Florida Community Care LLC

What Florida Community Care LLC does

Florida Community Care (FCC), LLC is a Florida-based Medicaid managed care organization headquartered in Miami at 4601 NW 77th Ave, with a claims mailing address in Eagan, MN. The company holds a Florida Medicaid managed care contract administered by the Florida Agency for Health Care Administration (AHCA) and serves Medicaid-eligible populations statewide across all nine Florida regions (A through I). FCC operates as a provider-owned health plan, distinguishing itself from larger national Medicaid carriers, and offers three core product lines: Managed Medical Assistance (MMA) for general Medicaid enrollees, Long-Term Care (LTC) for members needing nursing facility, assisted living, or home- and community-based services, and the Intellectual and Developmental Disabilities Comprehensive Managed Care (ICMC) Program for adults 18+ with intellectual or developmental disabilities on the iBudget Waiver pre-enrollment list.

The company supplements its core products with a layered portfolio of specialized programs: HIV/AIDS and Serious Mental Illness (SMI) specialty programs, a comprehensive maternal health offering under the AHCA-led 'From the Start' initiative (including unlimited doula visits, lactation support up to six months postpartum, breast pump coverage, and home-delivered meals for high-risk pregnancies), Applied Behavior Analysis (ABA) services delivered through a partnership with Behavioral Services Network (BSN), a Healthy Behaviors wellness program, and Disease Management programs for asthma/COPD, cancer, dementia, diabetes, and hypertension. Member-facing value-added benefits include a $65/month Over-the-Counter (OTC) benefit, prenatal and postpartum incentive rewards of $25-$50 per milestone, free non-emergency transportation, 24/7 nurse advice, and telehealth services.

FCC's revenue model is single-stream capitated Medicaid managed care: the company receives per-member-per-month (PMPM) payments from Florida Medicaid/AHCA and assumes full financial risk for delivering covered medical, behavioral, pharmacy, and long-term care services through its contracted provider network. Members access care at $0 out-of-pocket cost for covered services. The operational technology stack integrates Availity Essentials for claims clearinghouse (Payer ID FLCCR), HealthX for the provider portal, HHAeXchange for federally mandated Electronic Visit Verification (EVV), CVS Caremark for retail/specialty/mail-order pharmacy, iCare for vision, Hear USA for hearing, Ride2MD for transportation, BSN for behavioral health network management, PPL First for self-directed long-term care, and InterQual for medical-necessity determinations. Membership growth and revenue generation are entirely dependent on Florida Medicaid contract performance and are not diversified across other states, payers, or product types.

Name

Florida Community Care LLC

Legal name

Florida Community Care, LLC

Website

https://fcchealthplan.com

Company type

Private

Founded year

2017

Operating status

Operating

Headcount range

101–250 employees

Short description

Florida Community Care is a Miami-based, provider-owned Florida Medicaid managed care plan delivering MMA, LTC, and ICMC programs for Medicaid-eligible populations across all nine Florida regions under capitated contracts with AHCA.

Ownership category

akta.pro rank

Product category

Medicaid Managed Care

NAICS

Services for the Elderly and Persons with Disabilities (624120)

SIC

Hospital & Medical Service Plans (6324), Services-Health Services (8000)

akta.pro primary industry

Integrated Physical-Behavioral-Social Care (Whole-Person) Medicaid Plans (HLAEAEAI)

akta.pro secondary industry

Aged, Blind & Disabled (ABD) Managed Care Plans (HLAEAEAC)

Keywords

• Medicaid managed care
• Long-term care services
• Disability care programs
• Behavioral health plans
• Maternal health programs

Headquarters

HQ city

Miami

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Supply Chain, Technology or R&D, Marketing or Sales, Infrastructure

Revenue model

1. Capitated Medicaid Managed Care Revenue: Florida Community Care receives capitated (per-member-per-month) payments from Florida Medicaid/AHCA to provide covered health services to enrolled members. The plan assumes financial risk for providing comprehensive Medicaid services including MMA, LTC, and ICMC programs.

Pricing tiers

Go-to-market motion1 record

Distribution channels5 records

Marketing channels7 records

Core offering

Florida Community Care is a Florida Medicaid Managed Care Plan that delivers capitated healthcare coverage through three integrated programs: Managed Medical Assistance (MMA), Long-Term Care (LTC), and the Intellectual and Developmental Disabilities Comprehensive Managed Care (ICMC) Program. The plan covers comprehensive medical, behavioral, pharmacy, long-term care, and specialty services for Medicaid-eligible populations across all nine Florida regions. Revenue comes from per-member-per-month capitated payments from Florida Medicaid/AHCA, and services are delivered through a contracted statewide provider network supplemented with telehealth, OTC benefits, and care coordination.

