The Big Risk Florida Registries Can’t Ignore in 2026: Medicaid & Misclassification”

Florida’s home care landscape is changing. More families are asking about Medicaid. Some registries are trying to meet that demand. But if you’re a home care registry in Florida thinking about accepting Medicaid, stop and take a closer look. You might be stepping into a bigger risk than you realize.

The truth is that Medicaid and the independent contractor model don’t mix well. If you’re not careful, you could end up looking like an agency and that opens the door to audits, fines, and lawsuits.

Let’s break down what’s happening, why it matters, and what Florida registries need to know heading into 2026.

Medicaid Is on the Rise in Florida

Florida has seen a steady increase in home care funded by Medicaid. Families looking for help with daily care often ask registries if they accept Medicaid, and some registries have been tempted to say yes to win more clients.

Here’s the catch: Most Medicaid programs are set up for agencies, not registries. Agencies hire W-2 caregivers. Registries refer independent contractors. The rules and billing systems for Medicaid don’t always fit how registries work.

That’s where the trouble starts.

Why Medicaid and 1099s Don’t Always Mix

If your registry starts billing Medicaid directly, it might make your business look like it has employees. Here’s why:

• You’re acting as the provider of record. That’s what agencies do.
• You control payment and scheduling. That points to an employer relationship.
• You’re handling care plans, documentation, and visit notes. That adds more control.
• Alzheimer’s and dementia training (ADRD compliance)
• Caregiver qualifications
• Documentation and billing practices
• Back wages and taxes: You could owe years of unpaid payroll taxes.
• Penalties and interest: Fines can add up fast.
• Loss of registry status: You might be forced to operate as an agency.
• Legal action: Caregivers or their attorneys might come after you.
• Avoid acting like the caregiver’s boss
• Let families set care schedules and pay
• Stay out of the provider-of-record role
• Not provide training or supervision

When these things stack up, it becomes harder to argue that caregivers are truly independent. That puts your classification status at risk.

And in 2026, with more audits expected under the new Independent Contractor Rule, this risk is only growing.

AHCA Is Watching

Florida’s Agency for Health Care Administration (AHCA) oversees Medicaid services in the state. AHCA has been increasing oversight on how registries operate, especially when it comes to:

If a registry starts to look like it’s managing caregivers instead of connecting them, AHCA could see that as a violation. And if you’re also touching Medicaid dollars, the risk gets even higher.

What Misclassification Can Lead To

Let’s say the DOL or AHCA audits your registry and decides your caregivers are misclassified. What happens?

Even if you didn’t mean to break any rules, the penalties are real. Intent doesn’t protect you if the structure is wrong.

What to Watch for in 2026

The new Independent Contractor Rule took effect in 2025. It’s now fully enforced. That means the government is looking more closely at control, independence, and how much influence the business has over the worker.

If Medicaid is involved, you’re already under a microscope. Florida registries need to:

Even your language matters. Say that you “refer” or “connect” caregivers - not that you hire or assign them.

Should Registries Ever Touch Medicaid?

In rare cases, a Florida registry might be involved in Medicaid billing through a fiscal intermediary or some form of participant-directed care. But even then, the lines are thin.

If your model doesn’t clearly separate you from the care itself, Medicaid could turn your registry into something it was never meant to be. And that can cost you your business.

Keep It Clear, Keep It Safe

Florida registries have enough to manage without inviting trouble. Medicaid might seem like a growth opportunity, but it’s filled with risk.

Stick to private-pay when possible. If you’re being pulled toward Medicaid, talk to a legal expert who understands Florida’s registry laws. And make sure your software and systems support a true 1099 model.

In 2026, the line between a registry and an agency is thinner than ever. Make sure you stay on the right side.