What AmeriHealth Caritas Florida does

AmeriHealth Caritas Florida is a state-level operating entity within AmeriHealth Caritas, a privately held managed care organization that provides government-sponsored health plans to Medicaid, Medicare/Dual-Eligible, and (via AmeriHealth Caritas Next) individual/family Exchange populations. The Florida entity, founded in 2011 with 112 employees, delivers services under capitated contracts with the Florida state Medicaid agency and operates alongside sister state-level entities across multiple U.S. states. The broader organization traces its institutional Medicaid expertise back more than 40 years, anchored by a mission to serve chronically ill and low-income populations.

The company's core offering is a whole-person care model that integrates physical health, behavioral health (delivered through wholly-owned subsidiary PerformCare), pharmacy benefits management, and long-term services and supports (LTSS) for elderly and disabled members. Revenue is generated primarily through capitated per-member-per-month payments from state Medicaid agencies, supplemented by Medicare Advantage and Dual Special Needs Plan contracts, Exchange premiums via AmeriHealth Caritas Next, and pharmacy benefit service fees. Distribution relies on state procurement contracts, contracted provider networks (primary care physicians, specialists, hospitals, and Federally Qualified Health Centers), and community-based outreach including the Care Crew employee volunteer program.

AmeriHealth Caritas is privately held with no disclosed parent company, no public listing, and no disclosed revenue or funding history. Operations are anchored by deep regulatory and contractual relationships with state governments, partnerships with FQHCs and provider networks, and an integrated services portfolio that enables the company to bid as a full-service Medicaid managed care partner in state procurement processes.

Name

AmeriHealth Caritas Florida

Legal name

AmeriHealth Caritas

Website

https://amerihealthcaritasfl.com

Company type

Private

Founded year

2001

Operating status

Operating

Headcount range

101–250 employees

Short description

AmeriHealth Caritas Florida is a state-level Medicaid managed care entity serving low-income, chronically ill, and dual-eligible populations in Florida through capitated government contracts. It operates as part of AmeriHealth Caritas, a privately held managed care organization with multi-state operations delivering integrated whole-person care.

Ownership category

akta.pro rank

Product category

Managed Health Care

NAICS

Direct Health and Medical Insurance Carriers (524114), Direct Life, Health, and Medical Insurance Carriers (52411)

SIC

Accident & Health Insurance (6321), Hospital & Medical Service Plans (6324)

akta.pro primary industry

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

akta.pro secondary industries

Medicaid Expansion (ACA Adult) Managed Care Plans (HLAEAEAB), Medicare Advantage (MA) Plans (FSAIAGAA), MA-PD Plans (Medicare Advantage with Prescription Drug Coverage) (FSAIAGAG)

Keywords

• Medicaid managed care
• Medicare dual eligible
• Behavioral health services
• Pharmacy benefits management
• Long-term care supports

GTM type

B2B

Offering type

Services

Cost components

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

Revenue model

1. Medicaid Managed Care Capitation: State government contracts providing capitated payments for managing Medicaid beneficiary care. The company assumes responsibility for providing comprehensive healthcare services to enrolled Medicaid members in exchange for fixed per-member-per-month payments.
2. Medicare/Dual Eligible Plans: Programs for dual-eligible members who qualify for both Medicaid and Medicare, offering supplemental benefits and improved care coordination. Revenue derived from Medicare Advantage star ratings and dual special needs plan contracts.
3. Individual and Family Health Plans (Exchange): AmeriHealth Caritas Next offers health plans both on and off the Health Insurance Exchange, generating revenue through premium payments from individuals and families.
4. Pharmacy Benefits Management: Innovative, cost-effective pharmacy benefit services for Medicaid, Medicare, and commercial health plans with customized solutions ranging from specialized options to comprehensive pharmacy benefits management.

Pricing tiers

Go-to-market motion1 record

Distribution channels3 records

Marketing channels3 records

Core offering

AmeriHealth Caritas Florida is a managed care organization that delivers integrated health plans and care services primarily to Medicaid, Medicare, and dual-eligible beneficiaries in Florida. It operates through state Medicaid contracts, provider networks, and the federal Health Insurance Exchange, applying a whole-person care model that addresses physical health, behavioral health, and social determinants of health.

Product overview

AmeriHealth Caritas operates as a managed care organization offering a platform of integrated health care solutions. The portfolio includes Medicaid Managed Care as the core offering, Medicare and Dual-Eligible Plans, AmeriHealth Caritas Next℠ for individual and family health plans on Exchanges, PerformCare® for behavioral health care services, Long-Term Services and Supports (LTSS) for vulnerable populations, and Pharmacy Benefits Management. The company employs a whole-person care model that integrates these services to address both medical and social determinants of health, supporting members across Medicaid, Medicare, and commercial populations.

