Diagnosis for 4.18.24: Checking the pulse of Florida health care news and policy

Welcome back to Diagnosis, a vertical that focuses on the crossroads of health care policy and politics.

The Agency for Health Care Administration’s decision late last week to award six-year Medicaid managed care contracts to five incumbent health plans could be challenged.

Aetna Better Health of Florida Inc. AmeriHealth Caritas Florida, Inc. Florida Community Care, ImagineCare, Molina Healthcare of Florida, Sentara Care Alliance, South Florida Community Care Network (d/b/a Community Care Plan) and UnitedHealthcare of Florida filed a notice of intent to challenge the decision with the Agency for Health Care Administration by the Wednesday deadline, according to the Office of Public Information.

AHCA’s published decision last week shows the state’s intent to stick with five incumbent plans and reject four others: Aetna Better Health of Florida, 
AmeriHealth Caritas Florida, Molina HealthCare of Florida and United Healthcare, all of which are currently under contract, were not among the list of winning bidders.

All the rejected plans are currently under contract to provide care to Medicaid beneficiaries in the heavily populated Medicaid Region 11, which is composed of Miami-Dade and Monroe counties.

Aetna Better Health of Florida also has contracts to provide comprehensive care in Medicaid Regions 6, a five-county swath of Southwest Florida composed of Hillsborough, Manatee, Polk, Hardee, and Highlands counties, and Region 7, which is composed of Seminole, Orange, Osceola, and Brevard counties.

AmeriHealth Caritas also has a contract to provide care in Medicaid Region 8, which includes Sarasota, Desoto, Charlotte, Glades, Lee, Hendry, and Collier counties.

Molina is contracted for Medicaid Region 9, composed of Indian River, St. Lucie, Martin, Palm Beach and Okeechobee counties.

Additionally, United Healthcare currently has contracts in Medicaid Regions 3, 4, and 6.

Region 4 is composed of Baker and Clay counties and the stretch of coastal northeast Florida from Nassau to Volusia counties.

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— A closer look —

But it wasn’t just the rejected plans that filed challenges.

ImagineCare LLC and Sentara Care Alliance were new managed care plans hoping to enter Florida’s Medicaid managed care market.

Florida Community Care and South Florida Community Care Network are PSNs, or provider-sponsored networks, and were each chosen to provide care in five Medicaid Regions.

That’s a significant expansion for the South Florida Community Care Network, the PSN plan owned by Broward Health (North Broward Hospital District) and Memorial Healthcare System (South Broward Hospital District). Former DeSantis Chief of Staff Shane Strum heads Broward Health.

The same is not true, though, for Florida Community Care. The PSN that specializes in providing care to frail and aging adults and adults with disabilities currently has contracts statewide.

Last week’s announcement decreases the PSN’s footprint to just five Medicaid Regions. It’s worth noting, though, that Florida Community Care was selected as the sole provider for the Comprehensive Intellectual and Developmental Disabilities (CIDD) Managed Care Pilot Program.

Meanwhile, the state has sanctioned two of the incumbent plans that were awarded statewide contracts — Sunshine Health Plan and Simply Healthcare Plans.

Sunshine State Health Plan, which was awarded contracts statewide for its comprehensive long-term care plus, HIV/AIDS, serious mental illness plans, and child welfare plans, has been sanctioned twice. It was sanctioned and hit in the 3Q of state fiscal year 2018-19. AHCA’s records don’t indicate the plan was fined at the time. The second sanction was in the 3Q of FY 2021-22. The plan paid a $9 million fine.

According to a compliance dashboard maintained by AHCA, Simply Healthcare Plans was sanctioned $2,500 in Q1 of state fiscal year 2023-24.

Humana Medical Plan, which also was awarded contracts statewide for comprehensive long-term care plus, HIV/AIDS and serious mental illness specialty plans, has not been sanctioned.

