Florida Medicaid Telehealth: Covered Services, Providers, and Rules

Florida Medicaid telehealth coverage pays for medically necessary health care services delivered remotely by Florida-licensed, Medicaid-enrolled providers, primarily through live two-way video. Behavioral health has the widest telehealth footprint, and if you are in a managed care plan you may also have access to store-and-forward consultations and remote patient monitoring that the fee-for-service program does not routinely cover.

The rules are set by the Agency for Health Care Administration (AHCA). About 73 percent of Florida Medicaid recipients get their benefits through a Statewide Medicaid Managed Care (SMMC) plan, and the remainder through fee-for-service (FFS).¹ Which side you’re on shapes what telehealth options are actually available to you.

What Florida Medicaid Covers by Telehealth

Coverage attaches to the service, not to the video screen. A visit is covered when the underlying service is a Medicaid benefit, the care is medically necessary, and the provider judges that remote delivery meets the same clinical standard as an in-person visit. If a provider decides the virtual format would compromise care for your particular situation, they cannot bill it as a telehealth visit.

Behavioral health is where telehealth reaches furthest. AHCA reimburses behavioral health evaluations, diagnostic assessments, treatment recommendations, medication management screenings, and individual and family therapy delivered by telemedicine at the same rates as the community behavioral health fee schedule.² Primary care visits, specialist consultations, and certain screenings and child evaluations can also be delivered remotely when AHCA has approved the corresponding procedure code for telemedicine billing.

Live Video, Store-and-Forward, and Remote Monitoring

The FFS program mainly pays for synchronous visits using interactive two-way audio and video. SMMC plans are allowed to go further. They may cover asynchronous store-and-forward transmissions (images or data your provider reviews later) and remote patient monitoring (devices that send readings such as blood pressure or blood sugar between visits). Plans cannot be more restrictive than AHCA’s baseline, but they can be more generous, so your access to these modalities depends on your specific plan.

Audio-Only Phone Visits

Audio-only telephone calls are not covered as telehealth under FFS. Florida Statute 456.47 excludes audio-only calls, email, and fax from the definition of telehealth, and the temporary flexibility that allowed phone visits during the federal Public Health Emergency ended in May 2023.³ Managed care plans may still choose to cover some audio-only services on their own, so if you rely on phone appointments, ask your plan directly before the visit.

Who Can Provide a Covered Telehealth Visit

Two things have to be true. The clinician must be licensed under one of the health care practice acts Florida law recognizes for telehealth (physicians, physician assistants, advanced practice registered nurses, psychologists, clinical social workers, mental health counselors, marriage and family therapists, physical therapists, occupational therapists, speech-language pathologists, pharmacists, dentists, and others), and they must be enrolled as a Florida Medicaid provider.⁴ Being cleared to practice telehealth in Florida is not the same as being able to bill Medicaid for it.

Out-of-state practitioners can treat Florida patients by telehealth only after registering with the Florida Department of Health as an out-of-state telehealth provider.⁵ Whether they can then bill Florida Medicaid depends on their separate Medicaid enrollment status.

Where You Have to Be During the Visit

Florida law lets you take the visit from wherever you are, so long as you are in Florida. The statute simply says the provider and patient “may be in separate locations.”³ Home, a relative’s house, or another private setting in the state all work. If you are physically outside Florida at the time of the appointment, a Florida Medicaid telehealth visit may not be covered.

Prescriptions and Controlled Substances

Standard medications can be prescribed by telehealth in the ordinary course of a visit. Controlled substances are more limited. Schedule III through V drugs can generally be prescribed by telehealth when the provider is designated as a controlled substance prescribing practitioner on their state profile.

Schedule II drugs cannot be prescribed by telehealth except in four situations:⁷

Medications for a psychiatric disorder.

Treatment during inpatient care at a licensed hospital.

Care for a patient receiving hospice services.

Treatment for a resident of a nursing home facility.

Outside those categories, a Schedule II prescription requires an in-person visit. For non-cancer chronic pain lasting more than 90 days, Florida law separately requires a physical exam and complete medical history before a provider first prescribes any Schedule II through IV controlled substance. Renewals of existing controlled substance prescriptions do not require a physical exam and can be handled by telehealth.

How to Set Up a Telehealth Visit

Start from how you get your Medicaid.

If you are enrolled in an SMMC managed care plan, call your plan’s member services line. Ask which in-network providers offer telehealth, which services are covered remotely, and whether the plan covers store-and-forward or remote patient monitoring on top of live video.
If you are on fee-for-service, contact your primary care provider or specialist directly and ask whether they offer telehealth visits and bill Medicaid for them.

Once you confirm a provider offers telehealth, ask which platform or app they use, whether you need to create an account or complete intake paperwork in advance, and what to do if the connection drops mid-visit. For synchronous visits you need a device with a working camera and microphone and a stable internet connection. Any video, audio, or electronic records created during the session are treated as confidential medical records, and Florida law requires providers to document telehealth visits to the same standard as in-person care.6Florida Senate. Florida Statutes 456.47 – Use of Telehealth to Provide Services

If a Telehealth Service Is Denied

You can challenge a denial, reduction, or termination of a telehealth service the same way you would for any Medicaid service.

File an internal appeal with your managed care plan within 60 calendar days of the denial notice. Appeals can be oral or written, and written appeals with a letter from your treating provider tend to carry more weight. The plan must acknowledge receipt within five business days and resolve the appeal within 30 days.
If the plan upholds the denial, request a state fair hearing through AHCA within 120 days. You can start that process by calling the Medicaid Helpline at 1-877-254-1055 or emailing MedicaidHearingUnit@ahca.myflorida.com.
If the service was previously authorized and you file your appeal within 10 calendar days of the denial notice, you may be able to keep receiving it while the appeal is pending.

FFS recipients who receive a denial can request a fair hearing through AHCA directly, without a managed care plan’s internal appeal step first.