Oct 18 / Stephen Choate, MHA, MT-BC

The Future of Music Therapy in Florida

A few months ago, MusicMED published an article on an unfolding crisis in Florida, where music therapists hadn’t been paid for weeks and clients covered by insurance were losing access to care. That situation was resolved after Medical Transportation Management (MTM) disclosed it was under an audit and promptly submitted payments for outstanding claims. But it left a glaring question in the minds of everyone contracted with MTM: Will this happen again?

As the very existence of this article likely suggests, yes. And it already did - only this time, the effects don’t appear to be temporary.

In this article, we’ll explore the termination of Sunshine Health’s Expressive Therapy contract with MTM, how it will affect clients and providers, and what it means for the future of music therapy in Florida.

Recap: The Reimbursement Process

To fully grasp the current situation, it’s important to understand how music therapists have been accessing Medicaid funding in Florida.

What Is an MCO?

A Managed Care Organization (MCO) is a health plan that contracts with a network of doctors, hospitals, and other providers to deliver health services to its members. The state pays the MCO a fixed amount per member, per month (capitated payment) to manage that member’s care. This model differs from the traditional fee-for-service system, in which the state pays providers directly for each individual service rendered. Essentially, it’s designed to incentivize efficiency of services over quantity of services.

Sunshine Health’s Role

Sunshine Health, a Medicaid health plan and subsidiary of Centene Corporation, serves as one of Florida’s MCOs. It manages several government-sponsored programs, including Medicaid, Medicare, and specialized plans. Among those specialized plans is the Children’s Medical Services (CMS) Health Plan.

The CMS Health Plan

Oversight of the CMS program was recently changed from the Florida Department of Health (FDOH) to the Florida Agency for Health Care Administration (AHCA). AHCA contracts with private MCOs, like Sunshine Health, to administer benefits through a managed-care model. The CMS Health Plan is designed specifically for children and adolescents with special healthcare needs.

How Expressive Therapies Were Funded

  1. Medicaid, through AHCA, funded Sunshine Health and CMS via fixed monthly payments for enrolled members.
  2. Sunshine Health elected to include expressive therapies (music, art, pet, and equine) as expanded benefits.
  3. MTM, a fiscal intermediary, contracted with Sunshine Health in 2019 to manage the administrative aspects of those services - including credentialing, contracting, and billing.
  4. Therapists, as independent providers, contracted with MTM to deliver care. As of April 2025, there were 97 music therapy providers contracted with MTM - many of whom had entire teams of therapists operating under their contract.
  5. Authorizations for therapy were reviewed and approved by Sunshine Health or CMS, then routed to MTM for provider assignment and claim management.
  6. MTM reimbursed therapists on a Net-30 payment schedule through its provider portal.

For the last several years, this system provided access to music therapy (as well as other expressive therapy services) for thousands of children and families across the state - until now.

What Went Wrong

It’s important to note that Sunshine Health is currently the only MCO in Florida reimbursing for music therapy directly. While other managed care organizations (like UnitedHealthcare) operate within the state, covering music therapy is optional since it’s not a required Medicaid service.

During MTM’s audit three months ago, Sunshine Health implemented sudden and sweeping changes to its expanded benefit - the most significant being a one-session-per-week cap for all members. This policy drastically reduced service frequency for many clients, particularly those previously approved for multiple sessions per week.

Soon after, providers also saw an increase in denials for new authorizations and renewals. While medical necessity reviews are part of responsible oversight, the trend appeared without any apparent changes or updated clinical criteria. So in addition to reduced session volume per client, providers also continued operating with decreasing client volume, uncertain of what had changed.

Now, MTM’s contract with Sunshine Health is terminating effective December 31.

While no formal reason has been published, a couple of factors may have contributed:

  • Credentialing standards: MTM credentialed both board-certified music therapists (MT-BCs) and musicians with only a bachelor’s degree in music. This raised quality and compliance concerns, created a large provider pool within the network, and may have contributed to another issue:
  • Financial strain: There is speculation of overspending and excessive claim volume under the expanded benefit, perhaps fueled by high session frequencies and a surplus of providers.

