Medicaid changes cost people with disabilities music therapy

ORLANDO, Fla. — For several weeks, providers and families across Florida have dealt with confusion, frustration and financial strain due to changes in how expressive therapy is funded.

The therapy is something many people with disabilities depend on. Changes in requirements to how funding is being administered are leading to some losing services.

What You Need To Know

Expressive therapy is something many people with disabilities depend on. Changes in requirements to how funding is being administered is leading to some losing services.

Sunshine Health, which manages the state’s Medicaid funds for expressive therapy, reviewed MTM Health – a third-party company administering those reimbursements.  Sunshine Health says it found MTM was contracting with providers who were not meeting state Medicaid requirements. 
Sunshine Health is terminating MTM’s contract effective Dec. 31

Unlike 20 other states across the country, Florida doesn’t regulate music therapy providers through a licensing program.

Matthew Saul looks forward to his music lessons.

“Matthew is considered non-verbal, but in music, he has a voice,” said Tamela Ponder, founder and executive director of Joyful Music Therapy.

A voice to actually choose what he and Ponder, his music teacher, are singing.

“To us that might not seem like a big deal, but if you don’t have a voice, you don’t get a chance to have your preferences heard most of the time,” said Ponder.

In the decade Matthew has taken lessons with Joyful Music Therapy, his mother has noticed a huge difference.

“Through the years, she’s got him to where he talks now some, and even in this last year we’ve seen a huge improvement in that now it’s not whispering. He’ll actually say words now,” said Tammy Saul, Matthew’s mother.

But this could be Matthew’s last visit for the foreseeable future. His family can’t afford to cover the cost of his doctor-prescribed expressive therapy, which was covered by state Medicaid funding. Ponder said that months ago, they stopped getting state Medicaid reimbursements.

“I’ve had to call 70 families since October to say, ‘I’m sorry, this is out of our hands, we cannot see your kiddo anymore,'” said Ponder.

Spectrum News 13 looked into why this is happening. Sunshine Health, which manages the state’s Medicaid funds for expressive therapy, reviewed MTM Health – a third-party company administering those reimbursements. Sunshine Health says it found MTM was contracting with providers who were not meeting state Medicaid requirements. 

Sunshine Health is terminating MTM’s contract effective Dec. 31.

“It was literally like boom – we owe you 20 grand, and we’re not going to pay you again,” said Ponder. “So, that is where it felt like the rug is being pulled out from under my feet, and my clients and my families’ feet.”

Sunshine Health says it is now requiring even nationally board-certified therapy providers, like Ponder, to have a Medicaid ID. But Ponder said that’s something the state has not required her, or Joyful Music Therapy, to have since it opened about 18 years ago.

“I really haven’t had any problems with payment at all, it’s been really on schedule, until July. And things started getting behind,” said Ponder.

Ponder has applied for that Medicaid ID, and she said so far it looks like she and her other therapist at JMT will get approved for that. But in the meantime, she has lost out on tens of thousands of dollars of Medicaid reimbursements for therapy provided. She has had to lay off three of her seven certified music therapists. 

Unlike 20 other states across the country, Florida doesn’t regulate music therapy providers through a licensing program.

“If we would’ve been licensed, this would’ve never happened,” said Ponder. “But because we weren’t licensed, we had to go through a third party, and you know what? That third party messed up. No fault of my own – I did everything that I was supposed to do – but it ended up falling back on my clients.”

A spokesperson for MTM Health says it passed an audit by Sunshine Health in 2025 that examined its credentialing process. “Claims have been paid since early November to the majority of expressive therapy providers,” said MTM Health’s chief marketing officer, Michelle Lucas. “Any payments still held from expressive therapy providers are done so at the direction of Sunshine.”

Mallory McManus, deputy chief of staff for Florida’s Agency for Healthcare Administration, responded, saying in part, “The agency is working closely with Sunshine Health plan to ensure there are no gaps in care and to ensure remediation of any disputes with providers of this service.”

With the future of his therapy still unclear, Matthew’s mother says he continues to miss out on two things that make his life better.

“Matthew is not just in jeopardy of losing music, he’s in jeopardy of losing his equine therapy as well,” said Saul. “And those are the two things that are his lifelines.”

Ponder says even if her Medicaid ID is approved, she worries she may not be reimbursed for more than $20,000 she said she’s still owed in Medicaid reimbursements.

There could be legislation on the way to require expressive therapy providers in Florida to be licensed. Sen. Carlos Guillermo Smith says he is working on a bill that would require the licensure of expressive therapies in Florida. That’s something Ponder says she’s wanted for a long time.