Haris Ashley
The Children's Medical Services Health Plan, or CMS Health Plan, is a managed care plan for children and youth under 21 with serious, chronic conditions. It is provided by Sunshine Health in partnership with doctors in Florida. There are two versions of the CMS Health Plan: Title 19 and Title 21. The Title 19 plan is for members who qualified through Florida Medicaid, while the Title 21 plan is for those who qualified through Florida KidCare and pay a monthly premium.
| Characteristics | Values |
|---|---|
| Name | Children's Medical Services Health Plan |
| Provider | Sunshine Health |
| Target Group | Children and youth under 21 with serious, chronic conditions |
| Eligibility | Eligible for Florida Medicaid |
| Contact | 1-866-799-5321 (TTY: 1-800-955-8770) |
| Hours | Monday-Friday, 8 a.m. to 8 p.m. |
| Plan Versions | Title 19 (Florida Medicaid), Title 21 (Florida KidCare) |
| Monthly Premium | Varies based on the plan |
| Discrimination | Complies with Federal civil rights laws; does not discriminate |
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What You'll Learn
Children's Medical Services Health Plan
The Children's Medical Services Health Plan is a healthcare plan for children and young people under 21 with serious, chronic conditions. The plan is available to Florida residents and is administered by Sunshine Health.
There are two versions of the CMS Health Plan: the Medicaid CMS Health Plan and the KidCare CMS Health Plan. The Medicaid CMS Health Plan is for children who qualify for CMS Health Plan through Florida Medicaid and do not pay a monthly premium for their health insurance. This plan is known as the Title 19 plan. The KidCare CMS Health Plan, on the other hand, is for children who qualify for CMS Health Plan through Florida KidCare and pay a monthly premium for their health insurance. This plan is known as the Title 21 plan.
The specific benefits and services offered by each plan vary. For example, the KidCare CMS Health Plan includes a Pharmacy Benefit Manager (PBM), while not all benefits of the Medicaid CMS Health Plan may apply to those enrolled in the KidCare plan. Sunshine Health, the administrator of the CMS Health Plan, offers coordination support to help members and their families navigate the healthcare system and connect with the necessary providers and resources.
To summarise, the Children's Medical Services Health Plan is a vital programme that provides healthcare coverage for Florida's children and young people under 21 with serious, ongoing health conditions. The plan offers two versions with distinct benefits and services to meet the diverse needs of its members, ensuring they receive the necessary care and support.
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Eligibility criteria
The Children's Medical Services Managed Care Plan (CMS Plan) is a Florida program that provides comprehensive healthcare to children and young people with special health care needs. The CMS Plan is designed for those who are Medicaid-eligible up to the age of 21 or eligible for Florida's Children's Health Insurance Program (CHIP) up to the age of 19.
To be eligible for the CMS Health Plan, children must meet specific criteria related to their age, health care needs, and financial status. Here are the detailed eligibility criteria for the CMS Plan in Florida:
- Age Requirement: The CMS Plan is available to children and young people from birth up to the age of 21. Those eligible for CHIP through the CMS Plan must be under the age of 19.
- Health Care Needs: The program caters to children with special health care needs, including those with chronic and serious health conditions. To qualify, children must meet the Children's Medical Services clinical screening requirements or have a physician attest to their qualifying medical conditions.
- Financial Requirements: For the CMS Health Plan for Medicaid, enrollees must meet the Medicaid financial requirements. This means that the child's family must have a low income that falls within the Medicaid guidelines.
- Insurance Status: Eligibility is also determined by the child's insurance status. The CMS Plan is typically for children who are Medicaid-eligible or eligible for Florida's KidCare program. If a child does not qualify for Medicaid or KidCare, they may still be eligible for the CMS Safety Net Program, which assists families in paying for health services on a first-come, first-served basis.
- Residency: The CMS Plan is a statewide program in Florida, and eligibility is likely tied to residency within the state, ensuring that enrollees have access to Florida's Medicaid or CHIP programs.
It is important to note that eligibility for the CMS Plan is determined through a comprehensive assessment of these factors, and specific circumstances may vary from case to case. For personalized guidance on eligibility, families can refer to the Florida Department of Health or consult with a healthcare professional.
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Benefits and services offered
The Children's Medical Services Health Plan, provided by Sunshine Health, is a Managed Care Plan with unique and comprehensive coverage for children and youth under 21 in Florida's Child Welfare system with serious, chronic health conditions.
- The CMS Health Plan provides full coverage, programs, and services for children in need.
- Members enrolled in the Title 19 plan through Florida Medicaid do not pay a monthly premium for their child's health insurance.
- Members enrolled in the Title 21 plan through Florida KidCare pay a monthly premium and have access to a different set of benefits.
- Sunshine Health coordinates healthcare for its members and their families, working with multiple providers, state agencies, and local community resources to improve their lives.
- A Nurse Advice Line is available to answer any questions regarding a child's health, and rides to medical appointments can be scheduled at no cost.
- Children can easily connect with providers virtually through Telehealth, and medications can be delivered directly to the home.
- Sunshine Health partners with doctors in the member's area, ensuring easy access to providers when needed.
- Sunshine Health complies with Federal civil rights laws, providing services without discrimination based on race, colour, national origin, age, disability, or sex.
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How to enrol
To enrol your child in the Children's Medical Services Health Plan, they must be under 21 and have serious, chronic health conditions. You must also be eligible for Florida Medicaid.
There are two versions of the CMS Health Plan, and the benefits and services offered are different. If you do not pay a monthly premium for your child's health insurance, your child is enrolled in the Title 19 plan. If you do pay a monthly premium, your child is enrolled in the Title 21 plan.
To enrol, you can call Medicaid Choice Counseling at 1-877-711-3662 (TTY 1-866-467-4970), Monday to Thursday, 8 a.m.-8 p.m., and Friday, 8 a.m.-7 p.m. You can also visit the SMMC website. A Medicaid Choice Counselor will help you select a plan.
You can also call the CMS Health Plan toll-free at 1-866-799-5321 (TTY 1-800-955-8770), Monday to Friday, 8 a.m. to 8 p.m. Alternatively, visit SunshineHealth.com/CMS.
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Contact information
The CMS website provides a list of contact phone numbers and web links to answer your Medicare questions or program issues. You can find contact information for your CMS Regional Office on the website, as well as specific program issue contacts available as a PDF download.
For questions related to specific services, such as casework or program issues, you should communicate through the existing Centers for Medicare & Medicaid Services' resources. Additional information and assistance can be found on the Medicare website or under the “Related Links” section.
For Medicare queries, you can call the Medicare Service Center at 800-MEDICARE (800-633-4227).
Medicaid is a state-administered program, and each state has its own guidelines for eligibility and services. A list of State Health Departments can be found in the “Related Links” section of the website.
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Frequently asked questions
The CMS Health Plan is a Managed Care Plan with a Florida Medicaid contract. It provides children in Florida's Child Welfare system with unique healthcare coverage.
Children and youth under 21 with serious, chronic conditions are eligible for the CMS Health Plan.
To enroll your child, you must be eligible for Florida Medicaid. You can call Medicaid Choice Counseling at 1-877-711-3662 (TTY: 1-866-467-4970) Monday through Thursday, 8 a.m. to 8 p.m., and Friday, 8 a.m. to 7 p.m. A Medicaid Choice Counselor will help you select a plan.
