Two More Health Plans Get Medicaid Contracts

Two health plans that would have been locked out of Florida’s Medicaid market for the next five years were awarded state contracts after they threatened legal action.

Prestige Health Choice and Molina Healthcare will each be awarded contracts in two of Florida’s 11 Medicaid regions, the state announced late Monday. Moreover, the state announced it will award additional Medicaid managed-care contracts to Aetna Better Health of Florida, UnitedHealthcare of Florida and Simply Healthcare.

As a result of the decisions, Agency for Health Care Administration spokeswoman Mallory McManus said the state has settled legal challenges involving what are known in the Medicaid program as “managed medical assistance” contracts and “comprehensive” contracts. Plans with managed medical assistance contracts will provide services for general and acute health-care needs, from childhood checkups to surgeries. Comprehensive plans will also offer long-term care such as skilled nursing services.

However, legal challenges remain from companies that want to provide “specialty” services, including providing care to people with HIV and AIDS or serious mental illnesses. The state faces challenges from the AIDS Healthcare Foundation and Magellan Complete Care, among others.

Monday’s announcement brought to 13 the number of managed care plans that will sign contracts with the state for managed medical assistance and comprehensive care. The five-year contracts, in total, are estimated to be worth upwards of $90 billion.

Florida lawmakers in 2011 approved an overhaul of the Medicaid system to require most beneficiaries to enroll in HMOs and other types of managed-care plans. The state awarded an initial round of contracts and now is finishing a second round.

Under the announcement Monday, Molina has been awarded contracts to provide comprehensive services in Medicaid Region 8, which covers Sarasota, DeSoto, Charlotte Glades, Lee, Hendry and Collier counties, and Medicaid Region 11, which is made up of Miami-Dade and Monroe counties.

Currently, the company covers about 105,000 people in the two regions and is paid about $550 million annually for providing the care in those regions.

The California-based health plan has the third-largest market share in the Medicaid managed care program with contracts in eight Medicaid regions that are set to expire at the end of the year.

Before reaching the settlement with the state announced Monday, the plan would have been shut out of the Medicaid program going forward.

Pamela Sedmak, Molina Healthcare vice president of health plan operations, said the company was pleased it was able to persuade the state to alter its initial decisions.

“We weren’t awarded anything at all from the state (initially),’’ Sedmak said. “When you are starting from that position as you enter into settlement negotiations, we were thrilled to be able to recover over one-third of the revenue we did have in the state, and to continue our relationship with the state and providers there because this is a strategically important state.”

Meanwhile, Prestige Health Choice has been awarded managed medical assistance contracts in Medicaid Region 9, which includes Indian River, Okeechobee, St Lucie, Martin and Palm Beach counties, and Medicaid Region 11, which covers Miami Dade and Monroe.

Prestige Health Choice currently operates in eight Medicaid regions but, similar to Molina, would have been locked out of the program for the next five years had the state not modified its decisions.

AHCA officials went through a lengthy contracting process for the managed-care program. Florida law mandates that contracts be put back out to bid every five years.

While AHCA’s decisions keep Molina and Prestige in the Medicaid market, it also agreed to award additional Medicaid contracts to three other health plans.

Aetna Better Health of Florida will be awarded contracts in Medicaid regions 6 and 7, which are made up of nine Central Florida counties and include Tampa and Orlando.

UnitedHealthcare of Florida was awarded managed medical assistance contracts for Medicaid regions 3 and 4, which include areas in North Central Florida and the East Coast from Daytona Beach to Jacksonville.

Simply Healthcare was awarded an additional managed medical assistance contract in Medicaid Region 5, which is made up of Pinellas and Pasco counties, and a comprehensive contract in Medicaid Region 10, which is Broward County.

Copyright 2018 Health News Florida