Christine Jordan Sexton
Borrowing a page from its Medicaid program, Florida is putting its $3.12 billion state group health insurance program out for a competitive bid in nine regions across the state.
The Department of Management Services released three invitations to negotiate last week advertising the need for third-party administrators to manage for its HMO, PPO, and pharmacy benefits.
The three ITNs have the same timelines. Interested parties have until July 21 to submit questions they may have. DMS will post answers to timely submitted questions on Aug. 9.
Responses to the ITNs must be submitted to DMS by Sept. 27, according to the timelines in the ITNs. DMS will evaluate the responses for seven weeks between the beginning of October through late November. It will negotiate with top-rated responses between Dec. 5 and May 5, 2023.
DMS wants to announce the winning vendor on May 16, 2023, and have contracts signed and in place for the 2024 calendar year.
Florida has a self-insured state employee health program meaning the state of Florida pays for the costs of the claims. But the state hires companies to manage the network of providers and payments.
Economists for the Legislature and the Governor’s Office agreed earlier this year that about 170,000 current and former state employees and their spouses and children were enrolled in the state group health plans as of November 2021.
The economists also estimated that the state employee health insurance trust fund, which is a combination of employees’ monthly premiums and state tax dollars, to cover the employer’s portion of the premium, would have a $61.8 million deficit as of June 30, 2024.
State economists will update enrollment and program costs when they meet in Tallahassee on Aug. 10.
The state is moving ahead with the bid after the Legislature this Session agreed to ratify DMS rules that carved the state into nine regions. as part of the budget process, DMS drafted the rules after the Legislature in 2019 decided to allow the program to be competitively bid regionally and to limit the number of HMO contracts awarded in each region.
The Legislature in 2011 passed a sweeping rewrite of its Medicaid statutes which included a requirement that most beneficiaries enroll in Medicaid managed care plans. The law also authorized the state to bid out the Medicaid program across 11 regions and to sign contracts with a limited number of plans in each region.
In 2013, the Medicaid managed long-term care program was launched. The Medicaid managed medical assistance program followed in 2014.
State Medicaid officials are working on a new, third procurement with ITNs expected to be released before the end of the year.
