Skip to Main Content
Stay connected when you're away from home! Download our Health Insurance Portal mobile app to find care, view benefits, and access your member ID card. Get more information and download the app.
Stay connected when you're away from home! Download our Health Insurance Portal mobile app to find care, view benefits, and access your member ID card. Get more information and download the app.

American Society of Addiction Medicine (ASAM) Criteria Updates Effective Dec. 1, 2026

Date: 09/24/26

Providers who serve members of Sunshine Health (Medicaid), Ambetter Health (Marketplace), and Wellcare (Medicare) should note that the American Society of Addiction Medicine (ASAM) 4th Edition Criteria for Adolescents and Transition-Aged Youth (TAY) will implement the following updates effective December 1, 2026:

  • New admission and continued stay criteria for adolescents and transition-aged youth.
  • Changes to ASAM levels of care, including the addition of new youth levels of care and the removal of certain levels previously included in the adolescent criteria.
  • Revisions to the six dimensions assessment, including renamed and reordered dimensions and the addition of a new person-centered considerations dimension.
  • New considerations for co-occurring conditions and early intervention services.
  • Updated guidance for members 18 to 25 years of age who may qualify for either transition-aged youth or adult programming based on clinical presentation and treatment needs.

Providers should review internal assessment, documentation, and treatment planning processes to ensure alignment with the new ASAM criteria prior to the effective date.

If you have questions, please contact your Sunshine Health Provider Engagement Account Manager (PEAM) or call Provider Services at 1-844-477-8313.

This Guidance Applies to These Health Plans

  • Sunshine Health Medicaid (MMA)
  • Sunshine Health Pathway to Shine Child Welfare Specialty Plan (CWSP)
  • Sunshine Health Mindful Pathways Serious Mental Illness Specialty Plan (SMI)
  • Sunshine Health Power to Thrive HIV/AIDS Specialty Plan (HIV)
  • Ambetter Health (Marketplace)

Questions?

Sunshine Health has a wealth of resources available to help answer your questions and address your concerns:

SH_12700