Medicaid provides medical coverage to lowincome individuals and families. Allwell from sunshine health is a new medicare advantage plan, providing quality healthcare youd expect from a big company, but delivered on a local level. Your new health insurance offers comprehensive physical and behavioral healthcare. Florida department of children and families access florida. This workshop will provide an overview of sunshine healths child welfare specialty plan. Ambetter from sunshine health 2020 evidence of coverage florida. Florida state dental plans medicare, medicaid, chip. You can email your application and documents to the address listed on this page. The same high quality, high touch healthcare you get from nicklaus childrens health system will be available to you.
Floridas medicaid program is called the statewide medicaid managed care smmc. We have programs, tools and supports to help you get healthy and stay healthy. This statewide medicaid managed care health plan implements a traumainformed model of care that uniquely integrates physical health, behavioral health, and child welfare in order to support the specialized needs of the children served. Unitedhealthcare of florida, inc sunshine state health plan, inc ahf mco of. Childrens medical services health plan provider manual effective april 22, 2019 page 5 of 121. Staywell health plan is a managed care plan with a florida medicaid. Medicaid eligibility requirements are statespecific, so candidates must learn how to qualify for medicaid in florida if they plan to apply for governmentsponsored health coverage in the sunshine state. You can look forward to choosing a primary care provider pcp to work. Sunshine health provides the tools and support you need to deliver the best quality of care. If the agencys decision stands, sunshine health plan will operate in all 11 regions of the state. Sunshine health will cover services provided via telemedicine to the same extent that sunshine health covers the same services in person. Coming in second is sunshine health plan, a subsidiary of st. Florida community care health plan, covered services.
Our customer service team is friendly and cares about our members. You can mail completed application to florida kidcare, p. Authorizing services sunshine health medicaid and child welfare initial authorization of postevaluation, subsequent visits. Medicaid eligibility in florida is determined either by the department of children and families dcf or. Florida managed medical assistance program medicaid. Transportation is provided for medical and social service appointments, grocery trips, health and wellness, personal business and more. Managed medical assistance mma program, longterm care ltc program, and dental program. We provide the integrated solutions you need to make it easier to deliver the best preventionfocused care for. In 2011 the florida legislature established the florida medicaid program as a statewide, integrated. Sunshine health is a managed care organization mco contracted. Lighthouse health plan, a medicaid plan created by the doctors you know and trust. Inpatient medicaid prior authorization fax form keywords. The website contains our electronic billing manual, which offers detailed. Thank you for participating in our network of physicians, hospitals, and other healthcare professionals.
Medicaid, chip and medicare, including prescription drug plans and health plans for families and children. Sunshine health offers comprehensive medicaid, longterm. The provider must be licensed within the state of florida and a member must be present and participating in the visit. Sunshine health plan speci c information 01022018 page 1 of 9 atafl can receive an authorization request via facsimile at 800 9802380.
Your florida medicaid plan has many benefits to help you make the most of your plan. Head to our member and provider sections to find helpful information. However, their mother may choose another plan for the baby after enrollment. In florida, wellcare and sunshine health are bringing our health plans together to better serve our members, providers, partners and communities. Florida provider resources florida medicaid sunshine. Implementation plan florida department of transportation. Enrollment in a sunshine state health plan depends on contract renewal. Healthy florida plan may expand medicaid in sunshine state. American eldercare a littleknown delray beach firm that specializes in caring for seniors in independent living, assisted living and rehab centers, as well as in their homes is the only company that won. You can look forward to choosing a primary care provider pcp to work with you and coordinate your care. Sunshine health offers affordable florida medicaid, medicare plans and our health insurance marketplace product, ambetter. Medicaid provides free or lowcost health insurance to millions of americans. In fact, medicaid is a part of florida kidcare program. Its time to take control of your health and this is the place to start.
