Networks change. We verify your specific Sunshine Health 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: Sunshine Health Medicaid, Children's Medical Services Health Plan, CMS Health Plan, Sunshine Health Medicare. Offered in Florida.
Sunshine Health is Florida's largest Medicaid managed care plan and a subsidiary of Centene. It serves members in the Statewide Medicaid Managed Care program across all regions, including Palm Beach, Broward, Martin, St. Lucie, Brevard and Duval counties where Stedfast Psychiatry has offices, and it also operates the Children's Medical Services Health Plan for children with special health care needs, Sunshine Health Medicare Advantage plans, and the Ambetter marketplace brand. For Medicaid members, outpatient psychiatry, medication management and psychotherapy are covered with no copay. Referrals from a primary care provider are not required for behavioral health. Telehealth psychiatry is covered at parity for members located in Florida, which Florida Medicaid has made permanent.
Sunshine Health follows Centene's clinical policies and Florida Medicaid coverage rules for interventional treatments. Transcranial magnetic stimulation requires prior authorization and documentation of major depressive disorder with failure of at least two antidepressants, a psychotherapy trial and a current severity score; Florida Medicaid coverage of TMS for adults is limited, so approval depends on the specific program and criteria at the time of the request. Spravato requires prior authorization with treatment-resistant depression, a concurrent oral antidepressant and REMS-certified administration, and the drug is usually supplied through Centene's specialty pharmacy. Our staff verify Sunshine Health benefits and submit requests directly.
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 Sunshine Health Medicaid?
Stedfast Psychiatry accepts Sunshine Health Medicaid at our Florida offices where contracted. Because Medicaid managed care networks are assigned by region, confirm that your office of choice is in network by calling Sunshine Health member services or asking our front desk to check your eligibility before scheduling.
Is there a copay for psychiatry visits on Sunshine Health?
No. Florida Medicaid members on Sunshine Health pay $0 for covered outpatient mental health services, including psychiatric evaluation, medication management and therapy. Sunshine Health Medicare Advantage members may have a small mental health copay depending on the plan. Children's Medical Services members also pay nothing.
Does Sunshine Health cover telehealth psychiatry?
Yes. Sunshine Health covers video psychiatry visits for members located in Florida at the same level as office visits, with no copay for Medicaid members. Telehealth is suitable for evaluations and medication follow-ups. Children and teens can be seen by video with a parent or guardian present.
Will Sunshine Health cover Deep TMS?
Sunshine Health requires prior authorization for TMS and applies Centene's clinical policy along with Florida Medicaid coverage rules, which limit adult TMS coverage. Our Palm Beach Gardens TMS team can submit a request with full documentation of your diagnosis, medication history and severity scores, and we will tell you honestly what the likely outcome is.
Does Sunshine Health cover Spravato?
Sunshine Health covers Spravato with prior authorization for treatment-resistant depression when you are taking an oral antidepressant and receive treatment at a certified clinic. The drug is supplied through Centene's specialty pharmacy. Medicaid members pay nothing for approved treatment. We offer Spravato at Boynton Beach, Palm Beach Gardens and Royal Palm Beach.