State works to procure health care for medically complex children

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This could go down as the summer of the health care procurements.

The Department of Health (DOH) issued a request for information asking interested parties to inform the state of ways to improve and provide information to help make an upcoming procurement of a Medicaid managed care program for medically complex children.

Interested parties have until 2 p.m. on Aug. 5 to provide insights on ways to improve upon the Children’s Medical Services managed care program designed to serve the needs of children who, because of chronic medical conditions, require more complex care. 

The RFI asks for insights on ways to increase pediatric specialists and clinics that provide medically complex care to participate in the CMS network; improve behavioral and mental health access and outcomes; address health inequities; and increase preventative dental visits and dental sedation access.

The CMS network is one of a number of children’s health insurance programs, all of them run through managed care plans. Sunshine Health Plan currently has the contract to operate the CMS managed health care plan.

The poorest children in the state, or those living in families earning 133% or less than the federal poverty level, qualify for Medicaid, according to state data. There are no co-payments or monthly premiums. Children living in families that earn too much to qualify but earn less than 225% of the federal poverty level qualify for what’s called the Children’s Health Insurance Program, or CHIP, which in Florida operates under the Florida KidCare moniker.

Whether in the traditional Medicaid program or Florida KidCare, medically complex children are enrolled in the CMS managed care network. There’s more than $168 million in the current year’s budget to fund the program.

The DOH, which administers the CMS Medicaid managed care program, also wants insights into ways it can ensure a coordination of care for children who transition in and out of the CMS plan from Medicaid or the Florida KidCare program.

The RFI was first published at the end of June and interested parties had until July 12 to submit any questions about the RFI to the state. The state will publish answers to timely questions by July 19.

Florida Politics requested a copy of the questions that were timely submitted. The DOH did not respond to the requests for the public information by deadline.

Headed by state Surgeon General Joseph Ladapo, the DOH is the latest agency to delve into health care procurement.

The Department of Management Services earlier this month released three separate ITNs seeking third parties to administer the state’s $3.1 billion self-insured health care program for state employees, including legislators and legislative staff.

The Agency for Health Care Administration (AHCA) is working on developing a procurement to put the state’s Medicaid managed care program out for bid. The Medicaid managed care contracts are the most lucrative in the state. AHCA hopes to publish the ITNs before the end of the year. 

Similar to the DOH, AHCA published a RFI to help inform state health care officials who are working on the terms of the procurement.