The current Medicaid contracts have been in effect since state FY 18-19 and expire at the end of the year. In that time there have been 1,130 final actions taken against the contracted managed care plans for violations and $70.5 million in total dollar amounts associated with those final actions. Most of those actions (1,123) and monetary penalties ($61.4 million)

—What about DeSantis? —

Several states, led by Republican Governors, are warning that the new federal Medicaid guidelines released by the Centers for Medicare and Medicaid Services (CMS) would “devastate the Medicaid safety net” if they are implemented.

Gov. Ron DeSantis did not sign on to the letter sent late last week by eight GOP Governors, including Texas Gov. Greg Abbott and Georgia Gov. Brian Kemp.

The letter directly cites Florida as a state that could eventually lose out on $2.6 billion in funding but Gov Ron DeSantis is not one of the signatories.

The proposed rule centers on how states come up with matching dollars to bring in federal Medicaid payments. This issue is particularly acute in Florida, where the state relies heavily on money collected by providers, such as hospitals and nursing homes, to fund its share of Medicaid, which is funded jointly by the state and federal governments.

“If CMS nevertheless forges ahead and implements these policies, Medicaid funding could be reduced by $48 billion each year, impacting 49 states that rely on provider taxes to bolster their Medicaid programs,” states the letter sent to President Joe Biden.

“Suffering most would be states like Louisiana, Missouri, Texas, and Florida. Texas and Florida alone rely on provider taxes to support more than $8 billion and $2.6 billion, respectively, in critical Medicaid funding each year. Such reductions would harm critical health care systems serving our most vulnerable citizens, exacerbating disparities in care.”

The letter adds that “your administration’s actions constitute an immediate threat to Medicaid funding and to our most vulnerable citizens. We urge you to immediately abandon these misguided policies.”

DeSantis’ office did not respond to a request for comment about the letter sent to Biden and declined to comment on why the Governor didn’t sign onto the letter, instead deferring comment to AHCA.

—Q/A BioFlorida —

BioFlorida’s new President and CEO Mark A. Glickman is a New York native, former New Jersey entrepreneur and Florida venture capitalist transplant. He’s been at the helm of BioFlorida for less than five months and says he’s got big plans for the organization that, according to its website, represents 8,600 entities and research organizations in the life sciences industry that employ 107,000 Floridians.

Glickman will be in Alachua County April 25 at the 19th annual BioFlorida Celebration of Technology, an outdoor event that attracts more than 500 industry, life science, and community professionals to the home county of the University of Florida and a burgeoning hub for innovation in biotechnology and life sciences.

Glickman spoke with Florida Politics’ Diagnosis to discuss his plans for the organization. An edited version of that conversation is below:

Diagnosis: Can you discuss your vision for BioFlorida

I’m here to connect the dots in this ecosystem. You know, when you go to New Jersey, or you go to Massachusetts or California, it’s not that hard to connect the dots, you know, who the banks are, you know who the companies are, you know, who the representatives are, who are going to support you and who aren’t, it’s kind of, you don’t even need a map.

In Florida, you need that. You don’t even know. Let’s say I’m standing in Miami or I am standing in Alachua. Is that the right place to be? Six months ago, I didn’t know there was an Alachua County in Florida.

But in New Jersey, if you go to Princeton, you have a 90% chance that you’re in the right place. You’re going to find everything. So, I’ve taken it seriously. We need to connect the dots, and what I found in a short period is that we have a great product at BioFlorida.

It’s starting to come together really fast, meaning the dots. And now the Tallahassee piece is coming together.

Diagnosis: Can you explain what you mean by the Tallahassee piece?

So to me, the Tallahassee piece has a couple of different angles to it. If you look at our constituents, it’s probably one-third academic, one-third, let’s call it an investment, and one-third commercial phase two of the three. But all three of the constituents really don’t know how to navigate or become aware of what the state can even offer them, whether it’s the jobs, Opportunity Fund, discovering how to access these funds, or finding out what’s available. There’s a hole. And maybe this falls into the lobbying piece but is Florida open to the life sciences industry? For our 450 members, I’m not sure they all are fully aware that Florida values, the life sciences.

