Medicaid Managed Care Rates Tweaked

17 hours ago

State economists on Tuesday agreed to increase payment rates for Medicaid HMOs that treat women and children by an average of 0.2 percent but decrease the amounts paid to long-term managed care plans by an average 0f 2.3 percent. 

Senate Targets Denial Of Insurance Claims

Mar 4, 2018

The Florida Senate on Saturday unanimously approved a bill that would curb the ability of health insurers and HMOs to retroactively deny claims.

House Panel Sides With Doctors On Insurance Claims

Feb 15, 2018

A bill that would restrict the ability of health insurers and HMOs to retroactively deny claims passed the House Appropriations Committee on Wednesday, scoring a victory for physicians.

State Trims Medicaid HMO Payments

Oct 12, 2017

Florida has reduced by 3.7 percent the rates it pays HMOs and provider-sponsored networks in the biggest part of the Medicaid managed-care system but has given a 2.4 percent hike to plans that offer managed long-term care.

State HMO Contracts Spur Challenges

May 24, 2017
Wikimedia Commons

An administrative law judge will hear arguments next month as three health insurers challenge the way state officials want to divvy up contracts for HMO coverage for state employees.


The number of health care providers complaining about the state’s Medicaid insurers is on the decline.

2016 PPO Plans Remove Out-Of-Network Cost Limits, A Costly Trap For Consumers

Dec 3, 2015

Citing the flexibility they offer, many consumers choose health plans that provide some coverage outside the insurer’s network. Traditionally, such plans not only paid a portion of the bill, but also set an annual cap on how much policy holders paid toward out-of-network care.

Not anymore.

As HMOs Dominate, Alternatives Become More Expensive

Nov 30, 2015

Consumers seeking health policies with the most freedom in choosing doctors and hospitals are finding far fewer of those plans offered on the insurance marketplaces next year. And the premiums are rising faster than for other types of coverage.

Florida Office of Insurance Regulation

An analysis by the South Florida Business Journal of Florida Office of Insurance Regulation data on HMOs shows nearly half of Florida’s managed-care health insurance companies lost money in 2014.

Private Companies Shouldn't Run Medicaid

Oct 7, 2014

In reference to: "Despite Progress, Problems—New And Old—Pop Up In Florida's Medicaid Managed Care Program," Health News Florida, Sept. 15, 2014

To the Editor,

Like many other states, Florida has shifted the administration of its Medicaid into a program administered by the private insurance industry. 

Profits for Florida’s HMOs dropped sharply in 2013, with a nearly 31 percent reduction in combined profits, according to the South Florida Business Journal. The Florida Office of Insurance Regulation reported profits at $933.8 million in 2012 and $648 million in 2013.

Florida’s Department of Financial Services on Friday asked a judge to allow a takeover of the troubled Physicians United Medicare Advantage HMO.

The DFS filed a petition in Leon County Circuit Court to place the Orlando-based plan into receivership because it is insolvent. The company’s May financial statement reported assets of $92.4 million, while liabilities amounted to $105.3 million.

Florida’s Medicaid 'reform' project, which required all beneficiaries in five counties to enroll in managed care, succeeded in curbing health inflation just as state officials had hoped, a new study reports.

University of Florida researchers found that when they compared two of the pilot counties with two others over a four-year period, per-patient spending was lower in the pilot counties.

Florida hospitals had strong profits last year, according to an analyst's report, and so did its HMOs, especially those that specialize in Medicare patients.

Miami Herald

Jaime Pinto, 69, still sees the same doctors and gets prescriptions the same way he always has. He doesn’t know he’s part of a revolutionary change in the health-care system because he’s in an ACO -- an accountable care organization, the Miami Herald reports.