Christine Jordan Sexton
There’s growing interest in a Medicaid lawsuit that’s been filed in Leon County Circuit Court.
Florida Community Care (FCC) filed a motion to intervene in ImagineCare’s lawsuit to prevent Agency for Health Care Administration (AHCA) Secretary Jason Weida from executing new multiyear Medicaid managed care contracts until its underlying administrative complaint has been resolved. The lawsuit has been assigned to Leon County Circuit Court Judge Angela Dempsey.
FCC contends it will “suffer great harm” if ImagineCare wins its lawsuit and said that company ‘’must be given a meaningful opportunity to assert and protect its interest,'” attorneys for FCC wrote in their July 24 motion.
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.
FCC also is a PSN. But unlike ImagineCare, it currently does have contracts to operate in the state’s mandatory Medicaid managed care system. ImagineCare’s attorney argues that an injunction is necessary because AHCA intends to move ahead with rolling out the new contracts.
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 FCC; 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, including FCC, had notified the state of their plans to challenge the decision. Some have objected because they weren’t awarded contracts in the regions they were vying for while others are protesting that they were left out completely.
After months of negotiations with some of the plans AHCA earlier this month published a second decision to award Medicaid contracts.
FCC was awarded additional Medicaid contracts in the July announcement and dropped its legal challenge.
But other plans did not.
In addition to challenging the Medicaid ITN in circuit court, ImagineCare notified AHCA of its intent to file a state administrative challenge.
So did Sentara, which, like ImagineCare, was trying to break into Florida’s Medicaid managed care market but emerged from the ITN without a contract offer.
AmeriHealth Caritas, which currently is a contracted provider, was not awarded a new six-year contract. It too has filed its intent to challenge AHCA in state administrative court.
