Quick answer
Sunshine Health is a Florida Medicaid managed care plan, so it covers the behavioral health services Florida Medicaid requires of every plan, including detox, therapy, intensive outpatient and medication for opioid use disorder. What you also get depends on your plan, the level of care, and a medical necessity review. Florida has not expanded Medicaid.
Published: 2026-10-26 Updated: 2026-10-26
You have Florida Medicaid, or you think you might qualify, and Sunshine Health is the name on the card. Now you want to know whether it will pay for detox or rehab, and whether you need permission first. The short version: Sunshine Health carries a Florida Medicaid behavioral health benefit that reaches a long way into substance use treatment, and the details that decide your case live in your plan and in a medical necessity review.
Does Sunshine Health cover rehab and detox in Florida?
It depends on the level of care and on medical necessity, but the benefit list is broad. Sunshine Health is a managed care plan with a Florida Medicaid contract, and its published substance use disorder benefit includes detoxification through an addiction receiving facility, ambulatory detox, partial hospitalization, intensive outpatient, individual and group therapy, peer support, and medication assisted treatment. Higher levels of care typically go through the plan's authorization process, so the treatment provider confirms your benefits before you are admitted.
What Sunshine Health covers for substance use
Sunshine Health publishes a Substance Use Disorder (SUD) Guide for members that spells out the behavioral health services in its benefit. Alongside mental health services, the list includes treatment that matters for addiction specifically:
- Detoxification or addiction receiving facility — emergency substance use services delivered somewhere other than a regular hospital
- Ambulatory detoxification — managing withdrawal on an outpatient basis in a community setting
- Medication assisted treatment (MAT) — medication used to treat drug addiction, alongside counseling
- Intensive outpatient program (IOP) — structured treatment several times a week that lets you stay at home
- Partial hospitalization program (PHP) — hospital-based treatment several hours a day, several days a week
- Individual, group and family therapy, plus peer support services and case management
The guide also lists a short-term residential treatment program for pregnant women with substance use disorder. Coverage is provided as recommended by your doctor, which is another way of saying the plan ties payment to a clinical review.
Florida takes a second layer into account. Statewide Medicaid Managed Care is the program that covers most Florida Medicaid recipients, and the state lists community behavioral health services — assessments, medical and psychiatric services, individual, group and family therapies, and rehabilitative services — as one of the minimum covered services that every Managed Medical Assistance plan must provide.
How Florida Medicaid decides what is covered
Florida runs its Medicaid program through the Agency for Health Care Administration (AHCA). Under Statewide Medicaid Managed Care, which AHCA replaced with the SMMC 3.0 structure on February 1, 2025, most recipients are enrolled with a managed care plan that is responsible for delivering the benefit package.
Two things follow from that structure:
- The plan, not a brochure, decides your case. Sunshine Health's own materials carry a standard note that the benefit information it publishes is a brief summary, not a complete description, and that limitations, copayments and restrictions may apply. Your member handbook and plan documents are the authority.
- A higher level of care usually means an authorization. Residential and inpatient programs are where plans most often require a medical necessity review before they will pay. The treatment provider is normally the one who submits it, so ask what was requested and what the plan decided.
What it may cost you
For people who qualify, Medicaid has historically been a low-cost payer, and Sunshine Health lists waived copayments across services — including behavioral health — as an expanded benefit for members 21 and older. Because it is an expanded benefit tied to age, confirm it against your own plan materials rather than assuming it applies to you.
Your parity rights
The Mental Health Parity and Addiction Equity Act generally bars health plans that cover mental health and substance use disorder benefits from putting less favorable financial requirements and treatment limits on those benefits than they put on medical and surgical care. For Medicaid managed care, the Social Security Act requires plans that contract with state Medicaid programs to meet certain parity requirements.
Two things worth holding onto if you get a no:
- The criteria are disclosable. You can ask which medical necessity criteria were applied to your request and how your case was measured against them.
- A denial is appealable. Use the plan's grievance and appeal process first. Save the denial letter, the date, the reference number, and the name of anyone you speak with.
How to check your own benefits before you commit
Call the number on the back of your Sunshine Health card and ask three questions: Is the level of care I am considering covered, does it need prior authorization, and what will I owe? Sunshine Health Member Services reaches live help at 1-866-796-0530 (TTY 1-800-955-8770) Monday through Friday, 8 a.m. to 8 p.m. Eastern.
A hard eligibility fact is worth knowing up front: Florida has not expanded Medicaid under the Affordable Care Act, so coverage runs through categories such as children, pregnant women, parents and caretakers, people 65 or older, and people with a disability. If you are unsure whether you qualify, applying costs nothing and your state agency makes the call. If you do not qualify, SAMHSA's National Helpline (1-800-662-4357) is free, confidential and open 24 hours a day.
If you would rather talk the options through before calling the plan, call (800) 653-9376. The call is free to you, the referral service is paid for by treatment providers, and there is no judgment on the other end.
If you are in crisis right now, call or text 988 for the Suicide and Crisis Lifeline. Call 911 for a medical emergency.
Questions about Sunshine Health Coverage
Does Sunshine Health cover rehab and detox in Florida?
Sunshine Health is a managed care plan that holds a Florida Medicaid contract, and it lists a full behavioral health benefit that includes detoxification through an addiction receiving facility, ambulatory (outpatient) detox, partial hospitalization, intensive outpatient, therapy, peer support and medication assisted treatment. Whether a specific program is covered depends on medical necessity and your plan, so ask the plan directly about the level of care you are considering.
Do I need approval before starting treatment?
Florida Medicaid covers community behavioral health services, and managed care plans handle authorizations for higher levels of care themselves. The practical step is to have the treatment provider check your benefits and request any authorization before you are admitted. If you are unsure, call Sunshine Health Member Services at 1-866-796-0530 (TTY 1-800-955-8770).
Who can get Sunshine Health in Florida?
You have to qualify for Florida Medicaid first. Florida has not expanded Medicaid under the Affordable Care Act, so eligibility generally runs through categories such as children, pregnant women, parents and caretakers, people 65 or older, and people with a disability. Most Florida Medicaid recipients are enrolled in the Statewide Medicaid Managed Care program, where they choose a plan like Sunshine Health.
What does Sunshine Health cover for opioid use disorder?
Sunshine Health's behavioral health benefit lists medication assisted treatment services, and Florida Medicaid plans cover medications for opioid use disorder including methadone, buprenorphine and naltrexone. Ask which form your plan covers and where you can fill it, since methadone is dispensed through a certified opioid treatment program.
What if Sunshine Health denies coverage?
You can appeal. Federal parity rules limit how much more restrictive a plan's substance use disorder benefits and reviews can be than its medical benefits, and they require disclosure of the criteria used. Start with the plan's member grievance and appeal process, and keep copies of every denial letter and reference number.