State Challenged On Children’s Medical Contract

A managed-care plan owned by the North Broward and South Broward hospital districts is fighting a state decision to eliminate it from providing Medicaid services to some of Florida’s sickest children. 

The South Florida Community Care Network has filed a challenge to the Florida Department of Health’s decision last month to award a contract to a subsidiary of Tampa-based WellCare Health Plans to manage the Children’s Medical Services program.

In its filing with the state, South Florida Community Care Network --- which operates as Community Care Plan --- asked that the contract with WellCare be stayed until it can reach an “amicable agreement” with the Department of Health.

If the department and Community Care Plan cannot reach an agreement, the filing requests that the dispute be referred to state administrative court.

Community Care Plan bid to operate the Children’s Medical Services managed-care program in South Florida, including heavily populated Palm Beach, Broward and Miami-Dade counties.

But the Department of Health, which is in charge of the Children’s Medical Services program, granted a sole award to WellCare.

Community Care Plan’s “best and final offer was superior to the best and final offer supplied by WellCare,” Tallahassee attorney Frank P. Rainer, with the Broad and Cassel firm, wrote in the filing last week.

Rainer said the decision to award the contract to WellCare is clearly “erroneous, contrary to competition, arbitrary and capricious and violate(s) law.”

Among other things, Community Care Plan disputes that a sole award to WellCare can be legal because federal law --- as well as the Medicaid waivers that authorize managed-care programs --- require patients to have a choice of at least two health plans.

In addition to a procurement process for the Children’s Medical Services program, the Scott administration in the last year has rebid broader statewide Medicaid managed-care programs and created a statewide dental managed-care program.

Those decisions by the state Agency for Health Care Administration also have drawn challenges.

See  Community Care Plan's challenge.

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