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Medicaid plan to challenge state rules on long-term care

Florida’s effort to steer elderly Medicaid patients into managed care is running into its first significant hurdle.

A newly formed managed-care plan late last week told state officials that it is ready to challenge the initial contract the state is drawing up as part of a move to hold down the cost of providing long-term care under the state’s safety-net program.

Aetna Better Health gave notice on Thursday to the state Agency for Health Care Administration that it intends to challenge the contract's requirement that managed-care companies provide as many as three references. The state is banning managed-care plans from using any references from corporate affiliates.

“This will prove fatal to Aetna Better Health, which is newly formed in Florida but has deep and meaningful experience serving long-term care population through corporate affiliates,” Tallahassee attorney Bruce Platt wrote in a three-page notice of protest letter.

The parties have 10 days to resolve the dispute informally. If it isn't resolved, Aetna Better Health can pursue an administrative challenge in state court.

AHCA spokeswoman Shelisha Coleman said the agency could not discuss the notice of intent to challenge because of a “blackout period” that precludes the agency from commenting.
“We are reviewing the protest,” Coleman said in an email.

Aetna Better Health filed its challenge notice within 72 hours of the state publishing answers to nearly 600 questions about the requirements AHCA is pursuing in the contract, officially called an “invitation to negotiate.”

Several companies,  including Sunshine State Health Plan and WellCare, asked whether references for affiliated companies would be acceptable. AHCA consistently said no.

Since that requirement is mandatory, "failure to provide references will result in the rejection of the response,” wrote Platt, an attorney at Akerman Senterfitt.

Aetna Better Health is one of 21 managed-care plans to advise the state in writing of their interest in managing the health care and costs of Florida’s poor elderly who are already in a nursing home or enrolled in one of four home- or community-diversion programs.

Eager to better control costs, the Republican-led Florida Legislature in 2011 passed a sweeping bill that transforms Medicaid into a mandatory managed-care program. Most people -- from the cradle to the grave -- will have to be in a plan.

Long-term care patients will be the first required to enroll, by October 2013. The deadline for other Medicaid patients is 2014.

AHCA wants to divide the state into 11 regions and contract with a limited number of plans in each region, which sets up a competition to be included in the network.

Of the 21 plans that have shown an interest in bidding, eight have indicated they want to be statewide. The majority of plans, though, have shown an interest in selected regions.

The area with the least amount of interest is Region 2, which consists of 14 mostly rural Panhandle counties from Madison on the east to Bay on the west. There, just eight managed-care plans showed an interest in participating.

Region 7, which comprises Brevard, Seminole, Orange and Osceola counties, has the most plans interested, at 19.

Florida Medicaid Director Justin Senior said the state was pleased with the response. “Even in the most rural areas of the state we had more plans expressing an intent to bid than there are slots available for them,” he said.

The federal government must sign off on the program before the state can implement it; Florida continues to wait for approval.

“It’s taken maybe a little bit more time than we would have liked,” Senior said. He expects final waiver approval for the long-term care program “by the end of the calendar year or early next year.”

-- Health News Florida is an independent online publication dedicated to journalism in the public interest. Christine Jordan Sexton can be reached at  850-251-0358  or by e-mail. Questions, comments can go to Editor Carol Gentry at  727-410-3266  or by e-mail.





Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.