Christine Jordan Sexton
The insurer emerged from negotiations with Medicaid officials as one of the winners in the contest to deliver health care to poor, elderly and disabled Floridians over the next five years.
Though Humana didn’t receive top scores from the agency’s negotiation team that reviewed bids for new Medicaid contracts, Humana earned enough points for the health plan to be invited to the negotiating table.
And that’s all it took.
Once it was at the table, Humana — guided by Greenberg Traurig lobbyist Hayden Dempsey, a co-worker of former AHCA Secretary Liz Dudek — leapfrogged its competition.
For instance, Humana was one of seven companies to offer access to a comprehensive health plan in Medicaid Region 7, which covers Brevard, Orange, Osceola and Seminole counties. Comprehensive means the plan offers long-term care services and more-traditional managed medical care. State documents show that Humana’s response to the invitation to negotiate in Medicaid Region 7 was ranked near the bottom, coming in fifth.
The score was good enough, however, to get the company an invitation to negotiate. When the negitiations were finalized, Humana was able to edge Coventry Health Care of Florida, doing business as Aetna Healthcare, which received higher marks on the ITN but wasn’t the agency’s pick in awarding a plan for the area.
The same held true in Region 10, in Broward County, where Humana’s response to the ITN was scored fourth. Again, near the bottom, but good enough to move to the negotiating table. And when negotiatons ended, Humana edged competitor Simply Healthcare Plans which was ranked No. 2 for the region before negotiations started.
Humana also replied to the Medicaid ITN In Region 2, which covers 14 counties across Northwest Florida. Again, the plan scored well enough to be invited to negotiate a deal with the state and ultimately was awarded a contract for the region. That contract for Region 2 also allows Humana to serve people in Region 1, the western-most part of the Panhandle.
To encourage managed-care participation in the Panhandle, lawmakers agreed in 2011 to provide health plans an incentive to participate in regions 1 and 2. A law requires AHCA to award additional contracts in any other regions where plans bid if they have contracts in Region 1 or Region 2.
And it’s that provision that Humana used successfully to score contracts in Region 8 and Region 9, which include 14 counties in Southwest Florida and five counties north of Broward in Southeast Florida.
Dempsey and Dudek declined to comment on the Medicaid negotiations and the agency’s decison to award the five-year Medicaid contracts, which, in all, could be worth upward of $90 billion to Humana and eight other companies.
