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Health Plans Challenge Medicaid Contract Decisions

 hospital workers

With tens of billions of dollars in contracts at stake, a dozen health plans have told Florida officials they are challenging newly awarded Medicaid contracts.

The challenges could complicate plans by the state Agency for Health Care Administration to transition to new five-year contracts for Florida’s massive Medicaid program by Jan. 1. Medicaid is Florida’s safety-net health program that provides care for nearly 4 million poor, elderly and disabled people, with 85 percent of beneficiaries enrolled in managed-care plans.

Some of the bid protests filed late last week were expected because several managed-care plans currently providing Medicaid services would not have their contracts renewed. Some of those who filed challenges included Molina Healthcare of Florida, Prestige Health Choice and UnitedHealthcare of Florida.

“There’s a lot of investment that has happened over the last five years, so I don’t find it surprising there would be protests,’’ said Audrey Brown, president and CEO of the Florida Association of Health Plans, which represents the managed-care industry.

The health plans challenged contracts ranging from providing the full range of Medicaid services to specialized contracts for long-term care, services for HIV/AIDS patients and mental-health services.

The Agency for Health Care Administration has gone through a lengthy process of awarding contracts in 11 regions of the state, with contracts going to varying numbers of plans in the regions. Several health plans filed protests for all 11 regions, while others filed protests for specific parts of the state.              

This is the second such procurement since the Florida Legislature passed a law in 2011 mandating that most Medicaid patients enroll in managed-care plans.

The protest notices start a legal process for the plans to challenge the agency decisions. The notices submitted Friday did not provide the rationale behind the challenges. The companies have 10 days to file formal written protests that spell out why they think the agency erred.

AHCA last week announced the names of nine managed-care plans that won contracts.

Florida Medicaid Director Beth Kidder said earlier this year that the contracts could be worth as much as $90 billion over a five year-period. The state first issued its invitation to negotiate for the latest round of contracts in July 2017.

If the agency’s decisions stand, Sunshine Health Plan would operate in all 11 regions of the state. Sunshine Health would offer Medicaid beneficiaries access to a traditional plan as well as a separate “child welfare” specialty plan.

Simply Healthcare Plans, meanwhile, would offer a specialty plan for people with HIV and AIDS in all 11 regions.

Humana was picked by the state as a provider in 10 of the 11 regions across the state but did not win a bid in Medicaid Region 1, which includes Escambia, Okaloosa, Santa Rosa and Walton counties.

But by winning a contract in Region 2, which also includes parts of the Panhandle, Humana would be able to serve Medicaid beneficiaries in Region 1. To encourage managed-care participation in the Panhandle, lawmakers agreed in 2011 to provide health plans an incentive to participate in regions 1 and 2. A law requires AHCA to award additional contracts in any other regions where plans bid if they have contracts in Region 1 or Region 2.