Transitioning from Sunshine Health to Molina Medicaid in Miami-Dade
Florida’s Medicaid program uses a managed care model called the Statewide Medicaid Managed Care (SMMC) program, administered by the Florida Agency for Health Care Administration (AHCA). Under this model, the state contracts with private managed care plans, such as Sunshine Health and Molina Healthcare, to coordinate Medicaid-covered services for enrolled members in each region, including Miami-Dade County.[ahca] From time to time, AHCA’s contracting and enrollment periods can result in a member being reassigned from one plan to another, and Florida Medicaid members are notified directly by AHCA and their plan when this occurs.
If you or a family member has received a notice that Medicaid coverage is moving from Sunshine Health to Molina Healthcare, this article explains, in general terms, what a plan transition does and does not mean, and what questions to ask before assuming that services, providers, or authorizations will continue unchanged. This is educational information only. It is not legal, insurance, or medical advice, and it does not replace the official notice from AHCA or the member’s new plan.
Key takeaways
- AHCA oversees Florida’s Statewide Medicaid Managed Care program and determines which managed care plans operate in each region; plan assignments can change between procurement or enrollment cycles.[ahca]
- A new Medicaid managed care plan does not automatically inherit the prior plan’s provider contracts, network status, prior authorizations, or admission decisions; each must be verified independently with the new plan.
- Members generally have rights during a plan transition, including a choice period and, in many cases, continuity-of-care protections for certain ongoing services, but the specific rules must be confirmed with AHCA and the new plan.
- Ameri-Care can review a referral for a patient whose Medicaid plan is changing, but cannot guarantee network participation, authorization, admission, or coverage under the new plan.
- Always verify current requirements directly with AHCA, the Medicaid choice counseling service listed on your enrollment notice, and the new plan’s member services line.
Understanding Florida’s Statewide Medicaid Managed Care Program
Under SMMC, AHCA contracts with managed care organizations to deliver Medicaid benefits, and each region of the state is served by a specific set of plans chosen through the state’s procurement process.[ahca] Because these contracts are awarded and renewed on a periodic basis, the specific plans available in Miami-Dade County can change over time, and members can be moved from one plan to another as part of that process. When this happens, AHCA and the affected plans are responsible for notifying members in writing before the change takes effect.
Why a Medicaid Plan Might Change
A member’s assigned Medicaid plan can change for several general reasons, including:
- A new procurement cycle in which the state selects different managed care plans to serve a region.
- The end of a member’s choice period after an open enrollment window.
- An administrative correction or eligibility change identified by AHCA.
The exact reason for any individual’s plan change should be confirmed using the notice received from AHCA or the plan, not assumed from general information in this article.
What a Plan Transition Does Not Automatically Mean
It is important for families and referral partners to understand what a plan change from Sunshine Health to Molina Healthcare does not automatically guarantee:
- It does not mean every provider is in-network with the new plan. Network participation must be verified directly with Molina Healthcare, since a provider who worked with Sunshine Health is not automatically contracted with Molina.
- It does not mean prior authorizations automatically transfer. Some services may require a new authorization request, even if a previous authorization was approved by Sunshine Health.
- It does not guarantee admission to any specific home health agency. Admission still depends on a current order, clinical review, and the agency’s capacity and network status with the new plan.
- It does not guarantee coverage of any specific service, visit frequency, or duration. Coverage always depends on medical necessity, plan rules, and authorization that must be confirmed under the new plan.
Steps to Verify Your New Coverage
Before assuming that care will continue without interruption, members and referral partners should:
- Read the official notice from AHCA and the new plan carefully, and note the effective date of the change.
- Call the number on the new Molina Healthcare member ID card to confirm enrollment, effective date, and assigned primary care provider.
- Ask about continuity of care. Many managed care transitions include a temporary continuity-of-care period for certain ongoing services or providers; ask Molina Healthcare directly whether this applies to the specific service and time frame.
- Ask whether a current provider is in-network with Molina Healthcare, rather than assuming that a Sunshine Health network provider is automatically included.
- Ask whether existing prior authorizations transfer, or whether a new authorization request must be submitted.
- Keep records of who you spoke with, the date, and what was confirmed, in case a question arises later.
Transition checklist
| Question | Who should confirm it? | Record to keep |
|---|---|---|
| Is the new Molina enrollment active, and when does it begin? | AHCA or Molina member services | Notice, member ID card, effective date |
| Is the current provider in Molina’s network? | Molina and the provider | Representative name, date, reference number |
| Does an existing authorization transfer? | Molina authorization team | Authorization number, dates, written confirmation |
| Does continuity of care apply? | Molina and the treating care team | Applicable period and covered service |
| Can Ameri-Care review a new referral? | Ameri-Care intake | Referral status and documents requested |
This checklist helps organize questions; it does not change eligibility, network, authorization, or admission decisions.