Some of the legislation that was out there during the 2024 Session, whether it came from, you know, Rep. Randy Fine regarding international reference drug pricing, Canadian import drug pricing, or hospital 340 B, all these things, give the advice, give the appearance, that Florida is not interested in the life sciences industry. But that’s not true. So now I need to work with Agency for Health Care Administration Secretary Jason Weida and FloridaCommerce Secretary Alex Kelly to help tell the story if the funds are there and the warmth is there, and the state wants to attract these companies.

This is what we don’t have. But you have to talk to people, you have to understand where they stand. So, I can build that, and I will help them build the product, to say, ‘Hey companies who are here, we want you to stay here. Companies who are on the fence, we want you to move here, and companies that don’t believe that they could grow here, we have the resources to help you grow. None of that’s obvious to the constituents. The larger pharmaceutical companies like Medtronic, the Pfizers, and Bristol Myers Squibb, they’re here. They need to know that BioFlorida is vocal in their issues.

Diagnosis: What can BioFlorida do for the industry?

We’re starting to brand BioFlorida, and what I mean by branding it is. I’m putting this brand on from concept to consumer. And what I mean by that is, who can we be? From concept, I mean, that discovery stage spin spun out of a university, or it has a molecule from somewhere else from concept to impact in human lives. We feel like we need to tie this ecosystem together. This is the current need. We have university discovery stage companies, we have medical device companies, pre-clinical stage companies, clinical stage, and commercial stage, companies. The companies kind of come to the Florida ecosystem, and say, ‘Hey, I need help. ’I need to find vendors, whether it’s CROs we need policy help management, mentorship, capital, and human resources, is a big part of this.

And I did this when I became a CEO of a Florida-based company, I came to Florida, but I stayed focused on the people I knew in New Jersey. I went back to my sources to New Jersey.

So this is our vision here. We want to be the centralized model where all these different constituents come to BioFlorida and become the source. So, you don’t have to be a new company figuring out what policy is, how to navigate Tallahassee, and where to go for human resources. We want to create the source for all the needs of Florida Life Sciences.

So that’s, that’s my three-minute overview of what we’re trying to accomplish in a very short period here. So, what I’m doing is I’m prioritizing. That’s what’s so exciting it’s happening quickly.

— New partnership —

Florida’s child and family direct service providers have joined together in a new partnership called the Partners for Florida’s Children & Families to help shape a better future for Florida’s children, families, and communities.

Through this collective voice, the Partners for Florida’s Children & Families advocate for solutions to empower Florida’s children and families, strengthen communities, and create generational change. A key focus is working for a community-based care system in Florida that keeps children and families at the forefront and best serves the needs of our state’s communities.

The Partners for Florida’s Children & Families collectively offer services to all Florida children and families with programs and reach in Florida’s 67 counties and collectively bring unmatched on-the-ground experience in providing these services. These partner organizations and providers work to keep children safe and supported, create stronger families, and build bridges to success through prevention, intervention and ongoing treatment and support services.

Partners for Florida’s Children & Families said In a joint statement, “All children deserve to grow up in strong families and supportive communities and have every opportunity to reach their full potential.

“As Florida’s child and family service providers, the Partners for Florida’s Children and Families are at the front lines working to meet the greatest needs facing our children, families, and communities. We are there before the hotline call, during the crisis, and in the years of life to follow. Through this continuum of care, we provide Florida’s children and families, including those who need us most, with safety, security, hope, and the opportunities to help them reach their full potential.

“Our collective on-the-ground experience gives us an unparalleled understanding of how to support the best possible outcomes for Florida’s children and families. We are dedicated to working with our state’s leaders, policymakers, and communities to make Florida a state where families can thrive together.”

