Statewide Medicaid Managed Care Services

The Florida Statewide Medicaid Managed Care (SMMC) Master Agreement FP116 provides comprehensive healthcare services across multiple program components, focusing on Managed Medical Assistance (MMA) and Long-Term Care (LTC) services. The IDV covers specialized populations including Serious Mental Illness (SMI), HIV/AIDS, and Child Welfare, offering an extensive range of medical services such as preventive care, emergency services, behavioral health, home health care, and specialty care. Additional benefits include cellular phone services, disaster relief, doula services, transportation, and various healthcare and social support services designed to meet the diverse needs of Medicaid recipients across Florida.

Sunshine State Health Plan, Inc. is the prime contractor for this master agreement with the Agency for Health Care Administration (AHCA), effective from February 1, 2025, through December 31, 2030. The contract spans nine geographic regions in Florida and is valued at $51,181,005,711, with compensation structured through capitation rates that vary by region, population age, and program characteristics. As a master agreement, the contract includes performance-based incentives, requiring a medical loss ratio of at least 85% and subject to potential financial sanctions for non-compliance. The IDV is designed as a comprehensive managed care solution with robust provider networks and strict adherence to state and federal healthcare regulations.