Medicaid Archives - Page 2 of 39 - Florida Politics

Philip Levine talks Medicaid expansion, pre-existing conditions in new ad

Former Miami Beach Mayor Philip Levine is out with a new ad for his gubernatorial campaign detailing his plan to fix Florida’s health care system.

The 30-second spot, “Remedy,” is Levine’s first ad covering health care since he hit radio in the early phase of his campaign with English- and Spanish-language ads encouraging listeners to sign up for health care plans through the Affordable Care Act marketplace. It’s backed up by a $1 million ad buy.

The new ad features Levine speaking with patients in a clinic waiting room as he talks about health care in Florida and his plans to fix the problems with it.

“This is where families come for help, but we’re now ranked almost dead last for health funding, leaving thousands of Floridians on waiting lists fighting for their lives,” Levine says in the ad. “I’m Philip Levine and I’m running for Governor to give everyone the health care they need.”

Levine then details his health care plan: “We will expand Medicaid, end the waiting lists, and unlike the president we will cover pre-existing conditions, because no one should go to bed at night fearing they can’t afford to wake up.”

Though health care has been a staple of Democratic campaigns for a decade, the issue has been forced to take a back seat for the past several months of the 2018 election cycle as Puerto Rican migration, gun control, and most recently immigration issues have dominated much of the dialogue in the race to replace term-limited Republican Gov. Rick Scott.

Levine is running against Tallahassee Mayor Andrew Gillum, former Congresswoman Gwen Graham and Orlando-area businessman Chris King in the Democratic primary. Palm Beach billionaire Jeff Greene joined the field at the beginning of June.

Graham also recently released an ad saying she would expand Medicaid if elected governor and the other candidates have stated they would do the same, often using the topic to ding Scott for his flip-flop on expanding the federal and state health insurance program for the very poor.

To date, Levine leads the pack in fundraising with more than $15 million raised and more than $10 million spent so far, including a substantial amount of self-funding. That could change in the coming weeks depending on how deep Greene is willing to dig into his own pockets — he has told multiple media outlets that he is willing to spend “whatever it takes” on his campaign.

The ad is below.

Critics take aim at Medicaid change

A move by Gov. Rick Scott’s administration to eliminate a long-standing policy that gives poor, disabled and elderly Floridians 90 days to qualify for the Medicaid program isn’t getting support from people who care for patients or from patients’ family members.

More than 100 comments from people such as physicians, nursing-home and hospital executives and family members were sent to the federal government opposing the proposed change, which the Scott administration submitted for approval in April.

If the change is approved by President Donald Trump’s administration, the state would save an estimated $98 million in Medicaid spending this year. The change would eliminate a three-month window where Medicaid pays health care bills while people apply for the program.

Florida isn’t alone in moving ahead with eliminating the policy, but unlike other states that have made similar decisions, Florida has not expanded Medicaid eligibility to include able-bodied working adults.

American Academy of Family Physicians board Chairman John Megis said in his written comments on the proposal that Medicaid reimburses physicians less than Medicare or commercial health insurance plans and that eliminating the 90-day window could be a step too far.

“Should it be eliminated, it would pose more uncertainty to our members, especially those in rural or underserved areas, who are already operating on thin margins,” Megis wrote. “We fear the elimination of retroactive coverage would further dissuade physicians from treating Medicaid populations, further entrenching the health disparities facing the state, and leave others unable to offer services to vulnerable Medicaid populations altogether.”

One caregiver, whose name wasn’t published on the federal Centers for Medicare & Medicaid Services website, shared a story about the caregiver’s mother, who has Alzheimer’s disease and lives in an assisted living facility.

While the family is tapping into savings to pay for the facility, the caregiver worries that the mother may require nursing home care and would then need to enroll in Medicaid. The caregiver said the current policy allows families to focus on choosing the right nursing home instead of worrying about filling out applications.

