Christine Jordan Sexton
The state has announced the names of the 11 vendors that submitted responses to the state’s multiyear Medicaid managed care invitation to negotiate (ITN).
While many of the respondents have contracts with the state, two of the respondents do not: Sentara Care Alliance (formerly Optima Health) and ImagineCare, a provider service network and joint venture between CareSource and Spark Pediatrics. Spark Pediatrics is the largest provider of prescribed pediatric extended care in the state, according to its homepage.
The other respondents are Sunshine Health, Aetna Better Health of Florida, Molina Healthcare of Florida, United Healthcare of Florida, Simply Healthcare Plans, South Florida Community Care Network d/b/a Community Care Plan, Florida Community Care, Humana Medical Plan, and AmeriHealth Caritas of Florida.
About a dozen people went to the Agency for Health Care Administration’s (AHCA) Tallahassee office where the responses were opened. According to the ITN, the agency tentatively plans on making the names of the 11 vendors available Oct. 27.
AHCA is asking that providers who have experience with any of the vendors to share their insights by 5 p.m. advising Nov. 9 to submit their comments to the state.
The state anticipates negotiating with vendors between Dec. 4, and Jan. 26, 2024 and posting the names of the vendors it intends on contracting with Feb. 23, 2024.
AHCA released the ITN in April. The contracts mean billions for the health plans that submit winning bids. The providers that aren’t chosen to contract with the state are all but shut out of Florida’s Medicaid managed care marketplace.
As of Sept. 30, Medicaid managed care plans provided managed medical assistance, specialty and long-term care to nearly 3.8 million people according to enrollment reports. In all, there are more than 5.16 million people in Florida’s Medicaid program at the end of September, the latest available data.
Update: Eleven companies responded to the Medicaid ITN.
One comment
BRIAN PETRUCCI
October 30, 2023 at 2:57 pm
This is strictly a lobbyist money grab–FL Medicaid should operate like other states utilizing NADAC+ a $20 professional dispense fee. NO PBM needed! SAY NO TO PBM THEFT OF FLORIDA TAX DOLLARS!!!! ALL THEY DO IS CHARGE THE STATE A LOT AND PAY PHARMACIES LITTLE WHILE STEALING BILLIONS!!! WAKEUP! PBMS ARE NOT NEEDED!
NADAC
https://data.medicaid.gov/dataset/dfa2ab14-06c2-457a-9e36-5cb6d80f8d93
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