Sunshine Health Medicaid Florida Phone Number

Can I Still Fill My Medicines At My Current Pharmacy

Yes. You can keep getting medicines that Staywell or your doctor already approved for up to 120 days. During this time, Sunshine Health will pay for these approved medicines. Most Staywell pharmacies are in the Sunshine Health network. If your pharmacy is not in network, you can keep going to the same pharmacy for 120 days after Oct. 1, 2021. This is called the Continuity of Care Period. After 120 days, you will need to get your medicines at a Sunshine Health network pharmacy.

For More Information On What To Expect Next Log Into Your Online Member Account

If you dont have your account yet, setting it up is quick and easy get started now!You can also reach us from 8am-8pm EST at .

There are many ways to get in touch with us, and resources available on our website:

• New Ambetter Members Set up your Online Member Account
• Existing Ambetter Members Change your Primary Care Provider or see your benefits

Who Is Eligible For Medicaid In Florida

The following people may qualify for Florida Medicaid if they meet certain financialrequirements:

• Infants and children under the age of 21
• Recipients of Supplemental Security Income
• Seniors who are aged 65 or older
• People who are blind or expected to be disabled for at least a year
• People who need nursing home care or home and community-based care
• Medicare Beneficiaries whose income is low
• Aliens and refugees under a special assistance program
• Individuals who are medically needy

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Complaints Grievances And Plan Appeals

Sunshine Health wants to fully solve your problems or concerns. A grievance is an expression of dissatisfaction about any matter other than an action. An appeal is a request to review a Notice of Action. For more information on the Complaints, Grievances and Appeals Process please refer to the Member Handbook .

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Join The Movement For Better Health Insurance

Obamacare rates and group health insurance premiums are sky rocketing.

In todays market where health insurance is often unavailable or unaffordable, we can help you build a policy thats custom designed for your needs and your budget. Our product portfolio includes a sensible approach to health insurance.

Providing protection is what we stand for and we are determined to provide affordable coverage for every American

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Already Enrolled In Florida Medicaid

If you want to switch from your current Medicaid plan and enroll in Humana Healthy Horizons in Florida, you can:

• Text ENROLL to FLSMMC
• You will need the Medicaid ID number for each member and the account PIN number.

To pick a new plan, you will need each members birth year and Medicaid ID or Gold Card number.

Staywell Health Plan Members: Sunshine Health Is Excited To Welcome You

Staywell Health Plan and Sunshine Health are bringing our health plans together to better serve our members, providers, partners and communities.

Through this transition, we are committed to adding more value to better serve you.

Nothing is more important than taking care of you and your family.

In the coming months, well send you more information and a new member ID card in the mail. Please call Staywell Member Services if you need to update your mailing address or phone number.

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Will There Be Any Change In How You Protect My Privacy

No. Your privacy is important to us. You have rights when it comes to protecting your health information, such as your name, plan identification number, race, ethnicity and other things that identify you. We will not share any health information about you that is not allowed by law. Learn more about our Privacy Policy.

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Florida Medicaids Health Plan Resources

• Behavioral Health
• Utilization Management

The Agencys goals with this initiative are to improve communication and coordination between plans and providers generally, and more specifically: to reduce readmissions by improving communication among health plans and providers to improve members access to timely and appropriate services post-discharge and to streamline the coordination of behavioral health services for members, especially those with substance use disorder and opioid use disorder .

If you experience issues connecting with any of the plans’ provider resources, please contact the Agency by using the Florida Medicaid Complaint Form or call our Medicaid Helpline at 1-877-254-1055.

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Getting Help From Member Services

Our Member Services department can answer all of your questions. We can help you choose or change your Primary Care Provider , find out if a service is covered, get referrals, find a provider, replace a lost ID card, report the birth of a baby and explain any changes that might affect you or your familys benefits.

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S To Verify Eligibility

• Providers are asked to verify member eligibility by using the Sunshine Health secure provider portal. Using the portal, any registered provider is able to quickly check member eligibility by indicating the date of service, member name, and date of birth or the Medicaid ID number and date of birth.
• Providers may call Provider Services at 1-844-477-8313. Providers are asked to supply the members name and date of birth or the members Medicaid identification number and date of birth.

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How Do I Contact My Local Florida Medicaid Office

You can contact your local Florida Department of Children and Families office for help with your Medicaid application or benefits.

to locate an ACCESS Service Center Locations. You can search by county.

In addition, local community partner agencies help the Department of Children and Families provide access to public assistance services.

To find a partner agency in your area, to search by county or zip code.

