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AHCA, health plans huddle over Medicaid challenges

Agency for Health Care Administration Secretary Justin Senior is meeting with 12 managed-care companies that filed petitions with the state last week, as he tries to dissuade them from legal fights over the state’s decisions to award five-year Medicaid contracts that could be worth up to $90 billion.

Mallory McManus, an AHCA spokeswoman, forwarded a schedule to The News Service of Florida that showed Senior, Medicaid director Beth Kidder and three other staff members expected to meet with three companies on Wednesday: Aetna Better Health, which is challenging the state’s decisions in eight Medicaid regions; Magellan, which is challenging decisions statewide; and Prestige Health Choice, a plan that is partially owned by insurance company Florida Blue and is challenging decisions in nine Medicaid regions.

Senior kicked off the meetings with managed-care companies on Monday, talking with Lighthouse Health, a provider-sponsored plan hoping to get managed-care contracts in Medicaid regions 1 and 2.

Coral Care, which sought contracts in Medicaid regions 8 and 11, met with Senior and other agency officials on Tuesday as did two provider-sponsored networks that wanted to provide services to medically complex children: Our Children Provider Sponsored network and Miami Children’s Health. UnitedHealthcare, which filed 14 petitions challenging agency decisions, also met with Senior and Kidder on Tuesday.

The schedule indicates meetings will be completed Thursday, when Senior meets with Molina Healthcare of Florida, which will be shut out of Medicaid going forward if the agency decisions stand; the South Florida Community Care Network, a provider-sponsored network that wanted to offer specialty care to residents in Broward County; Simply Healthcare, which is challenging decisions in eight of the Medicaid regions; and the AIDS Healthcare Foundation managed-care plan, which will be shut out of Medicaid regions 10 and 11 if the decisions stand.

The agency 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.

Companies had until May 7 to file petitions with the state explaining why they planned on challenging the decisions.

The News Service of Florida provides journalists, lobbyists, government officials and other civic leaders with comprehensive, objective information about the activities of state government year-round.

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