Networks change. We verify your specific Florida Medicaid plan before your first visit; call with your member ID and we will confirm benefits, copay and any referral or authorization requirements.
Also appears on cards as: Statewide Medicaid Managed Care, SMMC, Florida Medicaid managed care, AHCA Medicaid. Offered in Florida.
Florida Medicaid provides health coverage to low-income children, pregnant women, parents with dependent children, seniors and people with disabilities, administered by the Agency for Health Care Administration. Most members are enrolled in a managed care plan under the Statewide Medicaid Managed Care program, such as Sunshine Health, Simply Healthcare, Humana Healthy Horizons, Molina, Aetna Better Health, Community Care Plan or United Healthcare Community Plan, with the plans available depending on your region. Florida did not expand Medicaid under the Affordable Care Act, so most working-age adults without children or disabilities do not qualify. Outpatient psychiatry, medication management and psychotherapy are covered with no copay, and no referral is needed for behavioral health. Telehealth psychiatry is covered permanently for members located in Florida.
Interventional treatments are handled by your managed care plan under state coverage rules. Florida Medicaid's coverage of transcranial magnetic stimulation for adults is limited, and plans apply prior authorization with medical necessity review; coverage for children and adolescents under the EPSDT benefit can be broader when medically necessary. Spravato is covered with prior authorization for treatment-resistant depression, with a concurrent oral antidepressant and REMS-certified administration, through the plan's pharmacy benefit. Stedfast Psychiatry accepts several Florida Medicaid plans and verifies your specific plan and region before scheduling.
What we check before your visit
- Whether your plan is in network at the office you chose and for telehealth
- Your copay or coinsurance for an evaluation and for follow-ups
- Whether a primary-care referral is required (common with HMO plans)
- Prior-authorization criteria for Deep TMS and Spravato, if those are being considered
Frequently asked questions
Does Stedfast Psychiatry accept Florida Medicaid?
Stedfast Psychiatry accepts several Florida Medicaid managed care plans at our Florida offices, including Sunshine Health and Simply Healthcare where contracted. Which plans are in network varies by office and region. Call the member number on your Medicaid plan card or ask our front desk to verify your eligibility and plan before your first visit.
Do I pay anything for a psychiatry visit on Florida Medicaid?
No. Florida Medicaid members pay $0 for covered outpatient mental health services, including psychiatric evaluations, medication management and psychotherapy, when you see an in-network provider through your managed care plan. Prescriptions on the plan's preferred drug list are also covered without copays for most members.
Is telehealth covered under Florida Medicaid?
Yes. Florida Medicaid permanently covers video mental health visits with in-network providers for members located in Florida during the appointment, at no cost to the member. Telehealth is useful for medication follow-ups and for children and teens with a parent present. Deep TMS and Spravato require in-person visits.
Does Florida Medicaid cover Deep TMS?
Adult coverage of TMS under Florida Medicaid is limited, and each managed care plan reviews requests under prior authorization and medical necessity rules. Coverage for members under 21 can be broader under the EPSDT benefit. Our Palm Beach Gardens TMS team can submit a request with full documentation and will tell you candidly what to expect.
Will Florida Medicaid cover Spravato?
Florida Medicaid managed care plans cover Spravato with prior authorization for treatment-resistant depression when you are taking an oral antidepressant and receive treatment at a REMS-certified clinic. The drug is supplied through the plan's specialty pharmacy at no cost to you once approved. We offer Spravato at Boynton Beach, Palm Beach Gardens and Royal Palm Beach.