How to Enroll
You must have Medicaid or in the process of getting Medicaid as aMedicaid Pending Enrollee in order to be a part of this health plan. Only members 18 years or older who have been defined by CARES to meet eligibility standards are eligible for Medicaid Long Term Care. Sunshine Health does not define Medicaid eligibility. Medicaid eligibility is measured by the Department of Children and Families (DCF). For more details, call the toll- free telephone number: 1-866-76ACCESS (1-866-762-2237).
If you are a mandatory enrollee made to enroll in a plan, once you are enrolled in Sunshine Health Long Term Care or the state enrolls you in a plan, you will have 90 days from the date of your first enrollment to try the managed care plan. During the first 90 days, you can change managed care plans for any reason. After the 90 days, if you are still eligible for Medicaid, you will be enrolled in the plan for the next nine months. This is called “lock-in”.
You may ask to change plans during your open enrollment period. You may also ask to disenroll from Sunshine Health Long Term Care for good cause at any time. If you would like to find out if you can disenroll for good cause you may call the Choice Counseling Help Line at 1-877-711-3662.
Some Medicaid recipients may change managed care plans whenever they choose, for any reason. To find out if you may change plans, call Choice Counseling Help Line 1-877-711-3662.
If you are a mandatory enrollee, the state will send you a letter 60 days before the end of your enrollment year telling you that you can change plans if you want to. This is called “open enrollment.” You do not have to change plans. If you choose to change plans during open enrollment, you will begin in the new plan at the end of your current enrollment year. When you pick a new plan or stay in the same plan, you will be locked into that plan for the next 12 months. Every year you can change health plans during your 60-day open enrollment period.
All Long Term Care Medicaid enrollees must belong to a health plan. The State only gives you a certain amount of time to pick a health plan. If you do not pick a health plan, the state will pick one for you.