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Two Health Plans Tapped For Medicaid Contracts

picture of medical insurance claim form
The Florida Channel
Leon County Judge John Cooper on June 30, 2022, in a screen grab from The Florida Channel.

Florida Medicaid officials on Thursday announced their intent to award contracts to two companies owned by health care providers, bringing to 11 the number of managed-care plans expected to sign five-year contracts with the state.

Lighthouse Health Plan, which is based in Pensacola, would provide Medicaid services in Northwest Florida, and Miami Children’s Health Plan would provide similar services in Southeast Florida.

Both companies --- known as provider-sponsored networks because they are owned and operated by health care providers --- are new and don’t have current contracts with the state. Lighthouse is affiliated with Pensacola-based Baptist Health Care, while Miami Children’s Health Plan is affiliated with Nicklaus Children’s Hospital.

The Agency for Health Care Administration on April 24 said it intended to sign five-year contracts with nine managed-care plans to serve Medicaid patients in regions throughout the state.

The announcement Thursday about Lighthouse and Miami Children’s Health Plan came after AHCA Secretary Justin Senior, Medicaid director Beth Kidder and other officials met this month with several managed-care plans that have threatened to challenge the contract awards. Such challenges could come from plans that were shut out of potential contracts.

The agency’s amended decision is not final, and other managed-care plans will have 72 hours to file notices with the state of their intent to challenge.

If the decision stands, Lighthouse Health Plan will provide what are known in the Medicaid system as “managed medical assistance” services in Medicaid Region 1, which is the western part of the Panhandle.

The plan earlier submitted a notice to the state of its intent to challenge contract decisions in Medicaid Region 1 and Medicaid Region 2, which includes a 14-county area from Holmes and Bay counties east to Jefferson and Taylor counties. It had bid on both regions and was invited to negotiate with the state but wasn’t initially selected.

Miami Children’s Health Plan, meanwhile, will provide managed medical assistance in the two regions where it vied for contracts, if the decision stands. Those are Medicaid Region 9, which goes from Indian River County south to Palm Beach County and Okeechobee County, and Region 11 which is made up of Miami-Dade and Monroe counties.

Managed medical assistance involves providing services for general and acute health-care needs, from childhood checkups to surgeries. If Thursday’s announcement stands, Medicaid patients in Region 9 and Region 11 will be able to enroll in provider-sponsored plans for those services.

In the initial announcement last month, the state awarded contracts in those regions to Medicaid HMO plans that offered what AHCA describes as “comprehensive” services. In addition to managed medical assistance services, comprehensive plans would offer long-term care such as skilled nursing services.

Miami Children’s Health Plan also wanted a Medicaid contract as a children’s specialty provider in those regions and filed a notice to challenge the decision not to provide it a specialty contract. AHCA did not modify its position on the specialty contracts.

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.

AHCA 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. This is the second procurement of the Medicaid program since the state required most Medicaid patients to enroll in a managed care plan.

The new five-year contracts are slated to go into effect January 1, which means that the state would need to advise patients of the available new plans beginning in the fall.