Christine Jordan Sexton
Florida health care officials are expected to drop another invitation to negotiate (ITN) for a Medicaid program, this one for the Children’s Medical Services (CMS) Health Plan.
The nearly $13 billion contract to provide health care services for medically complex children who are Medicaid or state children’s health insurance program eligible expires Jan. 31, 2025, and the Department of Health (DOH) is expected to drop an ITN to procure the program any day.
The soon-to-be-released ITN follows DOH’s decision in May to extend its current contract with Sunshine Health Plan. Under the amended contract Sunshine will be paid an additional $3 billion, bringing the total value of the contract with the state to no more than $12.9 billion.
Florida requires most Medicaid beneficiaries, including medically complex children who can require specialty health care services, to enroll in managed care plans. Families have a choice of enrolling their children in one of the plans participating in the statewide Medicaid managed care program or the CMS Health Plan.
While the Agency for Health Care Administration (AHCA) administers the statewide Medicaid managed care program, DOH is in charge of the CMS Health Plan. However, AHCA, which houses the Medicaid program, has been a guiding force in the development of the upcoming CMS Health Plan ITN.
The CMS Health Plan contract was first procured in 2019. Sunshine State Health Plan is the sole Medicaid provider for the CMS Health Plan currently under contract with the state. Sunshine also is the largest provider in the statewide Medicaid managed care program.
DOH issued a request for information (RFI) in June 2022 designed to obtain input on best practices and innovative ideas and to help inform the future development of the CMS Health Plan ITN.
In an amendment to the RFI posted the following month, the state said, “The details of the proposed procurement are not yet known.” The amendment contained answers to questions, including whether the state will contract with more than one plan and whether the state prefers to work with managed care plans over community-based networks of providers with experience in the care.
Meanwhile, there’s been a legal flip-flop in the procurement for the statewide Medicaid managed care program
ImagineCare, a provider sponsored network hoping to break into Florida’s Medicaid managed care market, originally filed legal challenges to AHCA’s procurement in both administrative and Leon County Circuit Court.
The health plan earlier this week surprisingly dropped both challenges to the state’s decision to award Medicaid managed care contracts to Aetna Better Health, Community Care Plan (CCP), Florida Community Care (FCC), Humana Medical Plan, Molina Healthcare, Simply Healthcare, Sunshine and United Healthcare.
The move means AHCA will have one less lawsuit to resolve before implementing the new statewide Medicaid managed care contracts, but other suits remain.
AmeriHealth Caritas and Sentara have not dropped their administrative challenges to the Medicaid ITN, according to a review of the docket.
Meanwhile, CCP Sunshine, Humana, Molina, and FCC have intervened on behalf of the state in the administrative challenges.
Florida officially launched the Medicaid re-procurement in April 2023 with the release of a massive ITN.
