Judges Set To Hear Medicaid Challenges

Jul 25, 2018

Twenty-seven legal challenges filed by managed-care plans protesting state decisions to award $90 billion in Medicaid contracts have been grouped into five cases that will be heard in administrative court next month.

A review of state Division of Administrative Hearings records shows that, for the most part, judges have agreed to consolidate challenges by the types of patients that managed-care plans would serve.

For instance, Administrative Law Judge Robert Kilbride consolidated three challenges that were filed by two companies about the provision of specialty care for people with HIV --- the virus that causes AIDS --- and AIDS. He is scheduled to hear the challenges Aug. 7.

The state Agency for Health Care Administration announced in April that it would sign a statewide specialty contract with Clear Health Alliance to provide services to people with HIV and AIDS. The AIDS Healthcare Foundation, which operates the managed-care plan known as Positive Healthcare, filed challenges in Medicaid regions 10 and 11, which encompass Broward and Miami-Dade and Monroe counties, respectively. The South Florida Community Care Partnership, a managed-care plan run by the North and South Broward hospital districts, filed a challenge in Region 10.

Managed-care plans filed the 27 challenges after the Agency for Health Care Administration awarded contracts in 11 different regions of the state to provide various types of care. The contracts range from caring for Medicaid beneficiaries with conditions such as HIV and AIDS to “comprehensive” contracts that include providing care to broad swaths of beneficiaries, including people who need long-term care.

Similar to the handling of the HIV and AIDS contract challenges, Administrative Law Judge R. Bruce McKibben, agreed to consolidate 14 challenges filed by three companies over the provision of specialty care for people with serious mental illness. He is scheduled to hear the cases Aug. 8.

McKibben consolidated challenges that were filed by Coral Care, which wanted to provide services to people with serious mental illness in Medicaid regions 8 and 11; one challenge filed by the South Florida Community Care Network, which wanted to provide specialty services to Broward County residents; and 11 challenges filed by Magellan Health Care, which wanted to provide care to people with serious mental illness statewide. Medicaid Region 8, sought by Coral Care, includes seven counties in southwest and south-central Florida.

Administrative Judge Lawrence Johnston, meanwhile, has agreed to consolidate nine challenges filed by two companies regarding the provision of specialty care to children with complex medical needs. Those challenges --- eight filed by Our Children’s Provider Sponsored Network and one filed by the South Florida Community Care Network --- are scheduled to be heard Aug. 6 and Aug. 7.

The only challenge that stands alone is a case filed by Best Care Assurance. The provider-sponsored network, a type of managed-care plan, filed a challenge after the state Agency for Health Care Administration agreed to award Molina Healthcare a “comprehensive” contract for Medicaid Region 8. Molina was awarded the contract as part of a settlement agreement reached with the state.

But Best Care Assurance said state Medicaid law limits to four the number of managed-care plans the state can contract with for Region 8, made up of Charlotte, Collier, DeSoto, Glades, Hendry, Lee and Sarasota counties. In its challenge, the health plan argues the state has contracted with five plans in the region. Administrative Law Judge Linzie F. Bogan will hear the challenge Aug. 15.

After approval from lawmakers in 2011, the Agency for Health Care Administration in 2013 launched a program that requires most Medicaid beneficiaries to enroll in managed-care plans. The agency initially signed five-year contracts with health plans across the 11 regions. It began reprocurement efforts in 2017, issuing an invitation to negotiate with managed-care plans that want new five-year contracts.

After months of reviews and negotiations AHCA has announced the 13 managed care plans it intends to contract with. In aggregate, the five-year contracts are expected to be worth about $90 billion, one top-ranking Medicaid official has said.

Some health plans with existing contracts, such as Positive Healthcare and Magellan Health Care, were not chosen for the new round of contracts, prompting them to file legal challenges. Other health plans that were new to the market also challenged the state’s decisions.  

Meanwhile, with existing Medicaid managed-care contracts set to expire at the end of the year, AHCA announced last month a timeline for transitioning to the new plans.

Southeast Florida, from St. Lucie County south to Monroe County, will be the first area of the state that transitions from the old to the new contracts, with Dec. 1 as the target date.

The target date for the state to transition from the old to new contracts for Medicaid regions 5,6, 7 and 8 is Jan. 1. Those regions include 18 counties, stretching across Central Florida from Pinellas County to Brevard County and in Southwest Florida.

Most of the northern half of the state --- stretching from Escambia to Volusia and Lake counties --- will be the last area for the change in health care plans, with a Feb. 1 target date to transition to the new contracts.

To see AHCA’s proposed rollout click here