Differentiator

Problem solved

Functional benefit

Brands

• PerformCare®: Full-service behavioral managed health care company providing innovative, confidential, and customizable behavioral health plans and substance abuse support for communities.
• AmeriHealth Caritas Next℠

Products and services

• Medicaid Managed Care Health plans providing comprehensive managed care services to Medicaid beneficiaries, including preventive care, chronic disease management, and specialty services, delivered through state Medicaid contracts.
• Medicare and Dual-Eligible Plans Health plans for members qualifying for both Medicaid and Medicare, offering supplemental benefits, preventative services, and improved care coordination across programs.
• AmeriHealth Caritas Next Individual and Family Health Plans Individual and family health insurance plans available on and off the federal and state Health Insurance Exchange, providing affordable coverage options for households at various life stages.
• PerformCare Behavioral Health Services Behavioral health plans and substance abuse support services providing confidential and customizable mental health care through an integrated managed care model.
• Long-Term Services and Supports (LTSS) Comprehensive long-term care services for elderly members and individuals with disabilities requiring help with daily living activities, medication management, and ongoing supportive care.
• Pharmacy Benefits Management Pharmacy benefit services offering customized solutions ranging from specialized options to comprehensive pharmacy benefits management for Medicaid, Medicare, and commercial health plan populations.

Quantifiable outcome

• 87% increase in procurement from small businesses since 2013
• +1 more outcomes

Segments5 records

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Feature3 records

Partnerships

Three partnerships are on record, tiered core.

• Federally Qualified Health CenterscoreStrategic or Co-development PartnerAmeriHealth Caritas partners with Federally Qualified Health Centers (FQHCs) to expand access to healthcare services for underserved populations. FQHCs provide primary care services in underserved areas and are a critical component of the company's provider network for delivering care to Medicaid beneficiaries.
• State Government AgenciescoreStrategic or Co-development PartnerStrategic partnerships with state Medicaid agencies to provide managed care services. These government contracts form the core of AmeriHealth Caritas's business model, providing capitated payments in exchange for managing the healthcare of Medicaid beneficiaries.
• PerformCarecoreStrategic or Co-development PartnerPerformCare is AmeriHealth Caritas's full-service behavioral managed health care subsidiary, providing innovative, confidential, and customizable behavioral health plans and substance abuse support through the company's integrated care model.

Scale indicators3 records

Recent moves5 records

Expansion highlights5 records

Direct peers

• CareSource: Non-profit, mission-driven Medicaid managed care organization with a similar focus on underserved populations, integrated care models, and government-sponsored plans across multiple states.
• Molina Healthcare: Pure-play government-sponsored managed care company with concentrated Medicaid and Marketplace exposure, including a Florida operating plan; similar capitation-based revenue model and member demographic.
• Centene Corporation: The largest publicly-traded U.S. Medicaid managed care insurer with deep Florida exposure via its Sunshine Health subsidiary; directly comparable business model focused on government-sponsored health plans for low-income and complex populations.
• Sunshine Health: Centene-owned Florida Medicaid plan and one of AmeriHealth Caritas Florida's primary in-state competitors; most direct head-to-head competitor for Florida Medicaid Managed Care contract.
• Humana Inc. Major Medicare Advantage and Medicaid managed care operator with Florida presence; directly comparable in dual-eligible / D-SNP offerings and value-based care orientation to Medicaid populations.

Broad incumbents

• Elevance Health (Anthem): Large diversified managed care company with significant Medicaid plan offerings across multiple states including Florida; competes on government contracts, dual-eligible programs, and integrated whole-person services.
• CVS Health (Aetna): Vertically integrated payor/retail/PBM with significant Medicaid managed care presence through Aetna; comparable product breadth across Medicaid, Medicare, dual eligibles, and pharmacy benefits.
• UnitedHealth Group / UnitedHealthcare Community & State: Largest U.S. health insurer with a substantial Medicaid managed care footprint including Florida; competes head-to-head for state Medicaid contracts while also offering Medicare Advantage and dual-eligible plans.

Regional players

• Simply Healthcare Plans (Elevance/BCBS Florida): Florida-focused Medicaid and Medicare Advantage plan affiliated with Elevance/BCBS Florida; competes directly for the same Florida state contracts and dual-eligible population.
• Florida Blue (GuideWell): Florida's Blue Cross Blue Shield licensee with a growing Medicaid managed care presence; in-state competitor for both Medicaid contracts and individual/family Exchange products including AmeriHealth Caritas Next.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks5 records

Key highlights6 records

Customer concentration

• LinkedInlinkedin.com/company/amerihealthcaritasfl

Revenue estimate

Valuation estimate

Number of profiles

Subsidiaries2 records

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 AmeriHealth Caritas Florida