What's Changing

With MTM exiting, Sunshine Health is transitioning to direct contracting with providers - a process already proving slow and cumbersome. Some of these immediate changes include:

  • Contract transition: MTM’s role ends December 31, and Sunshine Health will take over the Expressive Therapy contract on January 1.
  • Eligibility: Only providers previously credentialed through MTM appear eligible for new contracts. New businesses must wait to be contacted by Sunshine Health’s regional negotiators.
  • More robust credentialing: The onboarding process involves an extensive application process even before credentialing begins. Providers will have to be vetted, clients will need new authorizations, and billing systems will need to be designed - all through structures that don’t yet exist.
  • Rate reduction: Reimbursement is expected to drop by 35% to $65 per session.
  • Network remains closed: Though this will be a new contract, Sunshine is only contacting expressive therapy providers who were already contracted with MTM. No new vendors will be able to join, unless they do so under the contract of another provider.

Meanwhile, as Sunshine is rolling out these changes, MTM has made a few of their own:

  • Medicaid ID requirement: On October 13, MTM announced that, effective immediately, they would only be honoring claims submitted by providers with a valid Medicaid ID, a requirement that seems to have appeared overnight.
  • Client reassignment: Therapists without Medicaid IDs are seeing their clients reassigned to other providers with qualifying credentials. While this may help provide some degree of continuity of service, there is now a significantly reduced supply of providers with these IDs, and the reassignments often result in the ending of long-term therapeutic relationships, without notice.
  • Non-payment: When MTM announced the Medicaid ID requirement on October 13, they had already missed two payments to providers. As of publication, those providers have remained unpaid since September 26.

What It Means

The magnitude of these changes cannot be understated. Beyond the immediately pressing issue of non-payment, a cascade of other effects will unfold over the next several months.

Decreased Market Rate

The market value of music therapy isn’t going to be what it was.

As stated in a previous article: The problem for music therapy isn’t getting people to want it - it’s getting them to pay for it. And this arrangement with Sunshine Health fixed that very problem. Now that it’s changing, music therapists will have to adapt to the new reality.

Since MTM rolled out their contract, they have paid higher than the Florida market rate for services. Whereas many providers in the state may have been making $20-30 per hour through W-2 employment, MTM paid a flat session rate of $100 for 45 minutes of therapy. This reimbursement rate was well above what other employers were paying for music therapy, especially for an ancillary service. According to the most recent AMTA Workforce Analysis (2022), the average salary for music therapists in Florida was $58,625 ($28.18 per hour), the median salary was $53,000 ($25.48 per hour), and the mode was $40,000 ($19.23 per hour). And it should be noted that many of these therapists in the state are employed through private practices utilizing the higher MTM rates.

For smaller providers, that rate offered attractive compensation for clinical time. And for larger providers, it was viable enough to cover administrative costs and still pay employees and contractors well enough to build their own teams.

As one could expect, providers flocked to MTM to join their network - so many, in fact, that MTM closed its provider portal to new vendors in 2024 (though it left it open in underserved parts of the state). This swell - of open contracts, job opportunities, and high reimbursement rates - created a bubble in the market for music therapy. And it inflated the market rate for services.

And now that this bubble has popped, providers are due for a market rate correction.

For example, in higher income regions of the state, some practice owners were paying experienced therapists as much as $75 per session. That may have made sense for them at a rate of $100, but at $65 - before expenses - that’s no longer feasible.

Reduced Provider Supply

For many, pursuing Sunshine dollars may not even be worth it at all. And if that is the case, will they be able to continue their businesses without the rates they previously had through MTM? Only time will tell.

Regardless of if or when MTM pays providers the large sums owed, private practice owners have a much bigger question to answer: Should they continue with Sunshine at all? And if so, how can they make it work?

Providers don’t have to contract with Sunshine. On top of the daunting amount of work it takes to get credentialed, participating directly in a Medicaid-funded program comes with a high degree of regulatory oversight and thus - risk. With a 35% drop in reimbursement, there’s little incentive to take on that risk.

