Agreement Reached In Managed Care Dispute

Nov 20, 2018

A legal challenge to the state’s Medicaid managed care patient-assignment system in Northwest Florida has been withdrawn. 

Lighthouse Health Plan, a provider-sponsored network affiliated with Pensacola-based Baptist Health Care, agreed to withdraw its administrative challenge to the assignment formula after the state approved making a series of changes to a five-year Medicaid managed care contract.

The state, in part, agreed to eliminate a clause in the contract that would have prevented the company from being sold to a Medicaid HMO for 20 months.

The state also agreed to return to Lighthouse Health Plan a $10 million performance bond that was submitted to the state this year.

According to the agreement, Lighthouse was supposed to submit a $5 million bond but incorrectly submitted a performance bond for $10 million.

The state will return the $10 million bond, and Lighthouse will submit a $5 million bond within 30 days of the agreement.

Attorneys for Lighthouse filed a petition in state administrative court in October, arguing that the automatic assignment of Medicaid patients in Northwest Florida would benefit its competitor, Humana.

The company argued that the policy violated Florida law and a federal Medicaid waiver that allows Florida to operate its statewide managed-care program.

Lighthouse was awarded a five-year contract this year to provide Medicaid “managed medical assistance” services in Medicaid regions 1 and 2.

Combined, the regions stretch across 18 counties in Northwest Florida.

Medicaid managed-medical assistance plans cover acute care and other traditional health services.

Humana Medical Plan also was awarded a Medicaid contract in regions 1 and 2. It was awarded a “comprehensive” contract, which means it is responsible for managed medical-assistance services as well as long-term care.

Florida lawmakers in 2011 approved a major revamp of the Medicaid program that requires most beneficiaries to enroll in managed-care plans.