Learn more about what kinds of things medicaid covers. Exceptions may apply for individuals who develop esrd while enrolled in an allwell commercial or group health plan, or a medicaid plan. In 2014, cms plan signed a contract with the florida agency for health. A medicaid plan focused on you is a mission near and dear to our hearts. Provider request for reconsideration andclaim dispute form use this form as part of the ambetter from sunshine healthrequest for reconsideration and claim dispute process. Centene and its wholly owned health plans have a long and successful track record o. Florida inpatient medicaid prior authorization fax form. The institutional care program icp is a medicaid program that helps people in nursing facilities pay for the cost of their care plus provides general medical coverage. Provider service network psn nicklaus childrens health system. We do more than take care of our members when they are sick. Use our online search tool to find a dentist near you. Lighthouse health plan is a local, communitybased medicaid health plan created and run by doctors. If a practitionerprovider already participates with sunshine health in the medicaid or a medicare product.
This profile reflects state managed care program information as of august 2014, and only includes information on active federal operating authorities, and as such, the program start date may not reflect the earliest date that a program enrolled beneficiaries and provided services. What are the general medicaid requirements and what are the income requirements for medicaid in florida. Most medicaid recipients must enroll in a health plan that was selected through a competitive procurement to participate in the smmc program. This profile reflects state managed care program information as of august.
Starting on december 1, 2018, humana, staywell, and sunshine health the mcos will require providers to use hhaexchange to submit confirmed visits and bill directly to each mco through the free hhaexchange portal. It is referred to as the statewide medicaid managed care smmc program. Aarpmedicarecomplete choice plan 2 regional ppo united health care first coast advantage medicaid florida blue bcbs of florida see bcbs for determination humana ppo red stripe card only phcs. Eef therapy services will be authorized after submission of the patient intake form as described in this manual. Managed medical assistance mma title 19 provider manual.
Sunshine health is a managed care plan with a florida medicaid contract. We offer affordable medicare advantage plans in florida that includes the same benefits of original medicare plus extra benefits such as prescription drug coverage, vision, dental and hearing care. Florida provider request for reconsideration and claim. Florida medicaids health plan resources the agency is committed to working with smmc plans to promote continuity of and better access to care for medicaid members. They are american eldercare, sunshine state health plan and unitedhealthcare of florida. Provider directories florida medicaid sunshine health. The agency is committed to working with smmc plans to promote continuity of and better access to care for medicaid members.
If a practitionerprovider already participates with sunshine health in the medicaid or a medicare. The rewards program is one of your sunshine health plan benefits. This profile reflects state managed care program information as of august 2014, and only includes information on active federal operating authorities, and as such, the program start date may not reflect the earliest date that a. It also will offer access to a traditional medicaid managed care plan in nine of the 11 medicaid regions, after being shut out of regions 1 and 10. Were excited to bring our companies together, what it means for our employees, and. Flsunshine state health plan has a contract with medicare and medicaid to offer hmo snp plans. Federal waiver approval and implementation floridas new medicaid plan called the managed medical assistance program will move nearly all of the states medicaid beneficiaries into managedcare plans. Some providers may not perform certain services based on religious or moral beliefs. Sunshine health plan speci c information 01022018 page 7 of 9 please refer to the health plan issued member id card to find copayment information or you may obtain the copayment information when verifying eligibility with sunshine health directly. Familyrelated medicaid fact sheet 3 coverage for children children under age 19 medicaid may be provided to children under age 19, who are unmarried, not legally emancipated, or whose marriage was annulled. Are you looking for direction on medicaid in florida.
Guaranteed renewable means that your plan will be renewed into the subsequent. Coverage is open to lowincome people, families and children, pregnant women, senior citizens and people with disabilities. Sunshine health 1 international pkwy, 4th floor sunrise, fl 33323. This new plan, approved in june 20, is the final chapter in a. Our health insurance programs are committed to transforming the health of the community one individual at a time. This includes, children living with nonrelatives or.
In florida, most medicaid recipients are enrolled in the statewide medicaid managed care program. In 2014, the florida medicaid program implemented a new system through which medicaid enrollees receive services. Based on the information provided, visits for medicaid and child welfare. It is free or low cost, and it is run by both the state and the federal government. Statewide medicaid managed care smmc is the program where most medicaid recipients receive their medicaid services.
