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Medicaid Plan Required To Return $1.8 Million To State

Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Simply Healthcare Plans made too much money from Florida's health-care program that treats the poor, elderly and disabled and was required to return nearly $1.8 million to the state.
It is the first time that a managed-care plan participating in Florida's statewide Medicaid managed-care program had to return money to the state, according to testimony provided to the Florida Legislature early this year by Beth Kidder, a deputy secretary at the Agency for Health Care Administration.

Simply Healthcare spokesman James Freeman told The News Service of Florida on Friday that the managed-care plan had already made the payment to the state. Agency for Health Care Administration spokeswoman Mallory McManus said the agency hadn't received the payment but was expecting it early next week.

The Legislature in 2011 passed a law that requires most Medicaid patients — from the cradle to the grave — to enroll in HMOs or other managed-care plans. The state pays monthly premiums to managed-care plans to provide care to patients, and the plans are required to provide access to all covered services, regardless of whether the cost of those services exceeds the paid premiums.

To ensure that the plans don't make too much of a windfall, the Legislature included in the law a so-called “achieved savings rebate,” which is established by determining pre-tax income as a percentage of revenues. 

Under the achieved savings rebate, plans are required to return money to the state if their pre-tax incomes exceed certain thresholds. Simply Healthcare had to return $1.8 million based on the amount of money it brought in.

When asked whether the company's excessive income hurt patients, Freeman replied, “Simply Healthcare is committed to providing access to quality, affordable services and we continually support efforts that are in the best interest of the health and well-being of our members and the entire community. “

Simply Healthcare has participated in the statewide Medicaid managed-care program since the program's inception. The state is in the process of contracting again with managed-care plans. Simply Healthcare is one 10 plans that have indicated interest in providing Medicaid services statewide.

The Agency for Health Care Administration notified Simply Healthcare on Nov. 2 that it needed to return the $1.8 million, according to agency spokeswoman Shelisha Coleman.