Starting October 1, 2026, families in Florida with children enrolled in the Children’s Medical Services (CMS) Plan will experience a shift in their healthcare coverage management. Molina Healthcare has taken over from Sunshine Health as the new administrator. This transition affects a program dedicated to children with special medical needs, raising significant concerns for those relying on ongoing treatments, specialists, and prescriptions.
The Agency for Health Care Administration (AHCA) of Florida confirmed that beneficiaries already enrolled were automatically transferred to Molina without needing to reapply. The program retains the name CMS Plan, and existing service coverage is protected to prevent interruptions during the administrator switch.
Continuity of Care Amidst Transition
This statewide transition, including Miami-Dade, does not mandate that all Medicaid or Medicare members switch insurers—it specifically impacts the children's CMS Plan previously managed by Sunshine.
Regarding medical appointments, they should not be automatically canceled. Both AHCA's notice and Sunshine Health's information indicate that previously scheduled appointments and prior authorizations must be honored during the continuity of care period. Providers seeing enrolled children should not suspend existing consultations simply because of the company change.
However, while current appointments are protected, not all specialists will necessarily remain in Molina's network indefinitely. Sunshine clarifies that provider contracts are not automatically transferred; doctors and facilities must join Molina's network to continue offering services once the continuity protection ends.
Families with appointments for neurology, cardiology, rehabilitation, therapies, or home care should verify with the clinic and Molina's care manager that services are identified and authorized. It's prudent not to cancel appointments or discontinue treatments without first confirming covered alternatives.
Impact on Prescriptions and Pharmacies
Molina assures that during the transition, medications currently received by minors and listed in the program's preferred drug list will continue to be covered. Initially, families can use their usual pharmacy, even if it is not yet part of Molina's network. After the continuity period, they must use a participating pharmacy as per applicable conditions.
If a prescription is denied, it's advisable to ask the pharmacy to verify with the new administrator and contact Molina's care management or Member Services before assuming the medication is no longer covered. AHCA also issued a specific alert regarding medication dispensing continuity on September 15.
New CMS Plan Identification Card
Yes, there is a new card. Molina has sent a welcome package with a new identification card for each child, an enrollment letter, and a service guide. If the materials have not arrived, families should seek assistance by calling the official CMS Plan line at 1-800-262-0750 (TTY: 711).
Some cards include the instruction "Continue to see your current PCP," indicating that families should continue visiting their current primary care physician while Molina integrates doctors into its network. If the doctor is not yet listed as a participant, the family should not automatically assume they need to find another physician; they can request verification of their case. Molina has stated they will issue new cards when necessary.
If the card shows a different office address than usual, it's also possible to request an update without assuming a change in care location is required.
Understanding the Transition and Next Steps for Families
For inquiries about the CMS Plan, the official Member Services line is 1-800-262-0750 (TTY: 711), available Monday through Friday, from 8:00 a.m. to 7:00 p.m. Eastern Time. Molina indicates providing free language assistance for non-English speakers and accessible formats for individuals with disabilities.
Before calling, it's beneficial to have the new card handy, if received, along with details of appointments, prescriptions, and pending authorizations. It's useful to specifically ask if the doctor remains covered during the transition, which authorizations are recorded, when the applicable protection ends, and which pharmacy should be used subsequently. Sunshine has also warned about potential fake calls posing as program representatives; checking any communication through numbers published on official pages is preferable.
This change is not the same as Medicaid open enrollment. The CMS Plan administrator change is automatic for existing members and does not require reapplication. Separately, Florida has opened the annual period for certain managed care Medicaid beneficiaries to review and, if applicable, voluntarily change plans. CiberCuba explained how this open enrollment works and its deadlines.
This transition is also distinct from federal eligibility modifications for certain immigrants covered by Medicaid, which depend on individual program rules.
The takeaway for parents is clear: the children's plan continues, and there is no need to re-enroll due to the switch from Sunshine to Molina. However, reviewing cards, authorizations, and the continuity of each treatment before the protection period ends is advisable. For personalized and updated information, the reference is the official CMS Plan site of Molina.
FAQs on Florida's CMS Plan Transition
Will medical appointments be automatically canceled due to the transition?
No, scheduled appointments and prior authorizations should be honored during the continuity of care period and should not be automatically canceled.
What should families do if a prescription is rejected during the transition?
Families should ask the pharmacy to verify the information with the new administrator and contact Molina's care management or Member Services before assuming the medication is no longer covered.
Is the CMS Plan transition the same as Medicaid open enrollment?
No, the CMS Plan administrator change is automatic for existing members and does not require reapplication. Medicaid open enrollment is separate and allows eligible beneficiaries to review and change plans voluntarily.