State Names Nine Medicaid Health Plans But Challenges Loom
Wednesday, April 25, 2018
Posted by: Diane Berg
Florida officials on Tuesday announced the names of the nine health plans the state wants to ink contracts with to provide health care to nearly four million poor, elderly and disabled residents.
The decision is not final, though, and Molina Healthcare of Florida and Positive Healthcare --- both of which currently have contracts, but would be shut out of the Medicaid program between 2019-2024 --- have said they plan on challenging the Agency for Health Care Administration’s decision.
Florida Medicaid Director Beth Kidder said earlier that the contracts could be the largest ever awarded by the state, and could be worth more than $90 billion dollars over a five-year period.
If the agency’s decision stands, Sunshine Health Plan will operate in all 11 regions of the state. Sunshine Health would offer Medicaid beneficiaries access to a traditional plan as well as a separate “child welfare” specialty plan.
Simply Healthcare Plans, meanwhile, will offer a specialty plan for people with HIV and AIDS in all 11 regions.
Humana was picked as a provider in 10 of the 11 regions across the state, but failed to win a bid in Medicaid Region 1, which includes Escambia, Okaloosa, Santa Rosa and Walton counties.
Meanwhile, WellCare of Florida, which will operate under the moniker of Staywell Health Plan of Florida, will offer access to a mental health specialty plan in all 11 Medicaid regions. It also will offer access to a traditional Medicaid managed care plan in nine of the 11 Medicaid regions, after being shut out of Regions 1 and 10. Region 10 is comprised solely of Broward County.
Florida Community Care and Best Care Assurance are two new Medicaid managed-care plans enrollees would have access to, if the state’s selections stand. Florida Community Care will be offered in every region but North Florida Region 2, which includes Bay, Calhoun, Franklin, Gadsden, Gulf, Holmes, Jackson, Jefferson, Leon, Liberty, Madison, Taylor, Wakulla, and Washington counties.
Best Care Assurance will operate under the name Horizon Health Plan and will be made available in Medicaid Region 8, made up of Charlotte, Collier, DeSoto, Glades, Hendry, Lee, and Sarasota counties.
While the state will offer new plans, some health plans that currently have Medicaid contracts weren’t included in the list of nine announced Tuesday. Those include Molina Healthcare of Florida; Positive Healthcare, the plan offered by the AIDS Healthcare Foundation; Prestige Health Choice; and Magellan Complete Care.
The Legislature passed a sweeping rewrite of the state's Medicaid program in 2011, requiring nearly all beneficiaries, from the cradle to the grave, to enroll in managed-care plans. For purposes of contracting, AHCA divided the state into 11 different regions and negotiated contracts for each region.
The state issued its invitation to negotiate, the second under the Medicaid managed-care program, in July 2017.
Source: NEWS SERVICE OF FLORIDA