Medicaid Contract Challenged In Southwest Florida

A move by state health-care regulators to avoid litigation has, instead, created more.

Attorneys for Best Care Assurance, a managed care plan affiliated with Lee Memorial Health System, notified the state that they plan to challenge a decision last week to award a Medicaid contract to Molina Healthcare of Florida in a seven-county region of Southwest Florida.

The state decision would bring to nine the number of managed care plans for Medicaid patients over the next five years in what is known as Medicaid Region 8. The region includes Sarasota, DeSoto, Charlotte, Glades, Lee, Hendry and Collier counties.

The state Agency for Health Care Administration last week decided to award Molina Healthcare a contract to provide “comprehensive” care in the region, meaning it would provide acute-care services and long-term care.

Best Care Assurance, which will operate under the name Horizon Health Plan, was awarded a contract in April in Medicaid Region 8. Immediate attempts to contact attorneys or officials from Best Care Assurance about the legal challenge were unsuccessful.

Florida lawmakers in 2011 approved a plan to revamp the Medicaid system and require most beneficiaries to enroll in HMOs or other types of managed-care plans. The state awarded contracts to health plans in 11 different regions of the state, and AHCA is now finishing a second round of contracting.

AHCA announced in April its selection of health plans for five-year contracts, estimated to be worth about $90 billion overall. Molina Healthcare, which has been under contract with the state to provide care to Medicaid patients in eight regions, would have been shut out of Florida’s $29 billion Medicaid program if the agency’s initial April 24 decision stood.

But the contract decisions were challenged by a dozen managed care plans, including Molina Healthcare. Since then, AHCA has awarded contracts to four more health plans bringing to 13 the number of companies that will share the business.

To settle Molina’s challenges, AHCA agreed to award the plan contracts in Medicaid Region 8 and Medicaid Region 11, which covers Miami Dade and Monroe counties. About 200,000 patients are enrolled in Medicaid managed-care plans in the seven Southwest Florida counties.

Though the settlement agreement meant that Molina Healthcare would have a drastically reduced footprint in the Medicaid program, it kept the plan in Region 8. Company Vice President of Operations Pamela Sedmak said last week the company was “thrilled” because the settlement allowed it to “recover over one-third of the revenue we did have in the state.”

Laura Murray, a spokeswoman for Molina Healthcare, had no comment on the Best Care Assurance challenge.

Meanwhile, legal challenges remain from companies that want to provide “specialty” services, including providing care to people with HIV and AIDS or serious mental illnesses.

One of those challenges that’s still outstanding was filed by Coral Care, which is challenging the state’s decision to award a mental-health specialty contract to WellCare of Florida in Medicaid Region 8.

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