HNF Stories
11:01 am
Tue September 24, 2013

2 Public Co.'s Win in FL Medicaid

Sunshine State Health Plan, a subsidiary of Centene Corp., won more contracts than any other company in the bidding for a slice of the Florida Medicaid program as it shifts its entire enrollee population into managed-care plans.

Sunshine State won the right to compete in nine of 11 districts in the state. Tampa-based WellCare Health Plans scored in seven.

The Agency for Health Care Administration released the list of bid-winners late Monday afternoon, ending a nervous wait by companies, their investors and Wall Street analysts.
Billions of dollars are at stake, depending on how many Medicaid beneficiaries a company enrolls. Tom Carroll, analyst at Stifel, predicted Centene could earn between $1.5 billion and $1.8 billion on the Florida business, and that WellCare will bring in revenues between $434 million and $1 billion. His forecast presumes Centene's Sunshine State will gain more than 500,000 members, while WellCare could  will get 145,000 to 380,000.

"We believe yesterday’s results should lift the credibility standing for the management at WellCare," Carroll wrote. "Given the turnaround of its Kentucky operations, what we view are strategic acquisitions at reasonable prices, and the Florida results, we believe any questions about management have been answered."

Ten companies won bids for the general Medicaid-enrollee population -- mainly mothers and children, most of whom are healthy. Eight companies won bids to provide specialty care for a group that needs close attention, such as HIV/AIDS or those with serious mental illness. Contractors could choose which districts in which to bid.

For example, First Coast Advantage LLC -- a "provider-service network" or PSN (a managed-care plan that is run by a network of doctors instead of an insurer) that operates in the greater Jacksonville area -- will have a contract just for that region. The same is true for Preferred Medical Plan, which is based in Miami and whose contract covers that area.

For the healthier and more populous Medicaid group, the number of districts for which companies won contracts ranged from Amerigroup Inc. with two to Sunshine State with nine. 

Along with WellCare,  which has in past years been Florida Medicaid's largest contractor, Prestige Health Care won the right to compete in seven districts. Prestige is a PSN.

Neither will be operating in the specialty-group category. There, the big winner was Freedom Health Inc., which won a total of 32 contracts: eight districts apiece for cardiovascular disease, lung disease, diabetes and congestive heart failure. 

The chart can be seen here. (The vertical columns indicate the Districts: 1, 2, 3 and so on. See map above to determine which counties are in which district.)