The Partners for Florida’s Children & Families include 4 Sisters Solutions; A Kid’s Place; Boys Town of Florida; Champions for Children; Children’s Harbor; Children’s Home Network; Children’s Home Society; Florida Sheriffs Youth Ranches; Friends of Children & Families; IMPOWER; Kids In Distress; Residing Hope; St. Augustine Youth Services; and Thompson Child & Family Focus.

— RULES —

The Division of Health Access and Tobacco proposes new Rules 64I-7.001, 64I-7.002, and 64I-7.003 to establish the criteria for clients, dentists, and providers to participate in a voluntary dental services program. More here.

— LOBBYISTS —

David Daniel, Jeff Hartley, Lisa Hurley, Smith Bryan & Myers: Residing Hope

Kelly Mallette, Gabriela Navarro, Ronald L. Book P.A.: Florida Smoke-Free Association

— ETC —

There’s a new organization in town and it’s called the Partners for Florida’s Children & Families. The organization represents child and family direct service providers and will advocate for a community-based care system in Florida that, according to a news release, “keeps children and families at the forefront and best serves the needs of our state’s communities.”

The organization is composed of representatives from 4 Sisters Solutions; A Kid’s Place; Boys Town of Florida; Champions for Children; Children’s Harbor; Children’s Home Network; Children’s Home Society; Florida Sheriffs Youth Ranches; Friends of Children & Families; IMPOWER; Kids In Distress; Residing Hope (formerly known as Florida United Methodist Children’s Home); St. Augustine Youth Services; and Thompson Child & Family Focus.

— ROSTER —

— Alecia Collins is the new Deputy Chief of Staff Communications and External Affairs at the state Agency for Health Care Administration. She has worked at several state agencies, most recently at the Division of Emergency Management.

— Precision Healthcare Specialists hired Todd Lindquist, M.D., who specializes in conditions involving the ears, nose and throat.

— Jessica Reimers has been named Executive Director of the World AIDS Museum and Educational Center in Fort Lauderdale, Florida. The museum is a nonprofit with the mission of increasing awareness and decreasing the stigma of HIV/AIDS.

— ICYMI —

In case you missed them, here is a recap of other critical health care policy stories covered in Florida Politics this past week.

“More than 22K children dropped from Florida KidCare in 2024 as state challenges federal eligibility protections” via Christine Jordan Sexton of Florida Politics — In a move that some have called “egregious,” Florida since January has dropped more than 22,000 children from a subsidized health insurance program for failing to pay premiums despite the federal government saying it cannot. State data shows that 6,780 children were disenrolled from the Florida KidCare program Jan. 1, which, according to the federal government, is when a 12-month eligibility requirement went into effect for children enrolled in the Medicaid or the state children’s health insurance program (CHIP), which in Florida is called Florida KidCare.

“FDACS inspectors find nearly 200,000 hemp products targeting kids in search” via Gabrielle Russon of Florida Politics — State inspectors discovered nearly 200,000 hemp products illegally being marketed to children, with the state intervening to keep them off the shelves, said Florida Department of Agriculture and Consumer Services (FDACS) Commissioner Wilton Simpson.

“State announces intent to ink multibillion-dollar contracts with five managed care plans” via Christine Jordan Sexton of Florida Politics — The Agency for Health Care Administration on Friday announced the names of the winning bids for the Medicaid managed care program. The contracts are massive in scope since the managed care companies that are picked will get six-year contracts to administer a health care program that annually costs tens of billions of dollars. The most recent data from AHCA shows that there are 3.45 million Floridians receiving Medicaid through managed care plans.

“Rick Scott backs 15-week abortion ban with exceptions, distancing from law DeSantis signed” via A.G. Gancarski of Florida Politics — U.S. Sen. Rick Scott’s position on abortion continues to get scrutiny as he runs for a second term, with the former Governor distancing himself on the record from a law DeSantis signed in 2023. And comments he made to The Hill likely won’t take the heat off the Republican Senator from Democrats who want to remove him from office.

