Christine Jordan Sexton
The state’s Medicaid managed care procurement is officially underway.
The Agency for Health Care Administration (AHCA) released the Medicaid data book on Tuesday morning. Florida Statutes require AHCA to publish a data book at least 90 days before issuing the invitation to negotiate (ITN) for the statewide Medicaid managed care (SMMC) program.
AHCA will host a three-hour public meeting to address questions about the SMMC Data book on Jan. 5 in Tallahassee. The meeting agenda will be published on Dec. 29 and made available here.
The data book provides relevant background information that managed care plans will want to have as they decide whether to compete to participate in the Medicaid managed care regions.
Florida’s existing managed care contracts expire on Dec. 31, 2024, which means AHCA wants to start the process of soliciting new contracts.
The multiyear contracts are worth tens of billions to the Medicaid managed care companies that submit winning bids. Plans that aren’t chosen to participate in the program are locked out for six years unless they buy or merge with another health plan.
For over a decade, Florida has required most Medicaid managed care beneficiaries, from the cradle to the grave, to enroll in a managed care plan to deliver their health care. The Legislature this year agreed to make changes to the law, primarily administrative. Gone is the requirement that the agency issue separate Medicaid bids in each Medicaid managed care region. Additionally, lawmakers agreed to merge the number of Medicaid regions from 11 to nine.
To help prepare for the upcoming procurement, the state this summer issued a five-page request for information asking those with experience in the Medicaid managed health care and Medicaid managed long-term care industries to provide the state with innovative ideas and best practices to improve Medicaid for patients who receive care and providers who render services.
AHCA received 54 responses to the request for information it posted in May. Insurance companies and managed care providers that responded include Aetna; AmeriHealth Caritas Florida, Inc; Chrysalis Health; Community Care Plan; Community Health Choices; Humana Medical Plan, Inc.; MCNA Insurance Company; Molina Healthcare of Florida, Inc; Simply Healthcare Plans, Inc and Sunshine State Health Plan.
The Florida Hospice & Palliative Care, Florida Hospital, Florida Medical, Florida Pharmacy, and Florida Behavioral Health associations also submitted electronic responses to the agency’s request. So did the Florida Associations of Community Health Centers, Health Plans and Managing Entities.
