Florida’s CMS Plan Moves to Molina on October 1
Jessie Solognier, COO of Edwards Electronic Processing (EEP), on what the Children’s Medical Services Plan transition means for pediatric therapy clinics and how much of a typical practice’s volume is exposed.
What’s happening
Florida’s Agency for Health Care Administration picked Molina Healthcare of Florida to run the Children’s Medical Services (CMS) Plan, the specialty Medicaid managed care plan for children with special health care needs. On October 1, 2026, Molina takes over statewide operation from Sunshine Health, the Centene subsidiary running it today. Molina was the only plan selected and is expected to serve roughly 120,000 children across Medicaid and CHIP.
Your Sunshine contract does not transfer to Molina. This is common for clinics to miss. To keep seeing CMS Plan patients after the continuity-of-care period, you’ll need to credential with Molina directly. For dates of service before October 1, claims still belong with Sunshine.
EEP has lived through the last CMS Plan handoff, when Sunshine took the contract over. We asked our COO, Jessie Solognier, what this one means operationally.
What we know
Go-live: October 1, 2026. Molina replaces Sunshine Health as the sole plan administering the CMS Plan statewide.
Contracts: Sunshine contracts do not carry over. Clinics contract and credential with Molina directly.
Continuity of care: Per AHCA’s transition guidance, members may continue with current providers for up to eight months, until May 31, 2027, or until the care plan is finalized and ongoing services are authorized, whichever comes sooner. Non-participating providers are to be paid at pre-transition rates during that period absent an alternative agreement, and prior authorizations approved before October 1 are to be honored.
Earlier dates of service: Continue working claims and issues for date of service (DOS) before October 1 through Sunshine Health.
Where to find official details: Molina’s Florida CMS provider page.
The interview
What’s changing this fall, and what should clinics expect?
Florida puts these contracts up for bid every five years or so, and this time Molina won the CMS contract. Starting October 1, they take over the whole CMS Plan from Sunshine.
October is likely to feel like a reset. New insurer, new portals, new forms for authorizations, plus some payment delays and confusion early on. That’s generally how these changeovers go. The continuity-of-care rules help, and Molina has provider webinars where the operational specifics should fill in. Don’t wait on those to start preparing.
Across the clients EEP bills for, how much volume runs through the CMS Plan?
If you look across all payers, commercial included, about 50 percent of our clients’ patient base is CMS kids. If you narrow it to Medicaid only, it’s roughly 53 percent. That moves around by clinic, but for most of the pediatric therapy practices we bill for, about half the patients are on the CMS Plan.
That comes down to who these kids are. These children have chronic conditions, and chronic conditions need therapy. So a therapy practice carries far more CMS exposure than, say, a pediatrician or a podiatrist. That concentration is why this transition deserves more attention from therapy clinics than from most other specialties.
If a clinic isn’t contracted with Molina yet, how long can it keep seeing its CMS patients?
There’s a bit of runway here. AHCA’s guidance says kids can keep seeing their current providers until May 31, 2027, roughly eight months, or until their care plan is finalized and ongoing services are authorized, whichever comes sooner. There is some ambiguity in that statement regarding “until their care plan is finalized,” and we’re seeking to clarify it. This can be tricky since it plays out child by child, not on one clinic-wide date. Coverage doesn’t end all at once, it tapers as Molina finalizes care plans across your caseload.
During that window, the guidance says non-participating providers are paid at the rate they received before the transition, unless they’ve agreed to something different. My advice is to treat all of it as contracting runway, not a fallback. And the terms are AHCA’s, not mine. Check AHCA’s transition page and Molina’s provider page for the current version, because the details are still being published.
What are families being told, and what should the front desk expect?
Enrollment moves automatically, so families don’t re-enroll, and the plan keeps the CMS Plan name under Molina. AHCA has said families get confirmation letters at the end of August, and that’s when the phone calls start. Parents will ask whether they can keep coming. For now, the answer is yes. Sunshine’s guidance is explicit that providers shouldn’t cancel appointments, and existing appointments, prescriptions, and authorizations are to be honored through the transition.
Before those letters hit mailboxes, we recommend having conversations with your front desk to keep inquiries consistent, so ten parent conversations don’t become ten different answers. You may even consider writing up a small memo to keep at your front desk for patients to grab when they’re checking out.
What would you have every clinic do before October?
Start the Molina contracting now since there is a fixed deadline attached. Next, get clear on which authorizations you hold going into October, because an authorization being honored and an authorization being visible in a new plan’s system on day one are not the same thing. Then update the claim-side plumbing, payer routing, and each patient’s plan record. Finally, plan cash for a slower month or two.
The rest of this guide
Contracting and credentialing with Molina: the step with a deadline attached, and the contract detail worth reading closely.
What changes inside the claim: payer routing, remittances, electronic payment, and updating patient plans.
Denials and cash flow: what the last CMS Plan transition looked like, and how to prepare financially.
Where EEP fits
EEP focuses on speech therapy, physical therapy, occupational therapy, and ABA therapy. We’ve worked the last CMS Plan handoff, and we know Florida Medicaid inside and out, so clinics start from a playbook that already works. If you’d like to speak with someone at EEP about outsourcing your billing, you can reach us here.
Resources
General information reflecting EEP’s experience as of August 2026, not legal, coding, or reimbursement advice. Transition details are still developing and vary by plan. Verify current requirements with Molina and AHCA before you act.
