By Miami Senior Advisor Care Team · October 31, 2026
Three windows, and only one of them is generous
Florida does not let Medicaid long-term care enrollees change managed care plans whenever they please, and it does not lock them in forever either. There are three distinct periods, and knowing which one you are standing in determines whether a plan change takes one phone call or three months of paperwork.
The first is the 120-day change period. The Agency for Health Care Administration is explicit about it: once enrolled in a plan, enrollees may change plans during the first 120 days of enrollment. No reason required, no documentation, no approval. The clock starts on the effective date of enrollment in the plan — not the date of the Medicaid eligibility determination, and not the date the assisted living facility started billing. Those dates are often weeks apart, which is exactly how families lose the window without realizing it.
The second is annual open enrollment, a 60-day period each year when an enrollee can change plans without state approval. Florida's enrollment broker sends reminder letters ahead of these periods, and the letters are the single most important piece of mail a Medicaid long-term care household receives all year. They arrive looking like every other piece of plan junk mail. They are not.
Between those two is the third period, which the state calls the no change period — the stretch between the end of the initial 120 days and the start of the 60-day open enrollment window, and then the stretch between each open enrollment going forward. This is the lock-in. During it, a plan change requires a state-approved good cause reason, reviewed and decided by AHCA. Most of the families who call us are in this period, which is why the rest of this guide is mostly about good cause.
One practical note before anything else: find out, in writing, what the enrollment effective date actually was. Call choice counseling at 1-877-711-3662 (TDD 1-866-467-4970; Monday through Thursday 8 a.m. to 8 p.m., Friday 8 a.m. to 7 p.m.) and ask them to read it back to you, or look it up at flmedicaidmanagedcare.com. If you are inside day 120, stop reading and make the change today. Everything below is harder.
Why South Florida families want out
Not every reason to switch is a good cause reason, and it helps to separate the two honestly before spending three months on a request that was never going to be approved.
The reason that comes up most in Miami-Dade and Broward is network churn at the facility level. A family picks an assisted living facility precisely because it takes their plan at the Medicaid rate, the resident settles in, and then the contract between that facility and that plan ends. This is not rare in South Florida — the assisted living market here is dominated by small six-to-twelve-bed residences and single-building operators who negotiate plan by plan, and a contract that lapses can leave a resident's own apartment suddenly out of network. That one is good cause, and it is good cause you can act on immediately.
The second cluster is service delivery. Authorized hours that arrive on paper but not in the apartment. A home health agency that cannot staff the shift. An aide who stops showing up on Fridays. A request for a shower chair or a hospital bed that sits unauthorized for six weeks. These are real and they are often grounds — but the rule makes you take them to the plan first, through its grievance process, before the state will consider them.
The third cluster usually is not grounds, and families deserve to hear that plainly. Disliking a case manager, being reassigned to a new one, finding the member services line hard to reach, or hearing from a neighbor that a different plan is better — none of these, on their own, is a state-approved good cause reason. They are reasons to document, escalate within the plan, and then raise at open enrollment. If the case manager problem is severe enough that the care plan itself is not being coordinated, that is a different conversation, and it may fold into the quality-of-care or lack-of-access grounds below.
The fourth is geography. If a family moves — from Hollywood to West Palm Beach, say, or out of Miami entirely — the region changes, and a plan that does not operate in the new region means a new plan is not optional. Report the address change to the Department of Children and Families at 1-866-762-2237, and to Social Security at 1-800-772-1213 if that is where the eligibility runs through.
The three good cause reasons that work at any time
Florida's disenrollment rule, Rule 59G-8.600, Florida Administrative Code, splits good cause into two tiers. The first tier can be requested at any time, with no requirement to go through the plan's grievance process first. There are three reasons in it, and they come straight out of the federal standard at 42 CFR 438.56(d)(2) and section 409.969, Florida Statutes:
- The plan does not cover a service because of moral or religious objections. Narrow, but real, and it applies to the plan's objection, not the family's preference.
- The enrollee would have to change residential or institutional providers because that provider went from in-network to out-of-network with the plan. This is the facility-contract scenario above, and it is the single most useful provision in the rule for assisted living families. The resident does not have to move to prove the point; the fact that staying would now be out of network is the grounds.