Product overview

Florida Community Care (FCC) LLC is a Florida Medicaid managed care plan offering a unified portfolio of health coverage products and services. The core offerings consist of Managed Medical Assistance (MMA), Long-Term Care (LTC), and the Intellectual and Developmental Disabilities Comprehensive Managed Care (ICMC) Program, which together provide comprehensive medical, behavioral, and long-term care coverage. These core products are supplemented by specialized programs including Specialty Programs for HIV/AIDS and Serious Mental Illness, Pregnancy and Maternal Health Services (including the From the Start initiative and MOMitor app), Behavioral Analysis (BA/ABA) Services, a Healthy Behaviors Program (weight management, substance abuse, smoking cessation), and Disease Management Programs for chronic conditions. FCC also provides digital platforms including a Provider Portal (HealthX) and Member Portal, plus value-added benefits such as Telehealth Services and a $65 monthly Over-the-Counter (OTC) Benefit. The company's services are available statewide across nine Florida regions (A through I).

Differentiator

Problem solved

Functional benefit

Products and services

• Managed Medical Assistance (MMA) Florida Community Care's primary managed care health plan providing comprehensive medical coverage including primary care, specialty care, hospital services, emergency care, prescription medications, mental health services, and transportation to appointments. Available statewide across regions A through I for Florida Medicaid-eligible adults and children.
• Long-Term Care (LTC) Plus Plan Long-term care coverage including nursing facility services, assisted living, personal care, homemaker services, home health assistance, care management, transportation, meals, and medical equipment. Provides 100% coverage for eligible LTC services at $0 cost for members with 90-day regular care plan reviews and 24/7 access to care support.
• Intellectual and Developmental Disabilities Comprehensive Managed Care (ICMC) Program Statewide Medicaid program providing coordinated healthcare and support services for individuals with intellectual and developmental disabilities. Combines MMA services, LTC services, and IDD-specific services including Applied Behavior Analysis therapy, life skills development, personal supports, and residential services such as group homes and supported living. Provides 180-day continuity of care for transitioning members.
• Specialty Programs (HIV/AIDS and Serious Mental Illness) Specialized Managed Medical Assistance services for members with HIV/AIDS or Serious Mental Illness (SMI). Includes primary care, hospital services (inpatient and outpatient), emergency services, specialty care, mental health services, and pharmacy coverage tailored to the unique needs of these populations.
• Pregnancy and Maternal Health Services Comprehensive maternal health program for Medicaid-eligible pregnant women including unlimited doula visits, MOMitor app for high-risk pregnancies, home visiting services, enhanced care coordination, home-delivered meals (10-pack per week for high-risk pregnant members), lactation support 24/7 up to six months postpartum, breast pump coverage (one per lifetime), and prenatal/postpartum incentive rewards.
• From the Start Program Statewide maternal health initiative aligned with AHCA and Florida Medicaid that enhances services across managed care plans to improve birth outcomes, focusing on early access to quality care from pregnancy through a baby's first year of life.
• Behavioral Analysis (BA) Services Applied Behavior Analysis (ABA) therapy services for individuals with Medicaid coverage, particularly for children with autism. FCC serves members in Regions A-D and I through a partnership with BSN (Behavioral Services Network). Includes billing guidance, prior authorization support, and continuity-of-care provisions for transitioning members.
• Healthy Behaviors Program Voluntary wellness program offering weight management (nutrition counseling, diet plans overseen by physicians, telephonic dietitian support), substance abuse treatment access (psychiatrists, substance abuse professionals, community resources), and smoking cessation (counseling and non-nicotine medications).
• Disease Management Programs Chronic condition management programs for asthma/COPD, cancer, dementia/Alzheimer's, diabetes, and hypertension. Includes phone support, educational tools, self-management training, goal setting, and coordination with primary physicians and specialists.
• Telehealth Services Virtual healthcare delivery using electronic information and telecommunication technologies. Enables live phone or video consultations, secure messaging, remote patient monitoring (ECG, vitals), and access to general health care, prescriptions, dermatology, eye exams, nutrition counseling, mental health counseling, and urgent care conditions.
• Over-the-Counter (OTC) Benefit Monthly over-the-counter benefit of $65.00 per enrolled member per month for eligible members. Members can present their FCC ID card at FCC-contracted pharmacies to obtain OTC items from an approved catalog. Generic products provided when available.
• Provider Portal (HealthX) Web-based platform (HealthX) enabling providers to verify enrollee eligibility status, check authorization status, submit claims, and make claim inquiry requests. Accessible at secure.healthx.com/fcc_provider.
• Member Portal and Resources Online member portal providing 24/7 access to member handbooks (English and Spanish), OTC catalogs, preferred drug lists, provider search, parental real-time reporting for PDN services, and quarterly member newsletters in English and Spanish.
• MOMitor App Mobile application that supports high-risk pregnant members during pregnancy and after delivery, helping them look for early signs of common health problems that can occur. Part of the enhanced maternal health services under the 'From the Start' statewide initiative.

Quantifiable outcome

• $65 monthly OTC benefit for enrolled members
• +3 more outcomes

Segments6 records

Ideal customer profiles7 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration12 records

Feature6 records

Partnerships

Nine partnerships are on record, tiered core and standard.