“I know the state claims their costs will be ‘more predictable’ if this amendment is approved, but medical emergencies are NOT PREDICTABLE. Many ordinary people like myself and my family are dealing with serious illnesses and trying to do the best we can,” the caregiver’s comment said. “If the leaders of our state think saving money is more important than HUMAN LIVES I pray to God for the future of our country.”

If the change is approved by Centers for Medicare & Medicaid Services, Florida residents would have to apply for the Medicaid program the same month they get sick. That means, for example, if a patient was admitted to a hospital on April 10, the hospital — working with the patient — would have 20 days to gather information needed to properly fill out the Medicaid application.

However, a patient admitted to the hospital on April 29 would have just one day to gather what is needed to submit the application.

The Centers for Medicare & Medicaid Services, commonly known as CMS, has given Iowa and Kentucky the go-ahead to eliminate retroactive eligibility, but those states expanded Medicaid under the Affordable Care Act to able-bodied adults.

Florida has not. As a result, Medicaid is limited to people such as pregnant women, children, seniors and people with disabilities. Exempting pregnant women and children from the proposal means that the majority of the 39,000 people impacted by the change would be seniors and people with disabilities.

In his comments, Florida Health Care Association Executive Director Emmett Reed said the state should maintain the 90-day window. If the change is approved, though, people should be given 30 days after first being admitted to nursing homes to apply for the program, Reed said. He also predicted in his comments that if the change is approved, there “will be an increase in incomplete Medicaid applications submitted to (the state) and a decrease in the timely processing of Medicaid applications.”

Agency for Health Care Administration spokeswoman Mallory McManus dismissed the criticisms and said the policy change was “about paperwork, not patient care.” She said the proposal focused on quick enrollment into the Medicaid program.

“By enrolling individuals quickly, you ensure better-coordinated fully integrated care, as well as access to preventative services,” McManus said.

But Anne Swerlick, a health care attorney with the Florida Policy Institute, noted that most low-income adults in Florida are prevented from accessing coverage when they are healthy, or even when they suffer from serious chronic conditions, so there isn’t an opportunity to coordinate care and provide preventive services.

“It’s a cruel irony that Florida’s justifications for cutting (retroactive Medicaid eligibility) are the best arguments for why Florida needs to expand its Medicaid program,” Swerlick said.

Republished with permission of the News Service of Florida.

Two more health plans get Medicaid contracts

Two health plans that would have been locked out of Florida’s Medicaid market for the next five years were awarded state contracts after they threatened legal action.

Prestige Health Choice and Molina Healthcare will each be awarded contracts in two of Florida’s 11 Medicaid regions, the state announced late Monday. Moreover, the state announced it will award additional Medicaid managed-care contracts to Aetna Better Health of Florida, UnitedHealthcare of Florida and Simply Healthcare.

As a result of the decisions, Agency for Health Care Administration spokeswoman Mallory McManus said the state has settled legal challenges involving what are known in the Medicaid program as “managed medical assistance” contracts and “comprehensive” contracts. Plans with managed medical assistance contracts will provide services for general and acute health-care needs, from childhood checkups to surgeries. Comprehensive plans will also offer long-term care such as skilled nursing services.

However, legal challenges remain from companies that want to provide “specialty” services, including providing care to people with HIV and AIDS or serious mental illnesses. The state faces challenges from the AIDS Healthcare Foundation and Magellan Complete Care, among others.

Monday’s announcement brought to 13 the number of managed care plans that will sign contracts with the state for managed medical assistance and comprehensive care. The five-year contracts, in total, are estimated to be worth upwards of $90 billion.

Florida lawmakers in 2011 approved an overhaul of the Medicaid system to require most beneficiaries to enroll in HMOs and other types of managed-care plans. The state awarded an initial round of contracts and now is finishing a second round.

Under the announcement Monday, Molina has been awarded contracts to provide comprehensive services in Medicaid Region 8, which covers Sarasota, DeSoto, Charlotte Glades, Lee, Hendry and Collier counties, and Medicaid Region 11, which is made up of Miami-Dade and Monroe counties.

