WellCare Tapped For CMS Contract

Jun 27, 2018

The state expects to turn over management of the care of medically fragile children to a subsidiary of WellCare Health Plans beginning in January. 

The Florida Department of Health announced on Tuesday that WellCare’s Staywell Health Plan edged two competitors for a contract in the Children’s Medical Services program.

The decision is not final. Sunshine State Health Plan and the South Florida Community Care Network, which competed with Staywell, have until Friday to challenge the Department of Health’s decision.

“We are pleased Staywell Health Plan has been selected to work with the Florida Department of Health to serve children across the state through the Children’s Medical Services Managed Care Plan. This announcement reflects our proven track record of providing access to high-quality, comprehensive health care for our Medicaid members,” the company said in a prepared statement.

Immediate attempts Tuesday to contact Sunshine State Health Plan and South Florida Community Care Network, which is run by the North and South Broward hospital districts, were unsuccessful.

The three health plans are all currently under contract to provide care to Medicaid beneficiaries as part of the state’s broader Medicaid managed-care system.

They also have been picked to continue providing Medicaid services for the next five years.

The Children’s Medical Services program focuses on children with special health-care needs, and the state has grappled with the costs of caring for the children.

Traditionally, the program had a statewide network of physician specialists who agreed to treat the children and accept Medicaid reimbursement rates. The state assisted the physicians by providing access to care managers who helped with coordination.

Facing spiraling costs, Gov. Rick Scott’s administration removed more than 9,000 children from the so-called CMS program. The state then transitioned remaining children from the traditional program into a managed-care program.

It covers about 80,000 medically complex children who are between the ages of 1 and 19 who are either in the traditional Medicaid program or in the federal children’s health insurance program.

While it had retained control over the CMS managed care program, the Scott administration decided this year to transfer control to a third-party managed care company.