3 managed care plans challenge Florida Medicaid procurement

Florida’s decision to award Medicaid-managed care contracts to health plans following a massive re-procurement is being challenged in state administrative court by three spurned providers.

Florida Politics has confirmed that Sentara, AmeriHealth Caritas and ImagineCare notified the Agency for Health Care Administration (AHCA) of their intent to challenge the July 18 decision and another one from April.

The parties have 10 days from filing the Notice of Intent to file amended complaints. AHCA will likely refer the cases to the state Division of Administrative Hearings soon thereafter and a hearing should be held within 30 days.

In a release to Florida Politics, Sentara said the company was disappointed in the outcome of the ITN.

“Sentara has filed an intent to protest, as we remain dedicated to serving members in the communities that we support,” the release said.

The state wants to unfurl the new six-year Medicaid-managed care contracts with plans across the state beginning Sept. 1. AHCA will likely start the work necessary to accomplish that, including ensuring plans have an adequate network of providers.

To prevent AHCA from proceeding with implementation, ImagineCare has also filed a suit in Leon County Circuit Court seeking an injunction banning AHCA and its Secretary, Jason Weida, from proceeding with 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.

Circuit Judge Angela Dempsey has been assigned the case. Shutts and Bowen attorneys Joseph Goldstein, Daniel Nordby and Amber Stoner Nunnally represent AHCA.

ImagineCare is a type of health plan known as a provider service network (PSN). A joint venture of Spark Pediatrics and CareSource, it does not currently have a Medicaid-managed-care contract in Florida.

An ImagineCare representative told Florida Politics that the plan earned the highest scores for a PSN but was not chosen for a Medicaid contract.

“We are obviously extremely disappointed with the current outcome and confused as to how the highest scorer was not provided an opportunity to offer differentiating services to Floridians. We are in the process of determining the appropriate next steps while preserving our argument that we are the most qualified PSN in this ITN,” the company said in a statement.

Florida requires most Medicaid enrollees, from the young to the old, to receive health care through managed care plans.

In 2023, AHCA released its Medicaid-managed care ITN to renegotiate new multiyear contracts worth tens of billions to the winning bidders.

In April, the state announced its intent to award new contracts to 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.

Following the announcement, seven plans notified the state of their plans to challenge the decision, some because they weren’t in the regions they were vying for, others because they weren’t awarded any contracts.

After more negotiations, AHCA published a second decision on July 18 that quashed four of the seven complaints.

Under the tandem of agency decisions, AHCA will enter new six-year contracts with eight plans: Aetna Better Health of Florida, Florida Community Care (FCC), Humana Medical Plan, Molina Healthcare of Florida, Simply Healthcare Plans, Community Care Plan (CCP), Sunshine State Health Plan and UnitedHealthcare of Florida.

All eight have existing Medicaid-managed care contracts set to expire at the end of the year. AmeriHealth Caritas, which is currently under contract, wasn’t offered a new contract.

Two of the eight plans, FCC and CCP, are PSNs. The latter is owned and operated by the North Broward Hospital District, commonly known as Broward Health, and the South Broward Hospital District. Shane Strum, DeSantis’ former Chief of Staff, runs Broward Health.

AHCA is signing statewide contracts with FCC, Humana Medical Plan, Simply Healthcare Plans and Sunshine State Health Plans. This expands Simply’s current program.

Aetna and United will continue to operate in the same areas of the state they currently do.

Molina Healthcare, blanked in the initial agency decision, was offered a contract in one region, which pares back its presence in the Medicaid market. Nevertheless, the company issued a statement following the announcement.

“Under the contract award in Miami-Dade and Monroe counties, Molina expects to serve approximately 90,000 Medicaid beneficiaries. The contract term is expected to commence on Jan. 1, 2025, and run through Dec. 31, 2030,” the letter read.

While CCP’s footprint is limited to Broward County, it was offered Medicaid contracts in five of the nine Medicaid Regions across the state.