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Health Plan To Challenge Medicaid Contracts

A decision last week to award Medicaid contracts to two additional managed-care plans could mean more legal challenges for the state Agency for Health Care Administration.

Attorneys for Molina Healthcare filed a notice with the state Tuesday announcing the HMO’s intention to challenge the agency’s decision last Thursday to award contracts to Miami Children’s Health Plan and Lighthouse Health Plan.

The HMO has 10 days to file a legal petition with the state.

The Agency for Health Care Administration has gone through a lengthy process to award new contracts in the Medicaid system, which requires most beneficiaries to enroll in managed-care plans. In April, the agency announced a decision to award five-year Medicaid contracts, which one official has estimated to be worth upwards of $90 billion in all, with nine HMOs.

That decision drew challenges from a dozen health plans that were not chosen for contracts, including Molina Healthcare.

Under a 2011 law that called for the statewide use of Medicaid managed care, AHCA is awarding contracts in 11 different regions. The number of contracts varies by region.

Last week, AHCA announced that it was awarding additional contracts in Medicaid regions 9 and 11 to Miami Children’s Health Plan, which is affiliated with Nicklaus Children’s Hospital. Region 9 goes from Indian River County south to Palm Beach County and Okeechobee County, while Region 11 is made up of Miami-Dade and Monroe counties.

The state also announced that Lighthouse Health Plan would be given a contract in Medicaid Region 1, which includes the western counties of the Panhandle. Lighthouse is affiliated with Pensacola-based Baptist Health Care.

Molina’s notice filed Tuesday dealt with the additional contract awards.

Miami Children’s Health Plan and Lighthouse Health Plan are what are known as provider-sponsored networks because they are owned and operated by health-care providers. If the contract awards stand, they will provide “managed medical assistance” services, which involve the bulk of Medicaid beneficiaries and range from childhood checkups to surgeries.

Other health plans awarded contracts are expected to provide 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.

Overall, Florida’s Medicaid program provides care for nearly 4 million poor, elderly and disabled people, with 85 percent of beneficiaries enrolled in managed-care plans. The new five-year contracts are slated to go into effect Jan. 1, which means the state would need to advise patients of the available new plans beginning in the fall.