Ironically, the ones for whom the Sunshine contract makes the most sense are the ones who can’t access it - the employees and subcontractors already working with Sunshine members under the contract of another provider. For them, $65 could be an increase, as they would be contracting directly. However, since the network is closed to only current vendors (as of publication), their involvement is contingent on current providers who may not see enough incentive to pursue the relationship at all.

With these significantly lower rates and the increased regulatory risk, the supply of participating practices could very likely dip - leading to a further reduction of providers across the state.

Capital Losses

If practice owners do want to pursue the Sunshine contract, they have to make it to January 1.

Most providers had about two months of accrued invoices in MTM’s portal, and they are now without pay from - for what most of them - was their primary payer. Many are out tens of thousands of dollars - capital they need to pay their teams and to operate their businesses. The bigger the business, the larger the loss is likely to be.

MTM has yet to answer many questions on when and if providers will be paid for previously submitted claims. So, while most employees have been paid for their services, the business owners contracting through MTM directly are wondering if they’ll ever get paid at all.

Since MTM payments were made on a weekly basis, business owners aren’t just scrambling to make ends meet - they’re also having to adjust their cash flow in the process. For most of them, the reliance on MTM was massive.

Even if they can find the business to continue to provide work for their teams, they may not have the cash on hand to finance the transition.

Less Access to Care

Many business owners built their entire systems on the higher MTM rates, and those structures have been uprooted overnight. But it’s not just the loss of revenue directly - much of the private pay and discounted rates providers could offer were being subsidized by the more viable rates previously provided by MTM. Consequently, many will have to raise their rates to compensate for this. Not all clients will be able to afford it. So this will impact private pay clients, too.

Between the decline of in-network providers for clients on Sunshine (because therapists may not find it feasible or worth the risk), the reduction of therapists due to layoffs and practice closures, and rising rates to compensate for the loss of higher session revenue, many families will likely lose access to care.

Recommendations

Whether you’re an employee or contractor, a team member or business owner, and if you decide to pursue Sunshine or walk away, everyone in the music therapy community still has options.

Start Medicaid credentialing early.

Each business entity will need its own Medicaid ID number, as will every therapist seeing clients. And that’s just to start the application - then credentialing begins. The process is comprehensive, takes time, and will determine whether you can continue serving clients under Sunshine Health or CMS. If you’ve decided to pursue the Sunshine contract - even if you’re still deciding, start now.

Collaborate with colleagues.

There is a whirlwind of information circulating the state. Since providers have to wait for their local contract negotiators to initiate applications to credential with Sunshine, people are receiving different information at different rates. Little has been verified from Sunshine directly, but the community is rich in goodwill and mutual advocacy. Lean on it, and continue to share insights, resources, and support within the community.

Streamline operations and cut waste.
Businesses have two ways to boost profit: increase revenue or decrease costs. Building revenue takes time, especially when shifting marketing strategy. In the short term, providers can cut costs by consolidating caseloads, reallocating resources, and eliminating inessential costs.

Diversify funding.

MusicMED’s previous articles covered this, and it’s more critical now than ever. Pursue private-pay, grants, scholarship funds, and facility-based contracts to offset lost Medicaid revenue.

Stay connected.

If you are a parent, you can contact your Sunshine case manager to express your concerns.

If you’re a music therapist, follow the Florida Music Therapy Task Force for updates on state matters. You can join their email list at flmusictherapytf@gmail.com and access additional resources for navigating the contract transition via this link.

Looking Ahead

If the last few months have taught the music therapists in Florida anything, it’s the limits of their own resilience, and we applaud the many contributions from the range of professionals across the state.

In a single season, Florida’s music therapy community has endured two major payer crises - each exposing the same underlying weakness: our profession’s vulnerability within limited funding sources.

I recently spoke with another practice owner, and she said something that really stuck with me:

“We were doing this before MTM was ever around. We made it work then, and we can continue to make it work now. We just have to keep going. We have to fight.”

And she’s right. This door may have closed, but we can open others. Some of us are working to find new opportunities - even create them. Don’t stop. Keep building. Fight. The future of music therapy in Florida depends on it.

My heart goes out to you, your communities, and the clients you serve.
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