Search
  • Melissa Owen Norris

FL Medicaid SMMCs - "Best Plan" vs "Best for You"

As a privatized Medicaid system, the State of FL Agency for Healthcare Administration (AHCA) offers 13 Managed Care Health Plans (SMMC) and 5 Specialty Plans. Plan availability is by Region, and with the exception of the Specialty Plans, members may choose which plan they'd like for their medical insurance coverage. Many of those plans utilize third party "carve outs" for behavioral health services, therefore are fewer behavioral health plans in FL with whom providers would contract.


So the big question is always "With which plan should I contract?" Short answer: ALL of them! Medicaid SMMC membership tends to be fluid, and its not unusual that a client with Wellcare in March may switch to Beacon in April. If that happens, then you are left with a client who's insurance you are out of network.


But if you truly only want to pursue one or two SMMC contracts, then consider the plans in your region which can be found on the AHCA webpage: https://ahca.myflorida.com/Medicaid/statewide_mc/pdf/mma/SMMC_Plans_by_Region.pdf


Next, consider your specialties, and which population the plans cover. Your largest plans are:


SUNSHINE - 

  1. Sunshine also has a Specialty Plan for children in out of home foster care, those adopted from foster care and those recently aged out of care. If this is one of your targeted populations, then Sunshine is a must.

  2. When obtaining a Sunshine contract, they offer Medicaid, Long Term Care, Ambetter (Commercial/ Marketplace) and Allwell (Medicare) all in the same contract.

WELLCARE - 

  1. Wellcare has its standard Medicaid for all ages, they provide behavioral health to Children's Medical Services clients, and they also have a specialty plan for Serious Mental Illness. So if you have a specialty for SMI clients this would be best for you. 

  2. Wellcare also offers a Medicare line for LCSW


BEACON -  1. Beacon is a behavioral health carve out, it is a third party that offers behavioral health to many Medicaid plans in FL. These include Simply, Humana Medicaid, Aetna Better Health, FL Community Care, Miami Children's, Molina Healthcare, and Vivida.  

2. Beacon offers Medicaid & Medicare plans as well as Healthy Kids (CHIP) Plans


UNITED -  1. Optum/UBH offers Medicaid, Medicare and commercial plans in one contract

2. Optum is also BH provider for Prestige, Oscar (Marketplace and Medicare) and a new VA plan.


There is no easy answer for which is the "best plan" for providers to go in network with. If you have additional questions that could help you make your decisions, schedule a free consultation with us! https://www.credentialingconsultants.com/schedule

321-710-7747

©2019 by Credentialing Consultants of CFL. Proudly created with Wix.com