The State of Florida has announced its intent to award the next Medicaid managed-care contract for the Children’s Medical Services (CMS) Health Plan — which serves medically complex children — to Molina Healthcare of Florida. Although not yet final, this represents one of the most significant program transitions in recent years for families, providers, and care coordination partners statewide.

The Agency for Health Care Administration (AHCA) issued its notice of intent on November 3. Under Florida procurement rules, vendors had 72 hours to submit a notice of protest, followed by an additional 10-day period to file a formal challenge. Sunshine Health, the current statewide CMS plan administrator and a subsidiary of Centene, has stated it will not challenge the award “at this time,” citing terms in the final procurement document it could not accept. As of now, no other protests have been publicly confirmed. If no formal protest is filed within the statutory timeframe, Molina’s award will stand and implementation planning can begin.

What the CMS Health Plan Covers

The CMS Health Plan provides care coordination and specialized clinical services for Medicaid-eligible children under age 21 who have serious, chronic, or medically complex conditions requiring extensive preventive and ongoing care. Enrollment is projected to grow from approximately 113,000 children today to more than 120,000 by June 2030, underscoring the need for a strong, stable, and well-prepared statewide network.

A Major Shift: Molina Must Build a Statewide Network

Molina Healthcare currently operates Statewide Medicaid Managed Care (SMMC) plans only in Miami-Dade and Monroe counties. Winning the CMS Health Plan contract requires Molina to rapidly build out a comprehensive statewide provider network — including home health agencies, pediatric specialists, therapists, durable medical equipment providers, and hospital partners.

This transition will be closely watched, as the CMS population requires highly coordinated, medically intensive services that depend on strong provider participation and timely authorizations.

What This Means for Home Health Agencies

Home health agencies play a critical role in serving medically complex children — especially those requiring skilled nursing, private duty nursing, therapies, and ongoing care management. A statewide transition of this scale affects home health agencies in several ways:

• Contracting and Credentialing: Agencies may need to onboard with Molina for the first time, even if they previously contracted with Sunshine Health.
• Continuity of Care: Providers must prepare for potential shifts in authorization processes, documentation requirements, and clinical review workflows as Molina stands up its CMS program.
• Rates and Service Processes: No changes have been announced, but agencies should expect updated guidance as Molina builds its statewide structure and implements program standards.
• Network Adequacy: Because Molina does not currently operate statewide, ensuring adequate home health provider capacity will be essential to meeting federal and state access requirements.

HCAF’s Role in Supporting Members

Given Molina’s limited footprint outside Miami-Dade and Monroe counties, HCAF will be leveraging our strong relationship with Molina Healthcare of Florida to support a smooth, stable statewide rollout. This includes:

• Facilitating communication between Molina and HCAF member agencies.
• Addressing network adequacy considerations.
• Collaborating on guidance for contracting, credentialing, and authorizations,
• Monitoring transition timelines and ensuring members receive accurate, timely updates.
• Advocating for uninterrupted care and minimal administrative disruption during the transition.

Our priority is ensuring that medically complex children continue receiving high-quality, continuous care — and that home health agencies are well-positioned during this major statewide shift.

Looking Ahead

If no protests are filed within the remaining window, the transition from Sunshine Health to Molina will proceed. The contract runs through December 31, 2030, with the possibility of extensions only to support transition activities.

HCAF will continue to monitor all developments, engage directly with AHCA and Molina, and provide members with timely updates and resources.

If you would like assistance preparing your agency for contracting or operational transition, please let us know — we are here to help.