Currently, the company covers about 105,000 people in the two regions and is paid about $550 million annually for providing the care in those regions.

The California-based health plan has the third-largest market share in the Medicaid managed care program with contracts in eight Medicaid regions that are set to expire at the end of the year.

Before reaching the settlement with the state announced Monday, the plan would have been shut out of the Medicaid program going forward.

Pamela Sedmak, Molina Healthcare vice president of health plan operations, said the company was pleased it was able to persuade the state to alter its initial decisions.

“We weren’t awarded anything at all from the state (initially),’’ Sedmak said. “When you are starting from that position as you enter into settlement negotiations, we were thrilled to be able to recover over one-third of the revenue we did have in the state, and to continue our relationship with the state and providers there because this is a strategically important state.”

Meanwhile, Prestige Health Choice has been awarded managed medical assistance contracts in Medicaid Region 9, which includes Indian River, Okeechobee, St Lucie, Martin and Palm Beach counties, and Medicaid Region 11, which covers Miami Dade and Monroe.

Prestige Health Choice currently operates in eight Medicaid regions but, similar to Molina, would have been locked out of the program for the next five years had the state not modified its decisions.

AHCA officials went through a lengthy contracting process for the managed-care program. Florida law mandates that contracts be put back out to bid every five years.

While AHCA’s decisions keep Molina and Prestige in the Medicaid market, it also agreed to award additional Medicaid contracts to three other health plans.

Aetna Better Health of Florida will be awarded contracts in Medicaid regions 6 and 7, which are made up of nine Central Florida counties and include Tampa and Orlando.

UnitedHealthcare of Florida was awarded managed medical assistance contracts for Medicaid regions 3 and 4, which include areas in North Central Florida and the East Coast from Daytona Beach to Jacksonville.

Simply Healthcare was awarded an additional managed medical assistance contract in Medicaid Region 5, which is made up of Pinellas and Pasco counties, and a comprehensive contract in Medicaid Region 10, which is Broward County.

Rick Scott treads carefully about Obamacare lawsuit

Despite being a fierce critic of the Affordable Care Act, Florida Gov. Rick Scott isn’t saying where he stands on the Donald Trump administration’s refusal to defend the federal law against the latest legal challenge brought by 20 Republican-led states, including Florida.

Scott on Wednesday avoided directly discussing the litigation, which, if successful, could dismantle changes to how insurance is bought and sold in the state, including eliminating protections for people with pre-existing conditions.

“I believe that if you have a pre-existing condition, you need to still be able to get health care. So it’s very important to me,” Scott, who is running for U.S. Senate, said when asked about the litigation. “I believe everybody ought to be able to get health care insurance.”

Scott, Florida Attorney General Pam Bondi and other Republican leaders have consistently opposed the sweeping health care law — often referred to as Obamacare — that has helped lower the percentage of uninsured citizens in the state and nation.

Florida’s uninsured rate in 2013, the year before Obamacare plans became available, was 20 percent and one of the highest in the nation. In 2016, the rate was 12.5 percent.

Florida also has consistently led the nation in the number of people who enroll in the federal health-insurance exchange under the law. Last year, more than 1.7 million Floridians entered the marketplace to buy a plan. The vast majority, more than 90 percent, received federal financial help to reduce their monthly premiums.

Longtime Florida Republican political consultant Mac Stipanovich said Scott is carefully choosing his positions so he doesn’t alienate Trump supporters while trying to defeat Democratic U.S. Sen. Bill Nelson in the fall.

“You have to be careful about criticizing Trump if you want to continue to enjoy the unreserved support from the Trump base,” Stipanovich told The News Service of Florida.

Bondi signed on this year to the lawsuit challenging the Affordable Care Act. The litigation gained new urgency last week after the Trump administration said it would not defend key portions of the law.

