Medicaid managed care rewrite passes after House agrees to Senate plan

Legislators on Friday signed off on a last-minute deal to overhaul the state’s Medicaid managed care programs, overcoming a stalemate between the House and Senate that threatened to scuttle the effort this year.

The House unanimously approved the bill (SB 1950) as amended. That will send it to Gov. Ron DeSantis, but only after the Senate stripped out several provisions the House had initially insisted on.

Sen. Jason Brodeur, the Senate bill sponsor, called some of the House provisions in the bill “ornaments” and “hitchhikers.”

Earlier in the week, Senate President Wilton Simpson had warned that the bill was “definitely in trouble” and that his chamber was not planning to consider it — a move that put pressure on House Republicans to reconsider their position.

The bill reduces the number of Medicaid managed care districts from 11 to nine. It also allows the Agency for Health Care Administration (AHCA) to award contracts on either a statewide or regional basis.

Fleming Island Republican and House bill sponsor Rep. Sam Garrison said he would be lying if he did not acknowledge that he was disappointed the final bill did not include some of the changes that House Republicans had been pushing.

“It’s a bicameral Legislature, we have to work through these sorts of things,” Garrison told House members. “But ultimately these policies we’re talking about, they are not ornaments, they are not hitchhikers. They’re real policies that we grappled with and that we will continue to grapple with in this House to make sure we have the highest quality care, the lowest possible price for all Floridians.”

The House’s decision to drop some of the more contentious provisions drew praise from multiple Democrats who said they could vote for the bill.

“There’s such an important amount of important policy (in the bill),” said Rep. Nicholas Duran, a Democrat from Miami.

A large majority of the more than 5 million people enrolled in Medicaid — the state’s safety net health care program — receive their coverage through managed care companies.

Florida’s existing managed care contracts expire on Dec. 31, 2024, which means AHCA wants to start the process to solicit new contracts. AHCA Secretary Simone Marstiller advocated for the changes saying they would make the procurement run more smoothly.

Because of that, AHCA asked this year to change current law, including a requirement the state issue separate bids for each Medicaid region.

In its initial bill, the House sought to require that “essential providers” enter into regional or statewide contracts with those Medicaid managed care plans. The House proposal included a mediation process, but it spelled out that supplemental payments to those providers could be withheld if mandated contracts were not signed.

Opponents contended that this clause could wind up harming public hospitals if they could not reach a deal with the managed care companies involved in Medicaid.

The chambers’ disparate positions on the mandatory contracting put the bill in jeopardy of not passing.

“What an absolute whirlwind,” one managed care lobbyist said after the bill passed.

Legislators in 2011 mandated a rewrite of the state’s Medicaid statutes, requiring most beneficiaries to enroll in a managed care plan. In 2013, the Medicaid managed long-term care program was launched. The Medicaid managed medical assistance program, which provides services to women and children, followed in 2014.