Eligible medicaid recipients will receive a letter with enrollment information, including information on how to enroll. Sunshine health is contracted to provide specialized services and is also. The allwell medicare hmo plan gives you access to our network of highly skilled medical. Sunshine health provides a comprehensive health plan offering, medicaid and longterm care coverage under one plan, across more regions of the state than any other managed care company in florida. The allwell medicare hmo plan gives you access to our network of highly skilled medical providers in your area. Centene and its wholly owned health plans have a long and successful track record. Medicaid, indicate the software vendors trading partner id. Lighthouse health plan, a medicaid plan created by the. Sunshine medicaid provider manual page 5 of documentation plan of care documentation. Florida names nine proposed medicaid health plans blogs. At dentaquest, we are committed to improving oral health care for all. Ambetter from sunshine health operates under its legal entity, celtic. Open the attached list and use the adobe acrobat search tool to locate specific drugs by name or hic3 therapeutic class.
Wellcare s corporate office is located in tampa, florida. Ncqa health insurance plan ratings 20152016 summary report medicaid search for a health insurance plan by state, plan name or plan type private, medicaid, medicare. There are three different programs that makeup the statewide medicaid managed care. Sunshine healths medicaid child welfare speciality plan qpi.
Please refer to the member id card for the phone number of sunshine s eligibility department. Sunshine health has a child welfare specialty plan, called the child welfare. Please view our listing on the left, or below, that covers forms, guidelines, helpful links, and. Pdf medicaid and comprehensive longterm care member handbook spanish pdf home newsroom about us contact us careers. Atafl will not accept ranges from providers when indicating the following in the plan of care. Therefore, to ensure that part c remains the payer of last resort, the service provider must be enrolled in all of the medicaid mma plans for the uf nces area. Florida unitedhealthcare community plan medicaid mma. The sunshine health provider directory is a list of physicians, hospitals and other healthcare providers that are available to you. The tampa companys staywell plan now has more than 600,000 florida medicaid members. Ncqa rated more than 1,300 health insurance plans based on clinical quality, member satisfaction and ncqa accreditation survey results. To better connect members to appropriate services, please click on each health plans link to find information on expanded benefits, discharge planning tools and other helpful. Wellcare, centene medicaid winners health news florida.
Florida inpatient medicaid prior authorization fax form author. What are the general medicaid requirements and what are the income requirements for medicaid in. Sunshine health plan speci c information 01022018 page 1 of 9 ata fl can receive an authorization request via facsimile at 800 9802380. Staywell, a wellcare company, isnt affiliated with us but they provide information to those looking for florida medicaid solutions. Florida provider resources florida medicaid sunshine health.
Florida state medicaid managed care provider information. Ambetter from sunshine health makes it easier than ever to get health insurance coverage. People on medicaid will get services using one or more of these plan types. Evv and claims billing for floridas state medicaid managed care program. Sign in with your florida medicaid account use new password if you recently completed a reset. If you plan to use a billing agent clearinghouse to submit directly tofrom medicaid, indicate the billing agentclearinghouses trading partner id. Managed medical assistance, longterm care, and dental. Enhanced my health pays member rewards program helps ambetter from sunshine health members take charge of their health.
Oct 30, 20 the medicaid caseloads in state fiscal year 20142015. For example, the child welfare specialty plan and the plan for children with. Children eligible for medicaid can also receive benefits under florida kidcare program. Florida state medicaid managed care health health plan. A guide to the institutional care program medical assistance for low income individuals in or entering a nursing home what is institutional care program icp. Sunshine health would offer medicaid beneficiaries access to a traditional plan as well as a. Florida names 9 medicaid health plans but challenges loom. Florida medicare advantage plans with part d prescription. We focus on building strong, longterm partnerships with providersso you can depend on us now and in the. If that sounds like the information youre looking for, visit.
Centene shares your dedication to improving the health of our community. Services must be a covered health plan benefit and medically necessary with prior. The state and federal government share the cost of the medicaid program. This new plan, approved in june 20, is the final chapter in a medicaid reform effort that is almost a decade old. Florida managed medical assistance program the agency for required to enroll in an mma plan to receive florida medicaid covered services. Sunshine line provides doortodoor transportation and bus passes for elderly, lowincome, and people with disabilities who do not have or cannot afford their own transportation. Medicaid recipients who qualify and become enrolled in the florida mma. Childrens medical services managed care plan florida.
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