Whitney Ray, a spokesman for Bondi, said the attorney general believes people with pre-existing conditions should have access to coverage.

“But Congress must act in accordance with the U.S. Constitution when addressing the issue,” Ray said in a written statement.

If the suit is successful, it would do away with key parts of the law that require insurance companies to sell health policies to people regardless of pre-existing conditions and prevents charging more because of the conditions. The provisions benefit people who aren’t covered by employer-based plans or Medicaid.

Except for a brief period when Scott supported an expansion of Medicaid, Stipanovich said the governor “has been consistently opposed” to the Affordable Care Act or policies like it.

“I think that is something he cannot deny. And I’m not sure he would deny. Whether it turns out to be important in November or not as opposed to offshore drilling or gun control or immigration is a totally different issue,” Stipanovich said.

Florida Democrats are aggressively trying to make Scott’s opposition to the Affordable Care Act an issue. Democrats in the state’s congressional delegation sent a letter Wednesday to Scott calling on the state to immediately withdraw from the lawsuit, which is led by Texas.

“If successful, this dangerous lawsuit that you and Attorney General Bondi have joined will harm roughly 130 million Americans, including 7.8 million Floridians, who have a pre-existing condition,” the Democratic lawmakers wrote. “And it will take us back to a time when health insurers oftentimes outright rejected, or offered severely limited coverage to, Americans with such conditions.”

Democrats also have launched what they are calling “The Time is Now: Medicaid Expansion Tour” to promote Medicaid expansion in the state. The tour, which started in Gainesville, will highlight how Scott flipped his position on Medicaid.

Scott initially ran for governor in 2010 on an anti-Obamacare platform but said in 2013 he supported a three-year Medicaid expansion and described it as a “compassionate, common-sense step forward.”

During his campaign for re-election in 2014, Scott reiterated his support for the expansion, which was available to all states under the Affordable Care Act. After getting re-elected, though, Scott reversed his position and adamantly fought against efforts by the Florida Senate to expand Medicaid in 2015. The proposed expansion died in the Legislature.

A group called Floridians for a Fair Shake, held a press conference this week to highlight the litigation against the Affordable Care Act because of the potential impact it would have on people with pre-existing conditions. Stephen Gaskill, the group’s communications director, called pre-existing condition protections the most “compelling part of health care reform overall.”

Prior to the federal law, insurance companies could charge higher premiums based on pre-existing conditions or the use of health care services. The federal law also established adjusted community rating, which barred insurers from raising premiums based on health status, medical claims or gender, among other things.

While Scott did not directly address the Trump administration’s actions, he briefly outlined changes he thinks could lower health-insurance costs.

Scott said the changes should be incremental but said he supports “allowing more competition (among insurers), we gotta let people buy the insurance that fits for their family and we’ve got to reward people for taking care of themselves.”

Children lacking health insurance up slightly

While Florida has made strides in reducing the number of uninsured children, a national health-care expert warned Thursday that those gains are likely stalling, and she put part of the blame on increased scrutiny of immigration status.

Joan Alker, executive director of the Washington-based Center for Children and Families, said data released late last month by the National Center on Health Statistics shows that the number of uninsured children in Florida in 2017 rose slightly to 7.6 percent.

Alker said that while the small rise — from 7.4 percent the previous year — may be statistically insignificant, it could be “an early warning sign” that Florida’s seven-year trend of lowering uninsured rates for children is at risk.

She attributed the increase in part to attrition of what she called “mixed” families, or families where a parent is an immigrant and the child is either a citizen or legally residing in the state.

“Because of all the intimidation that is happening right now with immigrant families, we’ve heard lots of anecdotal evidence that they are very reluctant now to sign their kids up for coverage,” said Alker who has spent years observing Florida’s government-subsidized health insurance programs.

She suggested that other factors that could have played a factor in the slight hike include congressional efforts to repeal the Affordable Care Act and a push to restructure the Medicaid program and reduce funding.

