Florida Medicaid Updates!

Statewide Medicaid Managed Care Open Enrollment

This notice applies to Florida only

The Statewide Medicaid Managed Care annual open enrollment (OE) season begins October 1, 2021. During open enrollment, members may choose a different managed care plan or remain with their current plan. Open enrollment will occur in phases based on the region in which the member lives.

Merger Reminder

This notice applies to Florida only

Centene’s acquisition of WellCare's Medicaid products, including Staywell Health Plan, will be complete Oct. 1, 2021. Sunshine Health will also operate the Department of Health’s Children's Medical Services Health Plan beginning Oct. 1, 2021. WellCare Medicare products, claims and correspondence procedures are not changing at this time.

Share of Cost (SOC) Notices

This notice applies to Florida ALF's only

Sunshine Health will be initiating recovery notices this week to the providers who have been identified as having current amounts eligible for recovery related to the share of cost (SOC) claim audit. Share of Cost (SOC) notices going out this week.

Long-Term Care Overpayment Review

This notice applies to Florida only

Health Management Systems (HMS) has been contracted by Simply Healthcare Plans, Inc. and Clear Health Alliance (Simply) to conduct an Overpayment Review Program at long-term care facilities in the State of Florida. Health Management Systems (HMS) will be initiating reviews to determine the existence of any potential overpayments.

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