Florida CMS Plan Moved to Molina on October 1: What Providers Need to Know
The Florida CMS Plan Molina providers need to know about is now live. On October 1, 2026, Molina Healthcare of Florida took over administration of the CMS Plan from Sunshine State Health Plan. If you treat children with special health care needs, your contract, claims routing and authorizations are affected.
What changed: Florida CMS Plan Molina providers should know the plan name first
“CMS” here means Children’s Medical Services, a Florida Department of Health program. It does not mean the federal Centers for Medicare & Medicaid Services. The CMS Plan is a Florida Medicaid managed care plan for children with special health care needs.
The Agency for Health Care Administration (AHCA), Florida’s Medicaid agency, selected Molina Healthcare to run the plan. Sunshine Health ran it before. Molina’s roadshow says the new contract runs through 2030. The plan sits inside Florida’s Statewide Medicaid Managed Care (SMMC) program. For the bigger picture, see our Medicaid managed care guide.
When it takes effect
It took effect October 1, 2026, and it is in effect now. AHCA says members moved automatically, with no new application. Here are the dates that matter for billing.
| Item | Rule | Source |
|---|---|---|
| Go-live | October 1, 2026 | AHCA |
| Professional claims | Date of service before 10/1 goes to Sunshine. On or after 10/1 goes to Molina. Split claims that span both. | Sunshine Health |
| Inpatient facility claims | Admitted before 10/1 goes to Sunshine, even if discharged later. Admitted on or after 10/1 goes to Molina. | Sunshine Health |
| Prior authorizations | Molina honors authorizations approved before 10/1 during continuity of care. | Molina |
| Continuity of care | Up to eight months; Molina’s roadshow gives May 31, 2027 (240 days) or sooner if the care plan is finalized. | Molina |
Who it affects
This affects any provider who treated CMS Plan members under Sunshine. That includes psychotherapists and psychiatrists who see children in the plan. AHCA also notes that some children may need new providers, because all services now run through Molina. Medicaid rules apply here. Private insurance and Medicare follow different rules, so do not apply this to a commercial plan such as Florida Blue. Florida CMS Plan Molina providers include any practice that treats children enrolled in the Children’s Medical Services plan.
Practical impact
AHCA says no immediate action is required and that you may keep providing care. Contracting is a different matter. Molina’s FAQ says Sunshine contracts do not carry over, so you need your own Molina agreement to stay in network. Molina’s roadshow says it will pay current providers at their prior rate unless both sides agree to another rate. Florida CMS Plan Molina providers should expect claims, authorizations and eligibility checks to route to Molina after the change.
Claims routing is the biggest daily change. Molina’s FAQ says claims can go through the Availity Essentials portal or an EDI clearinghouse using Payer ID 51062. Old dates of service still go to Sunshine. Keep two payer setups in your billing system until your old claims clear. Your credentialing and network status records may need updating too.
On the behavioral health side, Molina’s roadshow lists expanded coverage for evidence-based practices, including trauma-focused cognitive behavioral therapy (CBT). Read the plan’s own policies before you bill any service. We do not set coverage rules here.
What to do next
- Apply to Molina through its CMS provider page if you have not. Do not assume your Sunshine contract moved.
- Log in to Molina’s provider portal and check your credentialing status, demographics and roster.
- Set up Availity or Payer ID 51062 for new dates of service.
- Run eligibility verification on each child before the next visit, since members received new ID cards.
- Work your old Sunshine claims by date of service. Use claim status inquiry to chase them.
- Sign up for AHCA Medicaid alerts so you see updates first.
Get a Free Quote Florida CMS Plan Molina providers can start by confirming contract status with Molina and updating the payer list in their billing system.
Questions to verify with the payer
Ask Molina’s provider relations team these before you rely on any answer: Ask Molina how Florida CMS Plan Molina providers should handle claims for services delivered before October 1.
- What is the timely filing limit for CMS Plan claims, and for claims sent to the wrong plan?
- When will my application be approved, and can I bill while it is pending?
- Which behavioral health codes need prior authorization under the CMS Plan?
- How will you handle denials tied to the plan change? Our denials and appeals guide explains the process.
Our insurance company contact directory and Florida Medicaid billing page help you find the right channels. More state pages are in the state billing guides, and the full library is in Resources.
What is the Florida CMS Plan transition in one answer?
Molina Healthcare of Florida replaced Sunshine as the CMS Plan administrator on October 1, 2026. Members moved automatically. Providers need a Molina contract, and claims route by date of service. Florida CMS Plan Molina providers should confirm timely filing directly with Molina.
Frequently asked questions
Do I need a new contract to see CMS Plan members?
Yes. Molina’s provider FAQ says current Sunshine Health contracts do not carry over, and providers must apply to Molina. Molina is accepting network applications statewide. Applying early is encouraged.
Where do I send claims for dates of service before October 1, 2026?
Send them to Sunshine Health. Sunshine’s provider notice says professional claims go by date of service: before October 1 to Sunshine, October 1 or later to Molina. Claims that span both dates must be split.
Can I keep seeing my current CMS Plan patients?
Yes. Both AHCA and Molina ask providers not to cancel appointments. Molina’s roadshow says current enrollees can keep seeing their current providers during the continuity of care period, and prior authorizations approved before October 1, 2026 will be honored.
Does the transition change what behavioral health services are covered?
AHCA says covered services and benefits stay the same during the transition. Molina’s roadshow lists expanded coverage for some evidence-based practices. Check the plan’s current authorization and payment policies before you bill a specific service.
More answers are in our billing FAQ.
Where MCM South works
MCM South works with psychotherapists and psychiatrists in ten currently served states: Georgia, Massachusetts, Connecticut, Texas, Florida, New York, Colorado, Tennessee, North Carolina and Illinois. See who we serve. This post is operational guidance, not legal advice.
Sources checked October 25, 2026: AHCA, Molina Healthcare of Florida and Sunshine Health provider pages linked above.