Questions to Ask During the Transition
When speaking with Molina Healthcare, Sunshine Health, or AHCA’s Medicaid choice counseling service, consider asking:
- What is the effective date of my new Molina Healthcare coverage?
- Is my current home health provider in-network with Molina Healthcare?
- Do my current prior authorizations transfer, or do I need a new referral and authorization?
- Is there a continuity-of-care period for my ongoing services, and how long does it last?
- Who do I contact if a service is denied or delayed during the transition?
- What are my rights to choose a different plan, if any, during the current enrollment period?
How Ameri-Care Reviews Referrals During a Plan Transition
When Ameri-Care receives a referral for a patient whose Medicaid coverage is moving from Sunshine Health to Molina Healthcare, the intake team reviews the physician’s order, checks the patient’s current plan and authorization status, and confirms whether Miami-Dade service-area and agency capacity requirements are met. Ameri-Care does not automatically treat a prior Sunshine Health authorization, network agreement, or admission decision as valid under Molina Healthcare. Each element must be verified with the new plan before services are confirmed. Ameri-Care cannot guarantee network participation, authorization approval, admission, or a specific service schedule.
Miami-Dade Coordination
Ameri-Care Professional Service, Inc. is licensed to provide home health services in Miami-Dade County. Referral partners and families outside of Miami-Dade should confirm service-area coverage with the intake team or contact 211 for community resources closer to home.
Keeping Care Coordinated During the Transition
A Medicaid plan transition can be a stressful time for a patient who is already receiving home health services, so it helps to treat the change as an administrative process that runs alongside, not instead of, the patient’s clinical care. The treating physician’s order does not expire simply because the payer changes, but the authorization tied to that order under the old plan does not automatically carry over. Families and referral partners can reduce confusion by keeping a simple written timeline of the notice date, the new plan’s effective date, the date any continuity-of-care period ends, and the date a new authorization request is submitted, then sharing that timeline with both the intake team and the new plan’s member services line if a question or delay comes up. This kind of documentation does not change the outcome of a coverage or network decision, but it does make it easier to follow up accurately with AHCA, Molina Healthcare, or Ameri-Care if something appears to have been missed.
Frequently Asked Questions
Why is my Medicaid plan changing from Sunshine Health to Molina Healthcare?
Plan assignments in Florida’s Statewide Medicaid Managed Care program can change between procurement or enrollment cycles, as determined by AHCA. Review your official notice for the specific reason.[ahca]
Does Molina Healthcare automatically accept my current home health provider?
No. Network participation must be verified directly with Molina Healthcare. A provider who worked with Sunshine Health is not automatically in-network with Molina.
Do my prior authorizations transfer automatically?
Not necessarily. Some services may need a new authorization request under Molina Healthcare, even if Sunshine Health previously approved the service.
Is my home health service guaranteed to continue without interruption?
No. Continuity depends on continuity-of-care rules, medical necessity, authorization, and network status, all of which must be confirmed with Molina Healthcare.
Can Ameri-Care guarantee admission once my plan changes to Molina?
No. Ameri-Care can review a referral and coordinate with the new plan, but admission depends on clinical review, authorization, and agency capacity, and is never guaranteed.
Who can help me understand my Medicaid choice options?
Your official enrollment notice from AHCA lists the Medicaid choice counseling contact information for your case. Contact that service directly with plan-choice questions.
Sources
- Florida Agency for Health Care Administration, Statewide Medicaid Managed Care Program — https://ahca.myflorida.com/medicaid/statewide_mc/index.shtml
- Medicaid.gov, Managed Care — https://www.medicaid.gov/medicaid/managed-care/index.html
- Molina Healthcare, official website — https://www.molinahealthcare.com/
- Sunshine Health, Florida Medicaid — https://www.sunshinehealth.com/
Next Steps
For questions about a Miami-Dade home health referral during a Medicaid plan transition, call 305.826.8800 or use the secure Patient Referral Form. For a medical emergency, call 911. This article is educational information only, is not legal or insurance advice, and does not guarantee network participation, authorization, admission, or coverage under any plan.
Sources and Notes
- Florida Agency for Health Care Administration, "Statewide Medicaid Managed Care Program," https://ahca.myflorida.com/medicaid/statewide_mc/index.shtml
Related guidance
- Read this Sunshine Health to Molina transition guide in Spanish.
- Start a secure Patient Referral Form for a Miami-Dade referral.