State Agency for Health Care Administration spokeswoman Mallory McManus said she wasn’t aware of the new data and said that “ensuring that children have access to health care has always been a priority of our agency.”

Combined, the subsidized Children’s Health Insurance Program and Medicaid provide coverage to an estimated 44 percent of the children in the state.

The National Health Interview Survey data is collected through personal household interviews. Alker called the data an “early sign,” but said that the release in September of information from what is known as the American Community Survey will provide additional insight about health insurance. The American Community Survey is the largest household survey conducted by the Census Bureau.

While the 2017 percentage increase was small, Alker said it shows that Florida lost ground while states such as Texas and California continued to make progress. Those states lowered their uninsured rates by 1 percent and 1.4 percent, respectively.

Alker made the remarks during a webinar where she discussed a new report called, “The New Federal Children’s Health Insurance Law and What it Means for Florida’s Children.”

It is one of a series of reports that Alker has conducted about health insurance for Florida children and was funded by the Florida Blue Foundation, the Health Foundation of South Florida, the Space Coast Health Foundation and the Winter Park Health Foundation, among others, operating under the Florida Philanthropic Network.

The report examines the impact of two recently passed extensions of the Children’s Health Insurance Program and what they mean for the state. CHIP funding expired last year, and many states, such as Florida, were forced to operate the program on carry-over funds from previous years. Congress agreed to extend CHIP funding in January and again in February.

CHIP funds subsidized insurance coverage for more than 345,000 children in Florida.

Under the extensions, Alker said Florida cannot make any future changes to the CHIP program that would make it more cost- restrictive, including increasing co-payments.

Health plan to challenge Medicaid contracts

A decision last week to award Medicaid contracts to two additional managed-care plans could mean more legal challenges for the state Agency for Health Care Administration.

Attorneys for Molina Healthcare filed a notice with the state Tuesday announcing the HMO’s intention to challenge the agency’s decision last Thursday to award contracts to Miami Children’s Health Plan and Lighthouse Health Plan.

The HMO has 10 days to file a legal petition with the state.

The Agency for Health Care Administration has gone through a lengthy process to award new contracts in the Medicaid system, which requires most beneficiaries to enroll in managed-care plans. In April, the agency announced a decision to award five-year Medicaid contracts, which one official has estimated to be worth upwards of $90 billion in all, with nine HMOs.

That decision drew challenges from a dozen health plans that were not chosen for contracts, including Molina Healthcare.

Under a 2011 law that called for the statewide use of Medicaid managed care, AHCA is awarding contracts in 11 different regions. The number of contracts varies by region.

Last week, AHCA announced that it was awarding additional contracts in Medicaid regions 9 and 11 to Miami Children’s Health Plan, which is affiliated with Nicklaus Children’s Hospital. Region 9 goes from Indian River County south to Palm Beach County and Okeechobee County, while Region 11 is made up of Miami-Dade and Monroe counties.

The state also announced that Lighthouse Health Plan would be given a contract in Medicaid Region 1, which includes the western counties of the Panhandle. Lighthouse is affiliated with Pensacola-based Baptist Health Care.

Molina’s notice filed Tuesday dealt with the additional contract awards.

Miami Children’s Health Plan and Lighthouse Health Plan are what are known as provider-sponsored networks because they are owned and operated by health-care providers. If the contract awards stand, they will provide “managed medical assistance” services, which involve the bulk of Medicaid beneficiaries and range from childhood checkups to surgeries.

Other health plans awarded contracts are expected to provide what AHCA describes as “comprehensive” services. In addition to managed medical assistance services, comprehensive plans would offer long-term care such as skilled nursing services.

Overall, Florida’s Medicaid program provides care for nearly 4 million poor, elderly and disabled people, with 85 percent of beneficiaries enrolled in managed-care plans. The new five-year contracts are slated to go into effect Jan. 1, which means the state would need to advise patients of the available new plans beginning in the fall.

