Sunshine Health

What Sunshine Health does

Sunshine Health is a Florida-based managed care organization and wholly-owned subsidiary of Centene Corporation, founded in 2007 and headquartered in Sunrise/Fort Lauderdale, Florida, with a workforce of 1,001-5,000 employees. The company provides government-sponsored health insurance across Medicaid managed care (including MMA, Long Term Care, and four specialty plans serving child welfare, serious mental illness, HIV, and children with chronic conditions), Medicare Advantage (operated under the Wellcare brand), and ACA Marketplace plans (Ambetter from Sunshine Health). Its portfolio extends beyond insurance to include the Start Smart for Your Baby maternity program, Sunshine Health Works workforce development initiative, Launchpad job support, telehealth services (including KidzDocNow pediatric and Brave Health behavioral platforms), disease management programs covering 16+ chronic conditions, and a member rewards program.

The underlying technology stack consists of a digital health platform comprising a member portal, mobile application (available on iOS and Android), the Wellframe digital health coaching platform, and integrated care management systems. Members access care through contracted provider networks across Florida, supported by 11 physical Community Connections Centers (Welcome Rooms) located in major metropolitan areas including Miami, Orlando, Tampa, Jacksonville, and Fort Lauderdale. Multi-language support spans 16+ languages to serve Florida's diverse population.

The business model operates on capitated per-member-per-month premium revenue from Florida Medicaid, CMS (for Medicare Advantage), and ACA Marketplace subsidies, with no public premium pricing. Members are acquired through Florida's Medicaid managed care enrollment system, the Medicare Advantage market, the ACA Marketplace, and broker/community partnerships. Distribution is anchored by the contracted provider network and supplemented by social media, the mobile app, Community Connections Centers, and a new athlete ambassador program (via Parity platform and Paralympian Dana Mathewson) launched in late 2025. Strategic community investments in food insecurity ($410,000 with Centene Foundation), childcare and transportation grants ($100,000), and 50 nonprofit health-related social needs grants ($106,000) demonstrate an integrated social determinants of health strategy tied to member outcomes and Medicaid quality metrics.

Name

Sunshine Health

Legal name

Sunshine Health

Website

https://sunshinehealth.com

Company type

Private

Founded year

2007

Operating status

Operating

Headcount range

1,001–5,000 employees

Short description

Sunshine Health is a Florida-based managed care organization and Centene subsidiary providing Medicaid, Medicare Advantage, and ACA Marketplace health plans, including specialty plans for child welfare, SMI, HIV, and chronically ill children, supported by 11 community centers and integrated workforce and social determinants programs.

Ownership category

akta.pro rank

Product category

Managed Care Health Insurance

NAICS

Health and Welfare Funds (525120), Health Care and Social Assistance (62)

SIC

Accident & Health Insurance (6321), Services-Health Services (8000)

akta.pro primary industry

Employer Wellness & Population Health Programs (HLAEAAAH)

akta.pro secondary industries

MA Chronic Condition Management & Supplemental Benefits (SSBCI) (HLAEACAI), Healthcare-Linked Social Benefits Administration (e.g., Medicaid/Means-Tested Health Coverage) (BPAIAKAH)

Keywords

• Medicaid managed care
• Medicare Advantage plans
• Health insurance marketplace
• Specialty health plans
• Managed care services

Headquarters

HQ city

Sunrise

HQ country

United States

HQ region

North America

Offices12 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Technology or R&D, Marketing or Sales, Infrastructure, Others

Revenue model

1. Medicaid Capitated Premiums: Sunshine Health receives capitated (per-member-per-month) payments from the Florida Medicaid program to provide managed care coverage to enrolled members across various plan types including MMA, Long Term Care, and specialty plans
2. Medicare Advantage Premiums: Medicare Advantage plans (Wellcare brand) generate premium revenue from CMS and member cost-sharing
3. Health Insurance Marketplace Premiums: Ambetter from Sunshine Health generates premium revenue from subsidized marketplace enrollments and member contributions

Pricing tiers

Go-to-market motion1 record

Distribution channels4 records

Marketing channels5 records

Core offering

Sunshine Health is a Florida-based managed care organization that sells government-sponsored health insurance plans — primarily Medicaid managed care (including specialty plans for child welfare, serious mental illness, HIV, and children with chronic conditions), Medicare Advantage, and ACA Marketplace plans (Ambetter from Sunshine Health) — to eligible individual members. It coordinates care through contracted provider networks and supplements its core insurance products with member support programs such as Start Smart for Your Baby, disease management, telehealth, and the Sunshine Health Works workforce development program.