Will I Lose Benefits When I Become A Sunshine Health Member

No. You will keep all the benefits you currently have as a Staywell Health Plan member, plus get more benefits from Sunshine Health. These new benefits are designed with your health in mind and include:

• Unlimited nutritional counseling as recommended by your doctor
• Unlimited art therapy as recommended by your doctor
• Various medical supplies and equipment, such as hypoallergenic bedding for people with asthma
• Unlimited coverage for outpatient hospital services recommended by your doctor
• Waived copayments for all services
• Eligible members with a SafeLink Wireless phone can get additional minutes as needed through the ConnectionsPlus program

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Health Insurance Resources For Providers

What you need to know about the Coronavirus. Learn More.

Healthy partnerships are our specialty.

With Ambetter, you can rely on the services and support that you need to deliver the best quality of patient care. Youre dedicated to your patients, so were dedicated to you.

When you partner with us, you benefit from years of valuable healthcare industry experience and knowledge. Were dedicated to helping your practice run as efficiently as possible, which is why we always strive for prompt claims processing.

At the end of the day, our job is to make yours easier. That way, you can focus on your patients. Theyve always been able to count on you. And, as a partner with Ambetter, youll be able to count on us.

Logisticare Is Now Modivcare Your Benefits Have Not Changed

To help you get healthy and stay healthy, we can provide rides to your medical appointments at no cost to you.

ModivCare provides transportation for Sunshine Health Medicaid members. There are no limits to the number of trips during the year between medical appointments, healthcare facilities or pharmacies.

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Will My Doctors Change

In most cases, your doctors will stay the same. Plus, our provider network is growing to give you even more choices. Most Staywell providers are in the Sunshine Health provider network. If your doctor is not in the network, you can continue to see your doctor for up to 120 days after Oct. 1, 2021. This is called the Continuity of Care Period. After 120 days, you will need to find providers in the Sunshine Health network.

The FL Medicaid eligibility income limit charts are divided by groups.

For example, the first chart is focused on income limits for children who qualify for Medicaid.

Similarly, the second chart below focuses on the Medicaid income limits for adults in Florida who qualify for Medicaid.

Florida Medicaid Income Limit for Children

Below is the income limit for children by age category. Find the age category your child falls into and you will see the income limit by household size.

How to Read the Florida Medicaid Income Limits Charts Above

You cannot have an income higher than the Federal Poverty Level percentage described for your group to be eligible for Medicaid.

Similarly, when you identify the income group that applies to you, the income limit you see refers to the maximum level of income you can earn to qualify for benefits.

Staywell Health Plan Is Joining Sunshine Health

We have good news. Your Medicaid plan, Staywell Health Plan, is joining Sunshine Health! You get to keep the same great benefits, plus get more benefits from Sunshine Health.

In most cases, your care manager, your doctors and the prescriptions you get will stay the same. Plus, our provider network is growing to give you even more choices.

On Oct. 1, 2021, our Staywell name will go away and you will become a Sunshine Health member. In the weeks leading up to Oct. 1, 2021, you will receive two mailings. You will get a welcome letter from Sunshine Health, followed by a new Member ID card.

You do not need to do anything to start enjoying the new benefits of becoming a Sunshine Health member.

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Why Choose Humana Healthy Horizons In Florida

We designed Humana Healthy Horizons in Florida to provide you with the care and support you need so you have more time to focus on what you love.

Now more than ever, your health and healthcare coverage are important. Humana Healthy Horizons in Florida makes available to Florida Medicaid enrollees access to the high-quality you want and extras you need.

Humana is proud of our strong, 20-year relationship with Florida Medicaid. Were focused on helping you make the most of your plan.

Here are some things to know about enrolling in a Florida Medicaid plan:

• All Medicaid plans have $0 copays
• All Medicaid plans have the same basic benefits
• All Medicaid plans have the same drug coverage
• Some plans, like Humana Healthy Horizons in Florida, may have .

Vaccine Coverage For Medikids Enrollees

Sunshine Health covers vaccinations for MediKids enrollees under the SMMC program. Services rendered in 2018-2020 will be paid at the applicable 2018 MediKids fee schedule or MPIP rate. Services rendered from 2021 forward will be paid at the current CDC vaccination rate. Any prior underpayments will be reprocessed automatically. Providers do not need to resubmit claims.

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How Do I Find My Florida Medicaid Number

Your Florida Medicaid identification number is not listed on your gold card. Your Florida Medicaid number is kept in your Florida Medicaid file.

Any Medicaid provider can use your gold card or health plans membership card to check the Florida Medicaid file to find out if you are eligible for Florida Medicaid services.

Other Behavioral And Mental Health General Resources

Florida Medicaid covers a wide array of behavioral and mental health services, as do Florida Medicaid managed care plans. This section provides links to various resources.