Julio Fuentes: Florida lives depend on naloxone co-prescriptions

As the nationwide opioid epidemic continues to destroy families, communities and lives across the country, Congress is currently considering dozens of bills to address this public health crisis. Their action is critical, and time is of the essence.

In 2016, more than 4,000 Floridians fatally overdosed on opioids. Fortunately, in 2016 Florida also passed a law allowing health care practitioners to provide naloxone to patients, caregivers and first responders. This life-saving, overdose-reversing drug kept our death toll from being much higher.

As Congress deliberates legislation to combat the opioid epidemic, expanding access to naloxone through co-prescription should be a top priority. The Surgeon General has emphasized the importance of naloxone co-prescriptions for certain patients at an increased risk for opioid misuse, including certain Medicare and Medicaid patients. The Center for Disease Control (CDC) has also come to the same conclusion.

Opioids are incredibly unpredictable, and even when taking medication as prescribed, patients can still accidentally overdose. That’s where naloxone comes in.

Opioid addiction and misuse do not discriminate based on age, gender or skin color. We are all at risk. As the president and CEO of the Florida State Hispanic Chamber of Commerce, I am especially concerned about the impact on our Hispanic community.

Opioid-related fatalities among Hispanics increased by more than 50 percent between 2014 and 2016.

Older Americans are at risk, too. A recent Washington Post article discusses the opioid crisis’ impact on the elderly, and states: “One in three older Americans with Medicare drug coverage are prescribed opioid painkillers.” Here in Florida, that statistic is especially concerning, because we have such a high population of seniors.

It is extremely important to arm at-risk patients with the potentially life-saving tool they need to avoid fatal overdoses. The federal government must follow their own advice and help increase access to naloxone.

Despite its potentially life-saving ability, naloxone is still not readily available to all CDC-recommended patients. One main reason is cost, which is why federal funding is so important. And, co-prescriptions are cost-effective, and can actually save the government more money in the long run. A National Institute of Health (NIH) study found patients receiving naloxone co-prescriptions had 63 percent fewer emergency room visits in one year compared to patients without a co-prescription. Considering Medicaid and Medicare pay for more than 50 percent and 68 percent of opioid-related emergency room visits, this policy change is also a fiscal win.

Encouraging co-prescription for Medicare and Medicaid patients and those at-risk individuals identified by the Surgeon General is a powerful first step toward reversing accidental opioid overdoses.

It is up to us to urge lawmakers, such as Florida Reps. Gus Bilirakis and Kathy Castor, to mandate co-prescription in future legislation.

Our priority should be to preserve life at any cost.


Julio Fuentes is the president and CEO of the Florida State Hispanic Chamber of Commerce.

Humana makes changes in Capitol, parting ways with Jon Bussey

After scoring a big victory in a statewide Medicaid managed-care procurement, Humana and Jon Bussey, who served as its regional director of corporate affairs, have parted ways.

Humana Director of Corporate Communications Mark Mathis confirmed the separation in an email to The News Service of Florida, saying the company made a decision last year to “restructure our Tallahassee government affairs team to align with new business strategies.”

According to his LinkedIn profile, Bussey was the health insurance company’s principal representative before state executive, legislative and regulatory bodies, including departments of insurance as well as state health and Medicaid agencies, in Florida, Louisiana, Mississippi, Texas, North Carolina and South Carolina. In the profile, he said he was responsible for providing strategic support on policy, political, public-sector procurement and regulatory matters, including commercial, long-term-care, Medicaid and Medicare and specialty insurance products.

The Florida Agency for Health Care Administration announced April 24 its decision to enter into five-year Medicaid contracts worth up to $90 billion with nine Medicaid managed care plans. If the decision stands, Humana will operate statewide.

Twelve managed care companies have filed petitions with the state notifying Medicaid officials of their intent to legally fight the decisions if changes aren’t made.

