Sunshine HMO Wins $1B Contract for Kids
Beginning in May, Florida will combine the 31,600 kids in the child-welfare system into a Medicaid specialty managed-care plan aimed at better meeting their needs.
The system includes 14,000 children in foster care, plus those who have been placed in group homes or with relatives under state supervision.
Sunshine Health, a subsidiary of Centene Corp., has the $1.1 billion contract for the job. Out of the premium it receives, the company will use about $150 per child for extras, such as a baseball glove or a prom dress, according to the Agency for Health Care Administration.
Several other states, including Tennessee and Texas, have already taken this approach. Georgia plans to follow suit later this year.
A recent study by a team at University of Florida found that over time, the managed care switch pays off by reducing health inflation.
Sunshine Health -- formerly called Sunshine State Health Plan -- was already a big player in Florida Medicaid. As Health News Florida reported, it won more contracts than any other vendor in September in the state's move to place all Medicaid enrollees into managed-care plans. (More vendors were added in October.)
Foster children are spread out over many different health plans. That creates problems for families that have two or more foster children, since not every doctor takes every plan.
For example, Pastor Chris Johnson and wife Alicia have 10 kids -- three biological, two foster children and five former foster kids they adopted -- all under one roof on the outskirts of Orlando.
As Kaiser Health News reports, the Johnsons sometimes run into roadblocks trying to get their foster kids health care, including mental health services, because most doctors don't take Medicaid. But that problem should soon be resolved, since Florida Medicaid requires all its managed-care contractors to guarantee access to care.
This state contract with Sunshine Health is only the latest twist in Florida Medicaid's all-out switch of beneficiaries to managed care, in part to control rising costs and ensure access to care. As Health News Floridahas reported, most regions in the state have already gone through the managed-care switch for the elderly and disabled on long-term care services. This summer, Medicaid will shift the rest of the beneficiaries who aren't yet enrolled in a plan, mostly children and their mothers.