Sunshine Health is one of the managed care plans that run Florida Medicaid. If your child's Medicaid card says Sunshine Health, ABA therapy can be a covered benefit when it is medically necessary. This page walks you through what Sunshine asks for, how approval works and what Paramount Behavior does so you do not have to carry the paperwork alone.
Is ABA covered under Sunshine Health?
Florida Medicaid covers behavior analysis services for eligible children and young people under 21 when they are medically necessary. The state's Medicaid agency, AHCA, states that all behavior analysis services need prior authorization, and that the request goes to the child's managed care plan. For families with Sunshine Health, that means Sunshine reviews and approves the therapy.
Sunshine Health's own clinical policy follows the state's rule. It says ABA is medically necessary when a member is under 21 and has behavior concerns that cause real difficulty in daily life. Examples include problems with safety, communication, repetitive behaviors or self-care.
What you need before therapy can start
Sunshine asks for a few items to be in place. Our team helps with every one:
- Active Sunshine Health Medicaid coverage for your child
- A referral from an independent physician or practitioner who can diagnose related conditions, such as your child's pediatrician, a developmental or psychiatric specialist or a child psychologist
- A comprehensive diagnostic evaluation (CDE), the standard evaluation used to diagnose autism and other developmental or behavioral conditions
- A behavior assessment by a BCBA, which includes standard questionnaires that you complete with the team
- A written behavior plan that you and the BCBA both sign
What "prior authorization" looks like with Sunshine
Once the assessment and plan are ready, the provider sends a request to Sunshine Health. Sunshine's provider page says it decides within five calendar days of receiving the request, and that one request can cover up to six months of services. The plan states the type and number of hours that are approved.
Sunshine also requires a Primary Care Provider (PCP) Acknowledgement form for new requests submitted on or after August 1, 2026. It simply lets your child's pediatrician know that ABA services have been requested. It does not require the doctor to approve the plan or set the hours.
How many hours Sunshine may approve
The number of hours depends on your child's needs. Your BCBA recommends hours, and the plan decides what it approves.
Keeping approval going
Approval is not forever. Florida Medicaid's behavior analysis coverage policy (AHCA) asks for a reassessment and an updated behavior plan about every six months. What you tell us about home makes the plan better.
What Sunshine does not cover under ABA
Sunshine's policy says behavior analysis does not include supervision, babysitting, companion or chaperone services, or acting as a one-on-one aide, and it does not include caregiver or childcare services.
If you are switching agencies, or if you are denied
If your child is already getting ABA somewhere else, moving to a new agency means a new approval from Sunshine and a Change of Provider form. We can walk you through it so there is no surprise gap. If Sunshine denies or reduces a request, you have the right to appeal. Sunshine's page says a member must file an appeal within 60 days of the notice. Keep that letter and call us.
How Paramount Behavior helps
We verify your Sunshine Health benefits for free, usually the same day you call. We tell you if a piece is missing, such as an evaluation or a referral, and where to get it. After that, our BCBAs write the assessment and plan, and our team submits and tracks the authorization. We have no waitlist: there are openings. Our team is bilingual in English and Spanish.
The fastest way to begin is the quick request form on this page. You can also call (561) 421-0047 and tell us your child's name and that you have Sunshine Health. If you have questions about your plan itself, call Member Services at the number on the back of your Sunshine Health ID card.
Do you accept Sunshine Health Medicaid?
Yes. Sunshine Health is one of the Florida Medicaid plans we work with, and we verify your benefits for free before therapy starts.
Do I need a diagnosis before I call?
Not to call. To start therapy, Sunshine requires a comprehensive diagnostic evaluation and a referral from a qualified physician or practitioner. If you do not have these yet, we will help you find local options.
How long does Sunshine take to approve ABA?
Sunshine says it decides on a request within five calendar days of receiving it. Getting the evaluation, assessment and referral ready can take longer, which is why we start the paperwork on day one.
Will I have copays with Sunshine Health Medicaid?
For covered ABA services under an approved authorization, most Medicaid families pay nothing out of pocket. We confirm your exact benefits for free before you begin.
Can my child get ABA at home and at school with Sunshine?
Yes, when the plan authorizes it. For school-based services, Sunshine's policy asks for the child's IEP, or an explanation if there is none, along with the request.