AHCA Secretary Justin Senior, Medicaid director Beth Kidder, and three other agency staff members have been meeting with the companies this week in hopes of avoiding litigation.

Bill Nelson, Democrats blast proposed Medicaid cuts

U.S. Sen. Bill Nelson and Democratic U.S. House members Thursday called for the federal Centers for Medicare & Medicaid Services to reject a move by Gov. Rick Scott’s administration to cut $98 million by trimming the length of time people have to apply for the Medicaid program.

“I rise here today because the state of Florida has again proposed to harm thousands of seniors and folks with disabilities who rely on Medicaid for their health care,” Nelson, a Democrat who faces an election challenge this year from Scott, said on the Senate floor.

Nelson, along with U.S. Rep. Kathy Castor and 10 other Democratic members of Florida’s congressional delegation sent a letter to CMS Director Seema Verma urging her to reject a proposed amendment to a state Medicaid “waiver” that would exempt Florida from a federal requirement that gives people up to 90 days following a health problem to apply for Medicaid coverage.

The Scott administration proposed — and the Republican-led Legislature agreed — to require people to apply for Medicaid during the same month of the health event.

“Retroactive eligibility is designed to protect Medicaid beneficiaries — including seniors, pregnant women, individuals with disabilities, and parents — and their families from the steep costs of medical services and long-term care. Importantly, this protection was also designed to minimize uncompensated care costs faced by hospitals and other health care providers who take care of our neighbors and are already challenged by the state’s low reimbursement rates,” the letter said.

The state Agency for Health Care Administration estimates that 39,000 people could be impacted by the change. Hospitals and nursing homes, though, say the numbers could be much higher.

The change has become a flashpoint between Democrats and Scott.

“It is our duty to ensure eligible individuals have access to care without going into debt to obtain it, which is why retroactive eligibility is so vital. This proposal would not only wipe out many families’ pocketbooks, but it would also place a financial burden on health care providers, the state and indeed all Florida taxpayers through increased uncompensated care costs,” the letter said. “We fail to see how this proposal will ‘enhance fiscal predictability’ as the state claims when it will increase costs across the board.”

But Mallory McManus, a spokeswoman for the Agency for Health Care Administration, issued a statement Thursday saying it is “categorically false to assert that this change impacts the care” provided to Medicaid beneficiaries.

“Florida continues to focus on quickly enrolling Florida’s most vulnerable people including children, frail elders, those with disabilities and pregnant women,” the statement said. “By enrolling individuals quickly, you ensure better-coordinated fully integrated care, as well as access to preventative services.”

Health plans mount challenges over Medicaid contracts

Twelve managed-care companies challenging the state’s award of tens of billions of dollars in Medicaid contracts have spelled out their arguments about why Florida officials were wrong in the handling of the coveted multi-year deals.

The filings allege a long list of errors by the Agency from Health Care Administration ranging from math mistakes, to not finishing reviews on time, to awarding a contract to a vendor that submitted the wrong bid.

In some cases, the petitions allege wrongdoing by rival health plans.

The challenges by the managed-care companies reflect the high stakes surrounding Florida’s massive Medicaid program. If the initial contracting decisions stand, some companies will be shut out of the managed-care program for the next five years.

The 12 plans filed challenges in 11 regions across the state for decisions involving a variety of health care services, including comprehensive care and specialty care such as providing services to people with mental-health issues or HIV and AIDS. In all, the companies filed 88 petitions by a Monday deadline.

Chief among the companies protesting the state’s handling of the contracts is Molina Healthcare, which currently has a footprint in eight of the state’s 11 Medicaid regions. The health plan applied for openings — through a process formally known as an invitation to negotiate — in all 11 regions but wasn’t among the top-scoring plans chosen by AHCA for negotiations.

Lawyers for Molina argue, among other things, that agency staff made mathematical errors throughout the scoring process. They contend the state was required to average scores of three different evaluators to determine top-ranking health plans but, instead, used aggregate scores.

