Christine Jordan Sexton
After having its administrative challenge tossed by the Agency for Health Care Administration (AHCA), a Medicaid managed long-term care provider is asking a Leon County circuit court to intervene and prevent the state from moving ahead with new multiyear contracts.
Attorneys for ImagineCare filed a lawsuit last week seeking a temporary injunction banning AHCA and its Secretary, Jason Weida, from moving ahead with the new Medicaid managed care contracts until its (and others) underlying administrative complaint has been resolved.
“Allowing AHCA and Secretary Weida to proceed with executing and implementing contracts while these protests remain pending will greatly prejudice ImagineCare and other protesting parties, cause irreparable harm to the Medicaid enrollees of the state of Florida and will violate both Florida law and the express provisions of the ITN,” attorneys wrote referring to the statewide Medicaid Managed Care Invitation to Negotiate issued April 2023.
Florida Politics reported last week that AHCA dismissed ImagineCare’s complaint and request for administrative hearing, because the requisite bond was not issued in ImagineCare’s name.
ImagineCare is a type of health plan known as a provider service network (PSN). A joint venture of Spark Pediatrics and CareSource, ImagineCare does not currently have a Medicaid managed-care contract in Florida.
According to the lawsuit AHCA’s dismissal came “immediately” after “Secretary Weida advised a representative of ImagineCare that ImagineCare was officially out of the running and would not be considered for a contract award.”
ImagineCare’s attorney argues that an injunction is necessary because AHCA intends to move ahead with rolling out the new contracts. According to the Medicaid ITN, AHCA wants to rollout the new contracts beginning September. Before that can occur, however, AHCA must ensure that the plans have sufficient provider networks and are ready to operate.
Florida requires most of its Medicaid enrollees, from the young to the old, to receive their health care through managed care plans. AHCA in 2023 released its Medicaid managed care ITN to renegotiate new multiyear contracts worth tens of billions to the winning bidders.
The state announced in April its intent to award new contracts with Florida Community Care; Humana Medical Plan; Simply Healthcare Plans; South Florida Community Care Network, which does business as Community Care Plan; and Sunshine State Health Plan.
Seven plans notified the state of their plans to challenge the decision, some plans, because they weren’t awarded contracts in the regions they were vying for, others because they were awarded no contracts.
After more negotiations, AHCA on July 18 month published a second decision announcing its plans to extend contracts to Aetna Better Health of Florida, United Healthcare of Florida and Molina Healthcare — all of which had initially been denied contracts. The July 18 notice offers additional contracts to Florida Community Care (FCC), allowing it to maintain its statewide presence, according to the new notice. Impacted providers have until tomorrow afternoon to notify AHCA of their intent to challenge the decision.
The notice also changed the Medicaid contracts offered to the South Florida Community Care Network, which operates as Community Care Plan (CCP) and also is a PSN. It is owned by the North Broward and South Broward Hospital Districts. The NBHD, which does business as Broward Health, is run by Shane Strum, Gov. Ron DeSantis’ former Chief of Staff.
CCP currently operates in only one region, Broward County. But AHCA announced plans to award the allow PSN contracts in four additional Medicaid Regions allowing it to operate as far north as Brevard County and as far west as Lee, Collier and Sarasota counties.
In its lawsuit ImagineCare asks the judge to enjoin the state from moving forward with the CCP contracts and the FCC contracts.
