Winning bid announced for Medicaid managed care developmental disability pilot program

Florida Medicaid officials have announced their intent to award a six-year contract to Florida Community Care as the state tests whether managed care can help integrate traditional health care with home- and community-based services.

The decision is not final until Wednesday and can be challenged until then.

The Agency for Health Care Administration (AHCA) announced the contracts for Medicaid Regions D and I. Region D comprises Hardee, Highlands, Hillsborough, Manatee and Polk counties. Medicaid Region I covers Miami-Dade and Monroe counties.

Florida Community Care and Simply Healthcare were the only entities to responded to the Medicaid Invitation to Negotiate (ITN), which was initially dropped in November 2023.

According to the notice Florida Community Care’s response to the ITN scored 983 points, and Simply Healthcare’s responses scored 938 total points. There were 1,000 total points available.

Lawmakers gave the green light to test whether managed care is a viable delivery system for people with intellectual and developmental disabilities last year in SB 2510. The legislation authorizes up to 600 volunteers who are 18 years of age and currently on the waitlist for services in the current Medicaid iBudget Waiver program to enroll in the new pilot program.

The iBudget Waiver allows people with intellectual or developmental disabilities to obtain the types of home- and community-based services they require to live outside of an institution. Those services, which can include help with eating and grooming, traditionally aren’t covered by Medicaid, which is why the state needed a waiver to provide the care.

Advocates, family members and caregivers have previously opposed efforts to require managed care for people with intellectual and developmental disabilities. Opponents have, in the past, successfully beat back efforts to require them to enroll in managed care plans.

While lawmakers directed Medicaid officials to create the pilot program, it isn’t the only effort underway to enroll individuals with developmental and intellectual disabilities into managed care plans.

Under the terms of the new Medicaid managed care ITN, the state will assign individuals with intellectual or developmental disabilities into Medicaid managed care plans, although those individuals can opt-out afterward.

According to the latest iteration of the timeline, AHCA is anticipated to announce the winners of the statewide Medicaid managed care on Feb. 23.

AHCA also is negotiating a Medicaid dental ITN and intends to announce which entities it intends to award contracts to on March 29. AHCA sent a Medicaid alert in January announcing that Avēsis of Florida, DentaQuest of Florida, LIBERTY Dental Plan of Florida and Managed Care of North America had responded to the dental ITN.