- Fraudulent enrollment. Enrollment the enrollee did not authorize or understand — which happens more than it should when a marketer, a facility, or a well-meaning relative fills out a plan selection on someone else's behalf without a valid Designation of Authorized Representative on file.
If one of these fits, the request goes to AHCA or its enrollment broker by telephone or in writing. Telephone means the choice counseling line. In writing means mail to the Agency for Health Care Administration, P.O. Box 5197, MS 62, Tallahassee, FL 32314. Either way, send documentation with it: the letter from the facility or the plan announcing the network termination, the dated notice, the name of the facility and its AHCA license number. A request that arrives as a story gets a slower answer than a request that arrives as a paper trail.
One timing point worth knowing: the rule sets out no filing deadline for a good cause request. That is not permission to wait. A network termination that is six months stale is harder to document and easier for a reviewer to treat as resolved, and in the meantime the resident has been sitting in an out-of-network bed.
The five reasons that require a grievance first
The second tier of Rule 59G-8.600 covers the service-delivery problems — and for these, the enrollee must first seek resolution through the plan's own grievance process, with AHCA confirming the outcome. The rule lists five:
- Related services that must be performed concurrently are not all available in network, and the primary care provider or another treating provider has determined that receiving them separately would subject the enrollee to unnecessary risk.
- Poor quality of care.
- Lack of access to covered services, including medically necessary specialty services.
- Lack of access to providers experienced with the enrollee's health care needs. For a resident with advanced dementia or Parkinson's, this one carries real weight, and it is underused.
- Unreasonable delay or denial of service under section 409.969, Florida Statutes.
There is one carve-out that families in a crisis should know by name. The grievance-first requirement does not apply when there is an allegation of immediate risk of permanent damage to the enrollee's health. If a resident is deteriorating now because a service is not being delivered now, say those words, in writing, in the request. Do not bury them in paragraph four.
Filing a grievance that actually counts is mostly a documentation exercise. Put it in writing even when the plan takes grievances by phone, and keep a copy. Name the authorized service, the authorization date, the hours or items approved, and what was actually delivered week by week. Attach the plan of care. Name the agency that failed to staff the shift. Ask for the grievance number and write it down. Note the date of every call and the name of every person on the other end. When AHCA later reviews documentation from the enrollee and from the plan, the family that kept a log is the family whose version of events is on the record.
AHCA makes the final determination on good cause and sends its decision in writing. An enrollee who disagrees with that determination may request a Florida Medicaid fair hearing. Separately, the state's Medicaid complaint line is 1-877-254-1055, and complaints about the assisted living facility itself — as opposed to the plan — run through AHCA's licensure side, which we covered in our guide to resident rights and AHCA complaints.
What happens to the apartment, the case manager and the care plan
This is the question that stops most families from switching, and the honest answer has two halves.
The apartment is only as portable as the facility's contracts. Changing plans does not move a resident, and nothing in the plan-change process requires a resident to leave an assisted living facility. But the new plan has its own network, and if the facility does not hold a contract with it, the family has traded one out-of-network problem for another. So the order of operations matters: before requesting any change, call the facility's administrator — not the front desk — and ask which Long-Term Care plans they currently contract with, and whether any of those contracts are in renegotiation. Then pick the destination plan from that list. Families who choose the plan first and check the facility second are the ones who end up moving a parent twice.
The case manager changes. Care coordination is a plan function, so a new plan means a new case manager, a new assessment, and a new plan of care built on that assessment. Expect the first weeks to be slower, not faster. Gather the current authorizations, the most recent 701B assessment if you have it, the medication list, and the physician orders before the switch, and hand the package to the incoming case manager at the first visit rather than waiting for records to travel between plans.
Authorized services do not automatically carry across at the same level. The new plan reassesses. In practice, a family that walks in with documentation of twenty authorized aide hours, a signed physician order, and a care plan that explains why those hours exist is in a much stronger position than one that arrives and describes the arrangement from memory. If hours come back lower than before, that denial carries its own appeal rights through the new plan — and a reduction that puts the resident at risk is itself appealable.
