Patients with serious mental illness may have an increased choice of health-care providers under an agreement between the state and one of the largest Medicaid mental-health plans.
Agency for Health Care Administration officials agreed to award three Medicaid managed-care contracts to Magellan Complete Care, which, in exchange, agreed to drop 11 challenges filed in state administrative court in Tallahassee.
Under the settlement agreement, Medicaid beneficiaries with serious mental illness who live in Medicaid regions 4, 5 and 7 will be able to choose Magellan as a health plan.
Region 4 is made up of Nassau, Baker, Duval, Clay, St. Johns, Flagler and Volusia counties, while Region 5 is made up of Pasco and Pinellas counties. Region 7 is made up of Orange, Osceola, Seminole and Brevard counties.
The settlement with Magellan came after the Agency for Health Care Administration this spring awarded contracts across the state to Medicaid managed-care companies. The contract awards drew a series of legal challenges, including from Magellan.
Prior to the settlement, WellCare of Florida had been the only company awarded a “specialty” contract this spring to provide services to people with serious mental illness.
“It’s good that individuals with serious mental illness have more than one choice of specialty plan,” said Melanie Brown-Woofter, president and CEO of the Florida Council for Community Mental Health.
The settlement agreement reached last week can be challenged. However, the health plan that had the most to lose from the agreement --- WellCare of Florida --- was given draft copies of the agreement prior to its execution.
WellCare did not immediately comment on the agreement.
The settlement also contains a caveat that allows AHCA “in its sole and absolute discretion” to place a six-month freeze on enrollment in Magellan one month after the effective date of the new contract.
The freeze would not apply if a patient actively chooses to enroll in Magellan and suffers from one of a number of serious mental illnesses, including schizophrenia.
If both of those conditions aren’t met, a Medicaid patient living in Medicaid regions 4, 5 or 7 with a serious mental health illness will be assigned to WellCare of Florida.
Although pleased with the increase of choices for patients in those regions, Brown-Woofter expressed concerns about the caveat, noting that sometimes patients with serious mental illness can have difficulties making decisions.
The settlement came just weeks before the state will send information to Medicaid patients about their choices of health plans, after the state has signed multi-year contracts worth at least $90 billion with managed-care plans, according to the state.
Florida lawmakers in 2011 overhauled the Medicaid system to require most beneficiaries to enroll in managed-care plans. An initial set of contracts is expiring, and AHCA went through a lengthy reprocurement process to award new contracts, completing the process this spring.
AHCA has announced that it will begin transitioning Medicaid patients in South Florida from their existing HMOs to new managed-care plans in December.
The News Service of Florida reported last week that Magellan and the state had reached an agreement in concept and that Magellan was going to drop its administrative challenges. WellCare attorneys told Administrative Law Judge John Newton that the company had received a draft copy of the proposed settlement agreement and was reviewing the document.
Meanwhile, AHCA still is defending in administrative court its decisions not to award Medicaid contracts to the AIDS Healthcare Foundation and an HMO owned by the North Broward and South Broward hospital districts.
