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Important Hospital Billing Guidance for the CMS Health Plan Transition

Date: 09/08/26

Beginning October 1, 2026, Molina Healthcare of Florida will operate the Children’s Medical Services (CMS) Health Plan, and all CMS Health Plan members will transition from Sunshine Health to Molina.

Hospitals should follow the billing guidance below for inpatient admissions that span the October 1 transition date.

Inpatient facility services

For CMS Health Plan members admitted before October 1, 2026, Sunshine Health is responsible for payment of the entire inpatient facility stay, including services provided on or after October 1. This applies regardless of whether the facility is reimbursed through a Diagnosis Related Group (DRG) methodology or a per diem rate.

Molina is responsible for the entire inpatient facility stay when the member’s admission date is October 1, 2026, or later.

Professional and ancillary services

Responsibility for professional and ancillary services is based on the member’s health plan on each date of service:

  • Services provided through September 30, 2026, should be billed to Sunshine Health.
  • Services provided on or after October 1, 2026, should be billed to Molina.

Example

If a CMS Health Plan member is admitted on September 28 and discharged on October 3:

  • Sunshine Health is responsible for the entire inpatient facility claim.
  • Professional and ancillary services provided September 28 through September 30 should be billed to Sunshine Health.
  • Professional and ancillary services provided October 1 through October 3 should be billed to Molina.

Providers should always verify member eligibility and plan assignment before submitting claims.

View additional information about the CMS Health Plan transition.

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

Questions?

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

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