Rewrite of Florida’s Medicaid managed care system signed into law

Health Care Concept. Doctor holding a jigsaw puzzle with MEDICAI
Florida’s existing Medicaid managed care contracts expire on Dec. 31, 2024,

One of the most heavily lobbied health care bills of the 2022 Session was signed into law by Gov. Ron DeSantis late Wednesday night.

SB 1950 was one of 42 bills the Governor signed into law, but it wasn’t the only bill related to the Medicaid managed care program that became law. The Governor also approved HB 855, which addresses Medicaid managed care reporting requirements.

Under the new law, Florida will have nine Medicaid managed care regions across the state instead of the existing 11. But the Legislature did not include in the legislation any changes to how Medicaid delivers dental care to beneficiaries.

Indeed, there was an industry fight over the provision of dental care and whether dental services should continue to be delivered through a separately procured Medicaid dental managed care program. The Agency for Health Care Administration (AHCA) wanted the Legislature to change the law to eliminate the separate managed dental care program and to require dental services to be provided by contracted managed medical assistance and long-term care plans.

But, in the end, the Legislature agreed to continue the separate Medicaid managed dental program.

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. That’s because the Legislature passed a bill that then Gov. Rick Scott signed into law that requires most Medicaid beneficiaries, from the cradle to the grave, to join a managed care plan.

In 2013, AHCA launched the Medicaid managed long-term care program. The Medicaid managed medical assistance program, which provides services to women and children, followed in 2014.

The law has guided the state as it twice procured lengthy, multi-year contracts with managed care plans. 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 and eliminate a requirement the state issue separate bids for each Medicaid region.

Meanwhile, under HB 855 signed into law Wednesday, contracted Medicaid managed care plans will be required — beginning in the 2025 calendar year — to start stratifying the data they are required to collect by age, sex, race and ethnicity, among other things.

The plans must report the stratified data in the 2026 calendar year. The bill also changes statutes to require HMOs to collect and report the Healthcare Effectiveness Health Plan Employer Data and Information Set (HEDIS) measures. Current law requires MMA plans to collect and report only the HEDIS measures identified by AHCA.

HB 855 also adds a statutory requirement for plans to report Centers for Medicare and Medicaid Services Adult and Child Core Set behavioral health measures, which are not currently required by AHCA, beginning in the calendar year 2025.

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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