Key Contacts And Important Phone Numbers
Sunshine Health provides a 24-hour help line to respond to requests for prior authorization. In addition, Sunshine Health staff is available from 8 a.m. to 8 p.m. Monday through Friday to answer provider questions and respond to provider complaints, emergencies and notifications.
After regular business hours the provider services line is answered by an automated system with the capability to provide callers with information about operating hours and instructions about how to verify enrollment for a member with an emergency or urgent medical condition. The requirement that Sunshine Health provides information to providers about how to verify enrollment shall not be construed to mean that the provider must obtain verification before providing emergency services and care.
The following are key services for which you may have a question and the phone number for that service:
- To contact a Provider Services representative, call 1-844-477-8313.
- For questions on medical or behavioral health authorizations, call 1-844-477-8313.
- For questions on the formulary or a drug that is provided through a retail pharmacy call, 1-800-311-0539.
- For questions on specialty drugs, call 1-866-796-0530.
- For questions on advanced imaging, call 1-877-807-2363.
- For questions on arranging covered transportation for our members, call 1-866-381-4853.
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.
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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Welcome To Children’s Medical Services Health Plan
Children’s Medical Services Health Plan is now operated by Sunshine Health! Your child keeps the same great benefits.
Get answers to Frequently Asked Questions.
CMS Health Plan, operated by Sunshine Health, provides managed care services to members. Sunshine Health is a licensed Florida health plan.
Medicaid And Child Welfare Specialty Plan
Until the actual date of enrollment with Sunshine Health, Sunshine Health is not financially responsible for services the prospective member receives. In addition, Sunshine Health is not financially responsible for services members receive after coverage is terminated. However, Sunshine Health is responsible for anyone who is a Sunshine Health member at the time of a hospital inpatient admission and changes health plans during that confinement.
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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.
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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Can I Pay My Bill Online
Ambetter offers convenient, online bill payment options. Auto pay saves you time and is worry-free. You can set up recurring or automatic payments on the same day each month. That way youll always pay on time. You choose the payment method . Then choose a date between the 15th and last day of the month to pay your bill. You can also make one-time online payments through your member account. Find instructions for Auto Pay or to make a one-time payment in your online member account.
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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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.
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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Why Am I Still Getting Bills When Im Set Up On Automatic Payments
You will continue receiving your bill as a reminder that your monthly bill is due. If you want to stop receiving paper bills, you can sign up for paperless billing. Paperless billing lets you view your bill in your online member account. You can also view your bill through a link sent to your email. Sign up for paperless billing through your online member account under billing.
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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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.
What Is Medicaid In Florida
Medicaid is a federal and state health insurance program for people with a low income.
It provides free or low-cost health coverage to millions of Americans, including families and children, pregnant women, the elderly, and people with disabilities.
The Childrens Health Insurance Program offers health coverage to children in families with incomes too high to qualify for Medicaid, but who cant afford private coverage.
The Medicaid program is different in every state. The federal government sets the general guidelines and each state decides how to run the program.
Florida implemented the Medicaid program on January 1, 1970, to provide medical services to low-income people.
The Florida State Legislature determines who qualifies for Medicaid, what services will be covered, and how much to pay for the services.
The state agency that administers Florida Medicaid is the Agency for Health Care Administration .
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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.
What Transportation Benefits Do I Receive As A Sunshine Health Medicaid Member
- Transportation to and from all your medical appointments. This could be on the bus, a van that can transport people with disabilities, a taxi or other kinds of vehicles.
- We cover the following services for members who have no transportation:
- Out-of-state travel
- Transfers between hospitals or facilities
- Escorts when medically necessary
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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.
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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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
Don’t Forget To Renew Each Year
Recertify your Medicaid coverage every 12 months to keep your benefits. Visit the Florida Department of Children and Families to sign up for email reminders.
ENROLLING AND CHOOSING SUNSHINE HEALTH IS EASY
1. Apply for Medicaid. If you are eligible for Florida Medicaid, the Agency for Health Care Administration will send you a letter asking you to choose a plan. Visit the Florida Department of Children and Families website to apply for Florida Medicaid. 2. Receive a letter to choose a plan. 3. Choose a plan. 4. Call a Choice Counselor toll-free at 1-877-711-3662 or visit the Statewide Medicaid Managed Care page online. 5. Receive a welcome packet from your plan.
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Can I Still Receive My Current Services From My Current Provider
Yes. You can keep getting services that Staywell or your doctor already approved. Sunshine Health will pay for these approved services. In addition, you can keep going to your same provider for up to 120 days, even if the provider is not in the Sunshine Health network. This 120-day period is called the Continuity of Care Period. After 120 days, you will need to get services through a Sunshine Health network provider. Please be aware, most Staywell providers are in the Sunshine Health provider network.
Comprehensive Long Term Care
Sunshine Health is responsible for providing LTC services once the Florida Department of Elderly Affairs determines an enrollee meets the medical requirements for nursing home level of care and the enrollee formally selects the Sunshine Health Comprehensive plan through AHCAs Choice Counseling. Following that selection, the Department of Children and Family Services determines if the member meets the financial criteria. Once AHCA receives confirmation of a members eligibility, AHCA notifies Sunshine Health of the members effective enrollment date. Coverage typically lasts for a year until DCF recertifies the member. During the annual recertification process, Comprehensive members may receive a 60-day extension of coverage and their benefit category is changed to SIXT on the secure provider portal of AHCAs website.
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What You Can Do
- Write us, or call us and follow up in writing, within 60 days of our decision about your services. or TTY at .
- Ask for your services to continue within 10 days of receiving our letter, if needed. Some rules may apply.
You can contact us at:
Sunshine Health
- Send you a letter within five business days to tell you we received your appeal.
- Help you complete any forms.
- Review your appeal and send you a letter within 30 days to answer you.
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.
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What Is The Florida Medicaid Income Limit
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.
| Florida Medicaid Income Limit Children |
| Children Medicaid Ages 0-1 |
| N/A |
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.
For example, if you are pregnant, to qualify for Medicaid, you cannot have an income higher than 191% of the Federal Poverty Level which for a family of two is $33,272 as shown in the chart above.
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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I Would Like To Change My Health Or Dental Plan
Change Health or Dental Plans Online
Log in to the FL Medicaid Member Portal to change your Health or Dental Plan. We will walk you through the process of changing your plan.
Why should you sign up for a FL Medicaid Member Portal account?
- You can check your Medicaid eligibility and enrollment status
- View and update your address
- Request help using secure messaging
- Enroll in a plan or change plans
- File complaint and see what is happening with your complaint
- Go paperless. Choose to only get letters from Medicaid electronically
- Receive email or text message alerts
Other Ways to Change Your Health or Dental Plan
If you are unable to change Health or Dental Plans online at this time, there are several other options available to you.
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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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.