• CVS / CVS CaremarkcoreTechnology or IntegrationFlorida Community Care has contracted with CVS for pharmacy services including retail pharmacy network, specialty pharmacy (CVS Specialty Pharmacy), and mail service pharmacy. CVS Caremark handles pharmacy benefit management including preferred drug list coordination with AHCA, prior authorization processing (Fax: 866-255-7569, Phone: 877-888-8347), and specialty medication coordination. Members can access 90-day mail service supplies and specialty medications delivered to their residence or local CVS pharmacy.
• Hear USAstandardChannel Partner/ Reseller/ DistributorFlorida Community Care has contracted with Hear USA for hearing services. Members can access hearing exams, hearing aids, and hearing-related care through Hear USA's provider network.
• iCare (iCare Health Solutions)standardChannel Partner/ Reseller/ DistributorFlorida Community Care has contracted with iCare for vision services including eye exams, glasses, and vision-related care. Members can access iCare's provider network for vision services.
• Ride2MDstandardChannel Partner/ Reseller/ DistributorFlorida Community Care has contracted with Ride2MD for non-emergency medical transportation services. Members can schedule transportation to medical appointments through Ride2MD by calling 1-833-FCC-PLAN.
• AvailitycoreTechnology or IntegrationFlorida Community Care partners with Availity Essentials, a secure provider portal offering claims clearinghouse and real-time transactions at no charge. Providers can submit electronic claims, verify eligibility, check authorization status, and access real-time information through Availity. Payer ID for FCC is 'FLCCR'. Registration available at availity.com.
• HHAeXchangecoreTechnology or IntegrationFlorida Community Care uses HHAeXchange as its Electronic Visit Verification (EVV) vendor as mandated by the 21st Century Cares Act. Providers of Personal Care Services (required since January 2021) and Home Health Care Services (required since January 2023) must use HHAeXchange for visit verification. Registration required at hhaexchange.com/florida.
• Behavioral Services Network (BSN)coreChannel Partner/ Reseller/ DistributorBehavioral Services Network (BSN) is Florida Community Care's behavioral health partner for ABA (Applied Behavior Analysis) services. BSN handles provider network contracting for behavioral analysis services. Providers interested in joining FCC's network for behavioral health services can submit requests through BSN's provider portal at providers.bsnnet.com.
• PPL First (Participant Directed Option Vendor)standardTechnology or IntegrationPPL First serves as the vendor for the Participant Directed Option (PDO) program, allowing certain members to direct their own care services. This self-directed care option is available for eligible LTC members.
• HealthX (Provider Portal)coreTechnology or IntegrationHealthX provides Florida Community Care's secure provider web portal for enrolled providers to access enrollee eligibility status, authorization status, claims status, and submit claim inquiry requests. Login available at secure.healthx.com.

Scale indicators2 records

Recent moves6 records

Expansion highlights5 records

Emerging players

• Magellan Complete Care of Florida: Specialty Medicaid plan with behavioral health and complex-care focus, operating in Florida. Overlaps with FCC's SMI and IDD service lines but with a more concentrated behavioral-health positioning.

Direct peers

• Molina Healthcare of Florida: Molina's Florida Medicaid managed care plan serving MMA, LTC, and specialty populations. Directly comparable to FCC in product mix and target population, with greater geographic diversification across other states.
• Humana Healthy Horizons (Florida): Humana's Medicaid managed care plan in Florida, offering MMA and LTC programs across multiple regions. Directly competes with FCC for Florida Medicaid enrollees and shares the same capitated revenue model.
• Simply Healthcare Plans (Anthem): Anthem-affiliated Florida Medicaid and Medicare plan serving MMA and specialty populations including HIV/AIDS. Direct competitor with established brand and parent-company infrastructure.
• Aetna Better Health of Florida: CVS Health-owned Medicaid managed care plan operating in Florida, offering MMA and specialty programs. Direct competitor benefiting from CVS pharmacy infrastructure similar to FCC's partnership.
• UnitedHealthcare Community Plan of Florida: UnitedHealth Group's Florida Medicaid plan providing MMA and specialty services across regions. A direct competitor with national scale and integrated UnitedHealthcare provider infrastructure.
• Sunshine Health (Centene): Centene-owned Florida Medicaid managed care plan offering MMA, LTC, and specialty programs statewide. Direct competitor with substantially greater scale and parent-company backing.

Regional players

• Children's Medical Services Health Plan: Florida-specific Medicaid plan for children with special health care needs, administered under Florida Health. Adjacent competitor serving overlapping complex pediatric populations with a specialized state-contract model.
• Prestige Health Choice: Florida-focused Medicaid managed care plan offering MMA services in select regions. Comparable Florida-only MCO with a more limited regional footprint than FCC's statewide coverage.

Broad incumbents

• Florida Blue: Florida's Blue Cross Blue Shield licensee, with a broader portfolio including commercial, Medicare, and Medicaid products. Competes in overlapping Florida Medicaid segments while operating a much wider business.

Market position

Strengths5 records

Weaknesses4 records

Competitive moat4 records

Key risks5 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/fcchealthplan

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

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

M&A

Investments

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

Frequently asked questions about Florida Community Care LLC