limits: Are the units consistent with the applicable billing instructions?
- Clinical records: Is the required assessment, care plan, order, or other supporting documentation available?
- Managed care requirements: Have applicable plan-specific claim and authorization requirements been checked?
- Payment reconciliation: Does the remittance agree with the expected payment under the applicable fee schedule or contract?
Record-retention periods and required documentation should be confirmed against the current Florida Medicaid provider requirements and any applicable federal rules. Avoid applying one universal retention period to every record without checking the governing requirements.
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Final Takeaway
Florida Medicaid medical foster care billing requires accurate code and modifier selection, current reimbursement references, appropriate documentation, and careful attention to the rules applicable to each service and payer.
For 2026 claims, verify the effective AHCA fee schedule instead of relying on rates copied from older articles. Separating medical foster care, targeted case management, specialized therapeutic foster care, and caregiver room-and-board payments is an essential step toward accurate billing and stronger reimbursement controls.
