Florida delivers most Medicaid coverage through Statewide Medicaid Managed Care (SMMC), reorganized as SMMC 3.0 into 9 lettered regions (A through I) effective February 1, 2025. Per CMS's most recent managed care enrollment data, report year 2024, Florida's comprehensive Medicaid managed care plans covered approximately 3.05 million members, predating the SMMC 3.0 regional realignment. Eight managed care organizations currently hold SMMC contracts, four of which also hold comprehensive long-term-care contracts across all 9 regions.
Florida delivers most Medicaid coverage through Statewide Medicaid Managed Care (SMMC), reorganized as SMMC 3.0 effective February 1, 2025 into 9 lettered regions (A through I), with contracts running through 2030. Eight managed care organizations currently hold SMMC contracts: Florida Community Care, Humana, Simply Healthcare Plans (Elevance), Community Care Plan, Sunshine State Health Plan (Centene), Aetna Better Health of Florida (CVS), Molina Healthcare of Florida, and UnitedHealthcare of Florida. Four of these plans (Humana, Sunshine State Health Plan, Simply Healthcare, and Florida Community Care) hold comprehensive long-term-care contracts across all 9 regions. Per CMS's most recent managed care enrollment data, report year 2024 (predating the SMMC 3.0 regional realignment), Florida's comprehensive Medicaid managed care plans covered 2,702,638 members in the 7 MMA+LTSS plans plus another 348,162 in specialty MMA-only plans, for a combined 3,050,800.
Long-term services and supports are integrated directly into the comprehensive managed care contracts ("MMA+LTSS") rather than carved out to a separate LTSS-only plan or vendor. LTSS enrollment is reported as part of the same comprehensive plans as physical and behavioral health, not as a separate program line. Humana and UnitedHealthcare also hold fully integrated dual eligible special needs plan contracts, combining Medicare and Medicaid coverage for full-benefit dual eligibles under one plan.
Integrated into managed care
Behavioral health is included within each Managed Medical Assistance (MMA) plan's comprehensive capitated benefit alongside medical, hospital, and specialty services, not carved out to a separate statewide vendor. Behavior Analysis (BA) services specifically were the one exception until SMMC 3.0: effective February 1, 2025, BA services for children under 21 moved from a fee-for-service-only delivery model into the MMA plans for the first time, ending the prior carve-out and requiring recipients to use an in-network BA provider with prior authorization routed through their plan rather than through the state's separate FFS utilization management vendor.
Carved in
Dental coverage is delivered through three statewide dental-only prepaid ambulatory health plans (PAHPs) on a choice basis, separate from the comprehensive MMA plans. All three operate statewide with a combined 2024 enrollment (3,091,795) larger than the comprehensive MMA+LTSS population, since dental PAHP enrollment covers both MMA and LTSS members plus additional populations. Effective October 1, 2025, SMMC dental coverage was expanded to include non-emergency dental services delivered in ambulatory surgical center and outpatient hospital settings.
Pharmacy is carved into each MCO's own capitated benefit rather than administered by a single statewide pharmacy benefit manager. Each of the 8 comprehensive plans manages its own pharmacy network and formulary. Florida maintains a uniform Preferred Drug List (PDL) for at least some drug classes, applied consistently across both fee-for-service and managed care to avoid formulary fragmentation between delivery systems.
Non-emergency medical transportation (NEMT) is delivered through two regional capitated brokers under SMMC's 9-region structure. Medical Transportation Management, Inc. covers Regions B, C, D, E, and F (91,965 enrollees per CMS's most recent data), and Modivcare Solutions, LLC covers Regions A, G, H, and I (73,612 enrollees).
Gainwell Technologies operates as Florida Medicaid's fiscal agent, handling provider enrollment, claims processing, payments, and provider call center support under the Florida Medicaid Management Information System (FLMMIS). A modernized provider enrollment system, AHCA Enterprise, operates under the same Gainwell fiscal-agent contract.
53 agency updates tracked for Florida. Available with Pro.
See them with ProU.S. Sen. Ashley Moody won a special election Tuesday to retain the Florida Senate seat she was appointed to after Marco Rubio became secretary of state, defeating Democratic state Rep. Angie Nixon by roughly 2 percentage points. The race centered on ideological attacks, with Moody branding Nixon a "socialist" over her Democratic Socialists of America affiliation. Nixon countered by repeatedly invoking the Hope Florida scandal, pointing to Moody's role as former attorney general in directing $10 million in Medicaid funds from a Centene managed care settlement to the Hope Florida Foundation, a charity championed by First Lady Casey DeSantis. Moody's win keeps the seat in Republican hands through 2028.
Florida has been especially affected by the expiration of enhanced federal subsidies for Affordable Care Act marketplace plans, leading many residents to lose or face unaffordable health coverage. The timing overlaps with this year's open enrollment period and upcoming elections, making healthcare access a prominent campaign issue in the state. The piece covers the political and consumer impact rather than announcing new federal or state Medicaid policy action.
AmeriHealth Caritas is closing PerformSpecialty, its Orlando-based specialty pharmacy, eliminating 61 positions according to state regulatory filings submitted Oct. 29. The facility will shut down by year-end, with layoffs beginning then and continuing in phases through April 7, 2027. The closure is part of a broader wind-down of PerformRx, AmeriHealth's in-house pharmacy benefit manager, announced in February following a multiyear review of pharmacy operations; the insurer is shifting pharmacy benefit management to Optum Rx in 2027. AmeriHealth Caritas, part of Independence Health Group, serves roughly 5 million Medicaid managed care members across 13 states and Washington, D.C.
Open enrollment for 2027 healthcare.gov coverage began Sunday in Florida, running through Dec. 15 for Jan. 1 coverage and Jan. 15 for Feb. 1 effective dates. Twelve insurers will offer marketplace plans and three more will sell ACA-compliant plans off-exchange, with average premiums rising 10.4% before subsidies, per the Florida Office of Insurance Regulation. Enrollment fell 10% in 2026 to 3.85 million after enhanced premium tax credits lapsed, pushing some consumers' premiums up dramatically and prompting shifts to bronze or catastrophic plans, referrals to federally qualified health centers, or going uninsured. Navigator funding for Florida Covering Kids and Families remains at $1.379 million, a 90% cut from 2024 levels, limiting outreach capacity during the sign-up period.
CMS announced Florida will receive $193.7 million from the Rural Health Transformation Program, a five-year, $50 billion initiative created under the federal reconciliation law, to fund telemedicine, remote patient monitoring, pharmacy services, diagnostic kiosks, and community paramedicine in rural areas. The award exceeds by more than $5 million what the DeSantis administration had requested. Critics, including the advocacy group Protect Our Care, call the funding a "pittance" compared to the estimated $13.5 billion or more Florida stands to lose from Medicaid cuts in the same law, including roughly $3.6 billion in reductions to the state's provider payment programs for hospitals and physicians treating low-income and disabled patients. The CMS announcement did not reference the Medicaid reductions.
27 active waivers tracked for Florida. Available with Pro.
See them with ProNo active solicitations currently tracked for Florida.
27 managed care contracts tracked for Florida. Available with Pro.
See them with Pro53 bills tracked for Florida. Available with Pro.
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