Product overview

Sunshine Health is a Florida-based managed care organization and subsidiary of Centene Corporation offering a portfolio of health insurance plans and wellness programs. The core offering includes Medicaid managed care and Medicare Advantage plans, supplemented by specialized plans for distinct populations: Sunshine Health Pathway to Shine (child welfare), Sunshine Health Mindful Pathways (serious mental illness), Sunshine Health Power to Thrive (HIV), and Children's Medical Services Health Plan (children with chronic conditions). The company also offers Ambetter marketplace plans. Beyond insurance products, the portfolio includes support programs such as Start Smart for Your Baby (maternity/newborn), Sunshine Health Works (workforce development), Launchpad (job support), Community Connections Centers (11 physical locations), Telehealth Services, Rewards Program, and Disease Management Programs covering 16+ chronic conditions. The portfolio operates as a platform model where members can access multiple coordinated services through a single managed care relationship.

Differentiator

Problem solved

Functional benefit

Brands

• Sunshine Health Works: Workforce development program that trains participants in healthcare certifications and creates career pathways
• Start Smart for Your Baby
• Ambetter from Sunshine Health
• Community Connections
• Wellcare

Products and services

• Medicaid Managed Care Florida Medicaid managed care plan providing comprehensive health coverage (medical, pharmacy, dental, behavioral health) for eligible low-income individuals and families enrolled through the Florida Medicaid program.
• Comprehensive Long Term Care Long-term care managed plan covering extended care services for Florida Medicaid members with chronic conditions or disabilities requiring ongoing support, including caregiver resources and participant direction options.
• Sunshine Health Pathway to Shine Specialty Medicaid plan for children and youth in Florida's child welfare system, including those in foster care, adoption assistance, or guardianship, providing healthcare coordination and support services.
• Sunshine Health Mindful Pathways Specialty plan for Florida Medicaid adults with serious mental illness (SMI), providing integrated behavioral and physical health services with dedicated care management.
• Sunshine Health Power to Thrive Specialty plan for Florida Medicaid individuals living with HIV, offering coordinated care and support services addressing both health and social needs.
• Children's Medical Services Health Plan Specialized health plan for children and youth under 21 with serious, chronic medical conditions, operated by Sunshine Health under the Florida KidCare program, providing specialized pediatric care coordination.
• Ambetter from Sunshine Health Health Insurance Marketplace plan offering qualified health plan coverage for individuals and families who do not qualify for Medicaid or Medicare, with tiered benefit options.
• Medicare Advantage Medicare Advantage plan for Medicare-eligible Florida residents, providing Part C coverage with additional benefits beyond Original Medicare, operated under the Wellcare brand by parent company Centene.
• Start Smart for Your Baby Maternity and newborn support program offering educational resources, care coordination, and rewards for pregnant members and new parents, including prenatal guidance, postpartum support, and breastfeeding assistance.
• Sunshine Health Works Workforce development program providing healthcare certifications, scholarships, employment pathways, and job support services for Medicaid members and community members seeking healthcare careers.
• Community Connections Centers Physical community centers located across 11 Florida cities (Fort Myers, Jacksonville, Lauderhill, Miami, Ocala, Orlando, Pensacola, Pinellas Park, Tallahassee, Tampa, West Palm Beach) providing member services, resources, and community programming.

Quantifiable outcome

• Nearly 1,900 participants trained in healthcare certifications through Sunshine Health Works program in 2025
• +2 more outcomes

Named customers7 records

Segments8 records

Ideal customer profiles4 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature6 records

Partnerships

Eight partnerships are on record, tiered significant, key, major and core.