A plan change also does not touch Medicare. For the many South Florida residents who are dually eligible, the Long-Term Care plan and the Medicare coverage are separate enrollments, and changing one does not change the other. If the resident is in a plan that handles both long-term care and regular medical benefits, ask the choice counselor specifically what the change does to each side before agreeing to it.
Which plans serve Miami-Dade, Broward and Palm Beach
Plan availability under Statewide Medicaid Managed Care is regional, and South Florida is carved up in a way that matters for anyone comparing options or considering a move. Miami-Dade shares a region with Monroe County. Broward is a region on its own. Palm Beach is grouped with Indian River, Martin, Okeechobee and St. Lucie — which is why a family moving from Boca Raton to Port St. Lucie usually stays in the same region, while a move from Fort Lauderdale to Miami does not.
The plan rosters themselves change with each contract cycle, and Florida re-procured its Statewide Medicaid Managed Care contracts for the current term, so a plan list from an older AHCA document is not a reliable guide to what is available today. The Long-Term Care plans that have served the South Florida regions include Florida Community Care, Humana, Simply Healthcare and Sunshine Health across all three, with Aetna Better Health, Molina and UnitedHealthcare appearing in the Miami-Dade region. Treat that as orientation, not as a current roster: confirm the live list for your county with choice counseling at 1-877-711-3662 or at flmedicaidmanagedcare.com before making a decision.
Comparing plans well is less about the brochure and more about three questions the brochure never answers. Which of the facilities you would actually consider does this plan contract with? Which home health agencies does it use in your zip code, and can they staff a weekend shift in Hialeah or Pembroke Pines? And what is the case manager's caseload — a question plans rarely answer directly, but one where the facility administrators who deal with all of them daily will usually tell you the truth off the record.
| Your situation | What you can do | First call |
|---|---|---|
| Within 120 days of plan enrollment | Change for any reason, no approval needed | Choice counseling, 1-877-711-3662 |
| In your 60-day open enrollment window | Change without state approval | Choice counseling, or flmedicaidmanagedcare.com |
| Facility went out of network | Good cause at any time, no grievance required | Facility administrator, then choice counseling |
| Hours or services not being delivered | Grievance with the plan first, then good cause | Plan member services; get a grievance number |
| Immediate risk of permanent harm | Good cause without the grievance step | Choice counseling; say “immediate risk” in writing |
| Moved to a different region | New plan selection required | DCF, 1-866-762-2237 |
| Denied good cause by AHCA | Request a Florida Medicaid fair hearing | Follow the instructions in AHCA’s written decision |
The sequence that works
Families who get this right tend to do it in the same order, and it is not the order instinct suggests.
First, establish the date. Get the plan enrollment effective date in writing and count 120 days from it. If you are inside that window, act today and skip everything else.
Second, call the facility administrator and get the list of plans they contract with, plus any contracts in renegotiation. This list, not the plan comparison chart, is the real menu.
Third, match the reason to the tier. Facility out of network, moral or religious objection, or fraudulent enrollment goes straight to AHCA. Service delivery, access and quality problems go to the plan's grievance process first — unless there is an allegation of immediate risk of permanent damage, in which case say so and go straight to AHCA.
Fourth, build the paper file before you make the request: the termination notice or authorization records, the plan of care, the physician orders, the dated call log, the grievance number. Then submit by phone to 1-877-711-3662 or in writing to AHCA, P.O. Box 5197, MS 62, Tallahassee, FL 32314. If someone other than the enrollee is handling this, get a Designation of Authorized Representative on file first; it is the single most common reason a request stalls.
Fifth, if the window has closed and no good cause fits, mark the open enrollment period on a calendar and use the intervening months to document. A family that arrives at open enrollment with a year of specifics chooses better than one that arrives with a grievance.
If you are earlier in this process than plan changes — still waiting on a screening, still on the pre-enrollment list, or still working out eligibility — our guides to SMMC long-term care eligibility and the waitlist and enrollment process cover that ground, and what happens when private pay runs out covers the transition itself. For help matching a parent to assisted living in Miami or anywhere else in Florida that works with their specific plan, reach out — the service is free to families, and hablamos español. The Elder Helpline at 1-800-96-ELDER (1-800-963-5337) connects to the local Aging and Disability Resource Center, which can also help with screening questions.