Tallahassee attorney Robert Vezina wrote that AHCA’s alleged failure to follow criteria about scoring and ranking was “clearly erroneous, contrary to competition, and arbitrary and capricious” and made the “entire procurement process fundamentally and fatally flawed.”

Molina is requesting that if the disputes cannot be amicably resolved that the state be required to start over with a new procurement process.

The Agency for Health Care Administration went through a lengthy process before it announced its April 24 decisions to award five-year contracts to nine managed care plans. For contracting purposes, the state is divided into 11 regions. State law establishes a minimum and maximum number of plans that can operate in each of the 11 areas.

This is the second such procurement since the Florida Legislature passed a law in 2011 mandating that most Medicaid patients enroll in managed-care plans. A top Medicaid official has said that the new contracts, in aggregate, could be worth up to $90 billion.

The new contracts also have the potential to upend parts of the existing Medicaid program because, in some instances, existing providers would be eliminated. Magellan, a long-standing Medicaid provider specializing in mental-health services, would be locked out of the managed-care program if the agency decisions remain intact.

Attorneys for Magellan allege in filings that numerous mistakes and errors were made during the procurement process. The plan argues that competitor Staywell was awarded a Medicaid contract to provide mental-health services to patients in Medicaid Region 2 despite not submitting a bid for the area, which stretches across 14 counties in Northwest Florida, including Leon County.

Magellan’s attorneys argue that Staywell erroneously responded to the invitation to negotiate in Region 2 by submitting its response to the so-called ITN for Region 5, which covers Pasco and Pinellas counties.

State evaluators “noted the discrepancies,” according to Magellan’s petition, but “there is no evidence that AHCA requested, or that Staywell submitted, a corrected Region 2 response.”

Magellan’s attorneys are asking that AHCA award a contract to Magellan or, alternatively, reject all specialty-plan submissions and conduct a new procurement.

Not all plans that filed petitions with the state would be locked out of the Medicaid program in the coming years. For instance, UnitedHealthcare was awarded contracts in Medicaid Regions 6 and 11 for comprehensive care, which includes long-term care services as well as traditional health care covered under Medicaid.

But United also wanted contracts statewide to provide services to people with serious mental illnesses and was shut out of that market. United filed 11 petitions — one in each region — challenging those decisions. United alleges in its petitions that AHCA agreed to extend an internal deadline for a trio of evaluators to complete their work but that time ran short before one of them — “evaluator No. 3” — could finish the review.

According to United’s petition, “evaluator No. 3” completed 20 percent of the task by the Dec. 29 extended deadline and executed what is known as an “independent evaluators certification.” The certification stated that any plan that scored a zero “was intended to score a zero”

But United attorney Seann Frazier argued that a score of zero should only be given if the vendor didn’t provide a response. Frazier said that “in reality,” a large number of the components in the ITN were scored by two, and not the required three, evaluators.

Not all of the allegations of wrongdoing were leveled against the state, though. In filings for Simply Healthcare, attorney Robert Hosay accused competing health plans of not following rules.

For instance, the ITN required health plans to disclose their largest out-of-state Medicaid contracts. But Hosay argued that Humana — which could operate statewide if the agency’s decisions stand — failed to disclose an out-of-state contract it has in Wisconsin or report on how the plan performed on certain quality-of-care measurements.

The contract is with a company called iCare, which is a joint venture between Humana and the Centers for Independence, a Milwaukee-based non-profit rehabilitation provider.

Hosay also alleged in the petitions that Staywell was not truthful when it disclosed that its Medicaid contract had been terminated in Iowa in December 2015. Staywell attributed the termination to bid protest proceedings, but Hosay argued the disclosure was misleading.

“In reality, WellCare’s Iowa contract was terminated as a result of unfair bidding practices on WellCare’s part being discovered, including a violation of bidding rules and an attempt to acquire an unfair advantage over competing bidders,” wrote Hosay, referring to Staywell’s parent company.

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