• 5 Florida Nonprofit Organizations (Childcare and Transportation Grants)significantStrategic or Co-development Partner · 31 March 2026Sunshine Health awarded $100,000 in grants to five nonprofit organizations across Florida to improve workforce access through childcare and transportation support, helping vulnerable populations access employment, training, and healthcare services across more than 40 counties.
• Parity (Women Athletes Sports Marketing Platform)keyGTM or Marketing Partner · 17 December 2025Sunshine Health partnered with Parity, a sports marketing platform for women athletes, to promote health awareness in Florida. The collaboration supports Florida's Medicaid program by focusing on mental health, child and maternal health, and community wellness through athlete ambassador content.
• Dana Mathewson (Paralympian Athlete Ambassador)keyGTM or Marketing Partner · 17 December 2025Paralympian wheelchair tennis champion and cancer advocate Dana Mathewson serves as Sunshine Health's first athlete ambassador, sharing health awareness campaign content across her social media channels to promote mental health, maternal health, and community wellness.
• Farm Share, Inc.majorStrategic or Co-development Partner · 19 November 2025Sunshine Health and Centene Foundation invested $300,000 in Farm Share, a Florida food bank, to distribute at least 125,000 pounds of food (over 104,000 meals) to address food insecurity across the state.
• 50 Florida Nonprofit Organizations (Health-Related Social Needs Grants)significantStrategic or Co-development Partner · 25 September 2025Sunshine Health awarded $106,000 in grants to 50 nonprofit organizations across Florida to support health-related social needs including food insecurity, homelessness, and maternal health.
• 12 Local Florida CollegescoreStrategic or Co-development Partner · 1 January 2025Sunshine Health Works workforce development program partners with 12 local colleges to provide healthcare certification training, including Certified Nursing Assistant, Home Health Aide, and Licensed Practical Nurse programs. The partnerships enable career pathways for community members and Medicaid beneficiaries entering or re-entering the healthcare workforce.
• Florida Healthcare ProviderscoreStrategic or Co-development Partner · 1 January 2025Partnership with healthcare providers to offer clinical training sites and employment pathways for Sunshine Health Works program graduates who earn healthcare certifications.
• Florida Community OrganizationscoreStrategic or Co-development Partner · 1 January 2025Community organizations partner with Sunshine Health Works to support workforce development participants with wraparound services and employment placement assistance.

Scale indicators8 records

Recent moves5 records

Expansion highlights4 records

Direct peers

• Simply Healthcare Plans: Florida Medicaid managed care organization and fellow Centene subsidiary serving Medicaid and Medicare Advantage members across Florida. Direct peer given shared parent, overlapping product portfolio, and same Florida Medicaid contract structure.
• Florida Blue: Florida's Blue Cross Blue Shield licensee, offering Medicaid managed care, Medicare Advantage, and individual/family plans in Florida. Direct competitor for Florida Medicaid contracts and Marketplace enrollment.
• Molina Healthcare: Government-sponsored healthcare specialist operating Medicaid and Medicare Advantage plans in Florida. Highly comparable business model focused on low-income and complex populations.
• Amerigroup Florida (Elevance Health): Elevance Health's Medicaid managed care subsidiary in Florida serving TANF, CHIP, and complex populations. Direct competitor for Florida Medicaid contracts.
• CareSource Florida: Nonprofit managed care organization with Florida Medicaid contracts serving low-income and complex populations. Direct competitor with similar mission-driven positioning.

Broad incumbents

• Humana: Major national health insurer with significant Florida Medicare Advantage and Medicaid presence. Competes with Sunshine Health for both MA and Medicaid members across Florida.
• UnitedHealthcare: Nation's largest health insurer offering Medicaid, Medicare Advantage, and individual marketplace plans in Florida. Competes across all of Sunshine Health's major product lines.
• Aetna (CVS Health): National insurer offering Medicaid managed care and Medicare Advantage in Florida as part of CVS Health's integrated care strategy. Competes in both government-sponsored product lines.

Regional players

• Children's Medical Services Health Plan (Florida): Florida's specialty Medicaid plan for children with chronic conditions. Operates as a state-administered plan that Sunshine Health administers; comparable in serving the same specialized pediatric population.
• Prestige Health Choice: Florida-focused Medicaid managed care plan serving children and complex populations. Comparable niche focus on specialty Medicaid populations in the same state.

Market position

Strengths4 records

Weaknesses4 records

Competitive moat5 records

Key risks5 records

Key highlights6 records

Customer concentration

• Xx.com/sunhealthfl
• Facebookfacebook.com/sunshinehealthplan
• LinkedInlinkedin.com/company/sunshine-state-health-plan-inc-

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments80 records

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Sunshine Health