Seven health plans have won bids to enroll Medicaid recipients in Hillsborough, Polk, Manatee and two other counties next year as Florida rolls out its statewide mandatory managed-care program, the Agency for Health Care Administration announced Monday.
Another seven health plans will be available in those counties especially for Medicaid patients who have chronic diseases, such as HIV/AIDS or serious mental illness. Tampa-based Freedom Health is sponsoring four of the specialty plans, for cardiovascular disease, diabetes, lung disease and congestive heart failure.
Meanwhile in Pinellas and Pasco, there will be four managed-care choices for the general Medicaid population, mostly healthy mothers and children, and the same seven specialty plans that are being offered in Hillsborough. (This chart shows which plans are in which district, with vertical columns representing the districts 1 through 11. The map above shows the districts.)
In other counties of greater Tampa Bay, including Sarasota, Citrus and Hernando, the state has chosen three plans for the general Medicaid population and six specialty plans.
Only two companies -- Tampa-based WellCare Health Plans and Centene Corp.'s Sunshine State Health Plan -- were chosen to compete in all the counties of greater Tampa Bay for the general Medicaid enrollees.
In 2011, Florida lawmakers voted to do away with the fee-for-service payment system in Medicaid for all but a handful of enrollees, converting to a statewide managed care system. This takes the state out of the position of being a direct payer for care; instead it will be supervising contracts with private insurers.
As Health News Florida reported at the time, lawmakers chose to begin with the elderly and disabled Medicaid patients who are in nursing homes or are one fall away from it, depending on family and community support. Supporters of the idea said this frail population most needed the kind of coordination of services that managed-care provides, and also they are the most expensive.
Four counties of central Florida were the first to shift their elderly Medicaid patients to managed-care plans on Aug. 1. Each month, another set of counties is folded into the program.
After all of the elderly and disabled patients are enrolled in managed care next spring, AHCA will turn its attention to the younger Medicaid beneficiaries. The announcement Monday conveyed which companies have been invited to participate, by district. The agency is finalizing contracts.
Some patient advocates have expressed concern that AHCA will not supervise the plans closely enough. But Secretary Liz Dudek said in a recent video that the state will keep a close eye on them.