— FOR YOUR RADAR —

Aside from coverage by Florida Politics, these stories are worth your time.

“Born to die: Florida’s infant mortality crisis” via Cindy Krischer Goodman of the South Florida Sun-Sentinel — Across Florida, many parents spend their days and nights watching monitors, adjusting tubes and struggling to keep their premature babies alive. Preemie children, many with undeveloped organs, face incredible odds to survive and thrive and often require years of monitoring and medical interventions that drain family and government finances. Premature births in Florida — those earlier than 37 weeks gestation — rose 4% over the last decade, even as the state’s overall birthrate declined by nearly 10% in the same time period. Florida doctors see a health crisis unfolding: Infant mortality rates in the state persist at levels higher than the national average, but equally concerning is the rising number of premature births. More advanced technology allows doctors to perform lifesaving measures on newborns the size of a shoe; premature babies tend to die within 28 days, leaving families grieving; fragile children are sent home from hospitals with breathing machines, feeding tubes and other medical devices to keep them alive.

“New surgical tower at TGH will bear a familiar name in Tampa health care circles” via Ashley Gurbal Kritzer of the Tampa Bay Business Journal — Tampa General Hospital’s new 13-story surgical tower will bear the name of Tampa’s Taneja family after a “historic gift” toward the project. TGH celebrated the groundbreaking of the tower, which will house surgical, neuroscience, and transplant services when it opens in 2027. Jugal and Manju Taneja founded Belcher Pharmaceuticals together in 2010. The tower is named in honor of the Taneja Family Foundation’s undisclosed gift to the TGH Foundation. In total, TGH says it has raised $120 million toward the surgical tower. “We have lived the American dream, and now we want others to have that same chance at life,” Jugal Taneja said in a statement on behalf of himself, Manju and the family. “What better way to pay it forward than to give greater access to world-class care for those who need it most?”

“COVID-19 death toll nears 2,300 in 2024; experts urge updated vaccines” via Caroline Catherman of the Orlando Sentinel — Although COVID-19 cases are currently low, nearly 2,300 people have died in Florida this year from a virus that refuses to disappear fully. That has health care experts reminding Floridians again that it’s time for another booster shot of vaccines designed to prevent serious illness and death. The biggest risk is for people ages 65 and up. They account for 91% of Florida’s COVID-19 deaths. During initial vaccine rollouts, elderly people were highly vaccinated. Now only 43% of U.S. residents over 65 are up-to-date on their shots. This has led experts to urge this group especially to get immunized.

“Florida conspiracy theorists are making a bid to commandeer a prestigious hospital” via Ja’han Jones of NBC News — There’s a new Daily Beast report on attempts by conservative anti-vaxxers to win control of the medical Board that oversees the prestigious Sarasota Memorial Hospital in Florida. As the Beast reports, the group of contenders looking to win seats on the Board includes Mary Flynn O’Neill, sister of former Trump adviser and conspiracy theorist Michael Flynn. A victory for the conspiracy theorists would allow them to set standards for what qualifies as effective and ethical health care — a horrifying prospect. Florida is already offering a crash course in the dangers of allowing pseudoscience to drive health policy, in the policies of its Surgeon General, Dr. Joseph Ladapo. And yet Florida alone doesn’t paint the full picture of the conservative movement’s assault on public health.

— PENCIL IT IN —

Friday

Happy birthday to Sen. Colleen Burton.

3 p.m. — AHCA holds a meeting on proposed changes to Rule 59G-4.002 regarding provider reimbursement rates. Agency for Health Care Administration, 2727 Mahan Dr. Bldg. 3, Tallahassee, 32308-5407.

Saturday

Happy birthday to Rep. Randy Fine.

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Diagnosis is written by Christine Jordan Sexton and edited by Drew Wilson.