Important 2025 Change to Medicaid Managed Care in Florida and Continuity of Care Requirements

Starting February 2025

Most people in Florida Medicaid will be automatically placed in a managed care plan by the Agency for Health Care Administration (AHCA). This includes some individuals who are not usually required to enroll in a plan. Every plan must follow continuity of care (COC) requirements during your transition.

---

Your Right to Continuity of Care

Continuity of care means you can keep receiving approved services and treatments without interruption when you switch to a new plan or provider.

What Your New Plan Must Cover

• Your new health or long-term care (LTC) plan must honor existing services and routine appointments approved under your old plan or Medicaid fee-for-service.

• Your doctor should not cancel your appointments. The new plan must pay for your ongoing treatment for at least 90 days after enrollment, even if your provider is out of network and without prior authorization.

Provider Payment Rules

• Providers are entitled to the same payment rate for 60 days after enrollment, unless they agree to a different rate.

• Your plan must pay out-of-network providers promptly, just as they do for in-network providers.

Timely Access to Care

• After your last authorization ends, your plan must ensure you get a new provider within 90 days.

• If in-network providers are not available, the plan must cover out-of-network services. Plans that fail to do this may face fines.

Dental Plans

• Dental plans must continue approved treatment or appointments for at least 90 days after enrollment.

• Out-of-network dental providers must be reimbursed at the prior rate for at least 30 days, unless another rate is agreed.

Extended Continuity of Care

Coverage beyond the standard 60–90 days applies if:

• Pregnancy: Current provider must be covered for the full pregnancy and six weeks postpartum.

• Transplants: Current provider must be covered for one year post-transplant.

• Cancer treatment: Current provider must be covered for the full round of chemotherapy or radiation.

• Hepatitis C: Full course of treatment must be covered.

• LTC plan members: Services must match your approved plan of care.

• Orthodontics: Coverage may extend past the standard COC period.

Filing a Complaint

If your rights are violated, you may file a complaint with AHCA through the Florida Medicaid Complaints portal. You will receive a complaint number within 24–48 hours to track your case. See the Florida Health Justice Project’s guide on filing a managed care complaint for details.

How to File a Complaint Regarding a Medicaid Managed Care Plan.pdf

Download PDF • 112KB

Need Legal Help?

If you are denied services, contact the Florida Health Justice Project through their Online Intake system (legalserver.org).

About the Author

Ask Medicaid Florida is a trusted independent author focused on simplifying Medicaid news, policy updates, and healthcare resources for Florida residents. With a mission to make complex Medicaid issues understandable, Ask Medicaid Florida provides clear, factual, and timely insights that help readers stay informed and empowered. "You are valued, thank you for visiting our website".

Disclaimer

The information provided on this website is for informational purposes only and does not constitute advice for your Healthcare decisions or any other type of advice. All content, materials, and resources made available are solely for educational purposes and should not be relied upon for making Healthcare decisions. AMF is a part of Amazon's Associate Affiliate program. This article may contain links to Amazon.com that allows us to earn a small commission on qualified purchases at no additional cost to you. Ask Medicaid Florida makes no claims to be associated with any state agencies including Medicaid of Florida. Read full disclaimer.