Agency wants $2.3M for legal, actuarial help with upcoming managed care contract negotiations

Enrollment in the Medicaid program is at an all time high due to the pandemic.

The statewide Medicaid managed care program won’t be renegotiated until 2023 but the Agency for Health Care Administration already is expecting legal challenges and wants lawmakers to earmark $2 million so it can hire attorneys to defend the state against any potential challenges when the time comes.

They’re also requesting $300,000 to hire actuaries during procurement negotiations for real time financial analyses and subject matter expertise.

AHCA Secretary Simone Marstiller presented the agency’s legislative budget request before the House Health Care Appropriations Subcommittee Monday. Former Medicaid Director Beth Kidder called the Medicaid contracts the most expensive in the state.

Given that the agency faced legal challenges during the last round of contract negotiations, Marstiller told members of the appropriations subcommittee the state is expecting more of the same when it  begins a new round of contract negotiations with managed care plans in 2023.

“We want to make sure the state has the best outside counsel,” Marstiller told Rep. Nicholas Duran, a member of the panel.

Florida requires most Medicaid patients to enroll in a Medicaid managed care plan. AHCA procures contracts with certain Medicaid managed care plans to provide health care services from the cradle to the grave.

The agency, which houses the state Medicaid program, also is requesting a 3.9% increase in state funding in order to cover increased needs in the program.

The Legislature allocated $35.4 billion to the Medicaid budget in the state fiscal year 2021-2022 budget, which is in effect until June 30. But state economists say the program will grow to more than 5 million beneficiaries by June 30, 2022 and will need an additional $1.5 billion to cover the costs. Most of that money, or $1.16 billion, is needed to cover the increased costs of prescribed drugs and nursing homes, hospitals and other institutional providers that receive Medicaid reimbursement.

Since the start of the pandemic, an additional 1,188,362 had enrolled in the program that pays the health care needs for the poor, elderly and disabled, Marstiller said. She said enrollment in the program was “by far and away the highest enrollment this state has ever seen.”

Medicaid funding isn’t the agency’s only big-dollar funding request for the fiscal year 2022-2023 budget, which is what lawmakers will work on when they meet in the upcoming Legislative Session in January.

Marstiller also is requesting $119.76 million to modernize the current Medicaid technology system and nearly $2 million to hire 12 full time equivalent employees to support the Office of FX and module system planning, implementation, and ongoing support.

Christine Jordan Sexton

Tallahassee-based health care reporter who focuses on health care policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep me busy.


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