The Office of Substance Abuse and Mental Health within the Florida Department of Children and Families is the Floridas single legislatively designated mental health authority. For information about the services offered, please visit

In addition, DCF contracts for behavioral health services through regional systems of care called Managing Entities . These entities do not provide direct services rather, they allow DCFs funding to be tailored to the specific behavioral health needs in the various regions of the State. Click here for more information, including links to the MEs throughout Florida:

For links to resources for supporting the mental and emotional health needs of children and families before, during, and after a disaster, please visit . These resources may be helpful to families, community planners and child care partners, or healthcare system partners.

This site provides an interactive map to show Mental Health First Aid trainers and instructors in the U.S.:

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Do You Need Help Communicating

If you do not speak English, we can help. We have people who help us talk with you in your language. We provide this help at no charge to you.

For people with disabilities: If you use a wheelchair, or are blind, or have trouble hearing or understanding, call us if you need extra help. We can tell you if a providers office is wheelchair accessible or has devices for communication. Also, we have services like:

• Telecommunications Relay Service. This helps people who have trouble hearing or talking to make phone calls. Call 711 and give them our Member Services phone number. It is 1-866-796-0530. They will connect you to us.
• Information and materials in large print, audio and braille.
• Help in making or getting to appointments.
• Names and addresses of providers who specialize in your disability.

All of these services are provided free to you.

The Interoperability And Patient Access Rule

You are now able to view your health information from a third party app on a mobile device or PC! Check out the Interoperability Page to learn more.

Welcome to Sunshine Health! Were glad youre a member.

Its time to take control of your health and this is the place to start. Your new health insurance offers comprehensive physical and behavioral healthcare. We have programs, tools and supports to help you get healthy and stay healthy.

You can count on us to provide the resources you need to care for yourself and your family. This page will help you understand how to use your new coverage.

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When Your Information Changes

If any of your personal information changes, let us know as soon as possible. You can do so by calling Member Services. We need to be able to reach you about your healthcare needs.

The Department of Children and Families needs to know when your name, address, county or telephone number change, as well. Call DCF toll-free at 1-866-762-2237 Monday through Friday from 8 a.m. to 5:30 p.m. You can also go online and make the changes in your Automated Community Connection to Economic Self Sufficiency account. You may also contact the Social Security Administration to report changes. Call SSA toll-free at 1-800-772-1213 , Monday through Friday from 7 a.m. to 7 p.m. You may also contact your local Social Security office or go online and make changes in your Social Security account.

Florida Medicaid Phone Number Summary

We hope this post on Florida Medicaid Phone Number was helpful to you.

If you have any questions about Medicaid in the state of Florida, you can ask us in the comments section below.

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Be sure to check out our other articles about Medicaid.

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What Is Changing On Oct 1 2021

New Member Rewards Program: You will be automatically eligible for Sunshine Healths member rewards program that pays you for certain healthy behaviors. Its called My Health Pays®. For example, pregnant members earn $20 just by filling out a Notification of Pregnancy form in the first trimester. See the full list of rewards.

New Easy Order OTC: Its easy to use your $25 per month per household over-the-counter benefit. Download the Envolve OTC mobile app. Browse and select products to be shipped to your home, all from your phone. Learn more about the OTC benefit.

New Specialty Pharmacy Provider: AcariaHealth provides Sunshine Healths specialty medications. If you need these, you may be able to have medicines shipped to your home. Learn more about the pharmacy benefit.

New Vision Provider: Your vision benefits have not changed, but your new vision provider will be Envolve Vision. Their customer service number is 1-833-705-1354 . Please see the Continuity of Care section for more information.

New Therapy Services: Your therapy benefits have not changed, but your new therapy benefit administrator will be Health Network One. To confirm if your current therapy provider is a participating provider or if you have any questions regarding therapy services, please contact Member Services at 1-866-796-0530 . Please see the Continuity of Care section for more information.

Continuation Of Benefits For Medicaid Members

If you are now getting a service that is going to be reduced, suspended or terminated, you have the right to keep getting those services until a final decision is made for your Plan appeal or Medicaid fair hearing. If your services are continued, there will be no change in your services until a final decision is made.

If your services are continued and our decision is not in your favor, we may ask that you pay for the cost of those services. We will not take away your Medicaid benefits. We cannot ask your family or legal representative to pay for the services.

To have your services continue during your appeal or fair hearing, you must file your appeal and ask to continue services within this time frame, whichever is later:

• 10 days after you receive a Notice of Adverse Benefits Determination , or
• On or before the first day that your services will be reduced, suspended or terminated

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