Here's what you should do if your Managed Care Plan enrollment is denied
- Kristen
- 2 days ago
- 4 min read
Choosing a Florida Medicaid plan is one of the most important decisions you will make for your healthcare. Under the Statewide Medicaid Managed Care (SMMC) program, most recipients must enroll in a plan that coordinates all care—doctor visits, prescriptions, hospital services, and more.
As of the latest state contracts, Florida has consolidated to five major managed care plans serving most recipients statewide or regionally. This article breaks down the top 5 Managed Care Plans in Florida.
When you choose Humana Healthy Horizons® in Florida, you get Medicaid that does more. We give you what you need to feel your best, plus things that you didn’t even know you needed. We call that human care.
As a Florida licensed health maintenance organization (HMO), we offer health plans for people enrolled in Medicaid and/or Medicare programs. Our plans are designed around meeting the unique health needs of our members and include many specialty plans. In fact, Simply began as a minority-owned HMO and was the first to offer a Medicaid specialty plan for people living with HIV/AIDS.
Sunshine Health is a managed care plan with a Florida Medicaid contract. The benefit information provided is a brief summary, not a complete description of benefits. Limitations, co-payments and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co-insurance may change. For more information contact the Managed Care Plan.
Understanding Florida Medicaid Managed Care
Before choosing a plan, understand how the system works.
The SMMC program includes:
Managed Medical Assistance (MMA) – doctor visits, hospital care, prescriptions
Long-Term Care (LTC) – nursing homes, assisted living, home care
Dental plans – required for all recipients
Most people are automatically placed into MMA and must actively choose a plan—or the state assigns one.
The 5 Best Managed Care Plans in Florida
These plans were selected based on:
State contract awards
Coverage area
Extra benefits
Provider network size
Member support experience
1. Humana Healthy Horizons in Florida (Best Overall)
Humana
Why it stands out:
Strong statewide coverage
Extra benefits like rewards programs and care coordination
Key benefits:
Transportation to appointments
Over-the-counter (OTC) allowances
Care managers for chronic conditions
Telehealth services
Enrollment help: Call Medicaid Choice Counseling or enroll online through the state portal.
If denied or stuck:
Request a fair hearing immediately
Contact Humana member services for escalation
Ask for a case manager assignment
2. Simply Healthcare Plans (Best for Extra Benefits)
Simply Healthcare Plans
Why it stands out:
Known for generous “extras” beyond standard Medicaid
Key benefits:
Expanded dental and vision perks
Healthy rewards cards
Wellness programs
Enrollment help: Use the Florida Medicaid Managed Care portal or call 1-877-711-3662.
If denied:
File an appeal within 90 days
Request plan reconsideration
Contact a Medicaid advocate organization
3. Sunshine State Health Plan (Best for Care Coordination)
Sunshine State Health Plan
Why it stands out:
Backed by a large national network (Centene)
Strong case management and behavioral health services
Key benefits:
Mental health and substance use support
Disease management programs
24/7 nurse advice line
Telehealth
Enrollment help: Available through the state portal or by phone.
If denied:
Request a continuity of care review
File a grievance with the plan
Escalate to the state Agency for Health Care Administration
4. Florida Community Care (Best for Long-Term Care Needs)
Florida Community Care
Why it stands out:
Focused on long-term care populations
Strong support for seniors and disabled adults
Key benefits:
Home and community-based services
Nursing facility coverage
Personal care assistance
Care coordination teams
Enrollment help: Must meet LTC eligibility criteria first (medical and financial).
If denied:
Request a level-of-care reassessment
File a fair hearing
Work with an elder law or Medicaid specialist
5. Community Care Plan (South Florida Community Care Network)
Community Care Plan
Why it stands out:
Strong regional performance
Community-based provider networks
Key benefits:
Local provider access
Preventive care programs
Transportation and wellness benefits
Enrollment help: Available in select regions—check eligibility by county.
If denied:
Request plan reconsideration
Switch during open enrollment or with a “good cause” reason
Benefits Comparison Chart
Feature | Humana | Simply Healthcare | Sunshine Health | Florida Community Care | Community Care Plan |
Coverage Area | Statewide | Statewide | Statewide | Regional/LTC focus | Regional |
Best For | Overall coverage | Extra benefits | Complex conditions | Long-term care | Local care access |
Telehealth | Yes | Yes | Yes | Limited | Yes |
OTC Benefits | Yes | Yes (strong) | Yes | Limited | Yes |
Transportation | Yes | Yes | Yes | Yes | Yes |
Care Management | Strong | Strong | Very strong | LTC-focused | Moderate |
Behavioral Health | Good | Good | Excellent | Limited | Moderate |
Long-Term Care | Limited | Available | Available | Primary focus | Limited |
How to Enroll in a Florida Medicaid Plan
Enrollment is handled through the state—not the plans directly.
Step-by-Step Enrollment
Get approved for Medicaid
Go to the Florida Medicaid Managed Care Program portal
Compare available plans in your county
Choose a plan within 30 days
Confirm your enrollment
If you don’t choose:
The state auto-assigns a plan
You can change plans:
Within the first 120 days
During annual open enrollment
What to Do If You Are Denied Enrollment
Denials happen more often than expected—and usually for administrative reasons.
Immediate Actions
Call Medicaid Choice Counseling: 1-877-711-3662
Confirm your eligibility status
Verify documents (income, residency, identity)
File an Appeal
Request a Medicaid Fair Hearing
Deadline: typically 90 days from denial
Request “Good Cause” Plan Change
You may qualify if:
Your doctor is not in-network
You have continuity of care needs
The plan cannot meet medical needs
How to Get Help With Enrollment (Critical)
Most people struggle here—not because they’re ineligible, but because the system is complex.
Best Options for Help
1. Medicaid Choice Counselors (Free)
Explain plan differences
Help you enroll correctly
2. Local Medicaid Assistance Programs
Nonprofits and community groups assist with applications
3. Healthcare Navigators
Help fix denied or stuck applications
4. Plan Case Managers
Once enrolled, they can fix issues internally
Hard Truth: Why Many People Lose or Delay Coverage
Missed notices or deadlines
Incorrect or outdated contact information
System auto-closures during redetermination
Choosing the wrong plan for their doctors
The system is administrative-heavy. Staying covered requires active follow-up, not passive enrollment.
Conclusion
Florida Medicaid is managed care-driven, not fee-for-service
The best plan depends on your needs, not just reputation
Always verify:
Your doctors are in-network
Your medications are covered
If denied: act immediately—delays cost coverage
The difference between a good and bad Medicaid experience often comes down to choosing the right plan and staying proactive.
Disclaimer
This website is for informational purposes only. Always do your own research as it relates to coverage and healthcare needs. Read full disclaimer
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