AHCA awards managed-care contracts to HMOs, leading to protests by providers

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As part of the updated Florida Medicaid managed-care system, the Agency for Health Care Administration awarded contracts to several HMOs, to the dismay of other health plan administrators.

In September, the AHCA awarded contracts to 10 managed-care plans statewide, in addition to five companies offering “specialty” plans, which include such services as HIV/AIDS treatment. The awards came after a bidding process in 11 different regions of the state.

Last week, AHCA made three additional awards: United HealthCare of Florida, Amerigroup Florida, and Simply Healthcare Plans.

United’s award covers two regions, for four regions in total. Amerigroup also received two other regions, for contracts in four regions overall. Simply Healthcare’s contract award is for the area including Miami-Dade and Monroe counties.

The recent awards sparked protests from other providers, claiming they were shut out of several regions.

Conventry Health Care of Florida protested through the state agency while Molina Healthcare of Florida protested in eight regions, according to data supplied by the AHCA.

WellCare of Florida, doing business as Staywell Health Plan of Florida, protested in three regions, although last month they received contract awards for seven other regions.

The contracting process has a vital role in AHCA compliance with a 2011 law, which will result in almost every Medicaid recipient enrolling in HMOs, as well as other managed-care plans.

AHCA representatives chose plans to serve a majority of Medicaid beneficiaries. The agency has gone through a similar contracting process, as well as began enrolling a smaller population of seniors needing long-term care services in managed care plans.

Peter Schorsch is the President of Extensive Enterprises and is the publisher of some of Florida’s most influential new media websites, including SaintPetersBlog.com, FloridaPolitics.com, ContextFlorida.com, and Sunburn, the morning read of what’s hot in Florida politics. SaintPetersBlog has for three years running been ranked by the Washington Post as the best state-based blog in Florida. In addition to his publishing efforts, Peter is a political consultant to several of the state’s largest governmental affairs and public relations firms. Peter lives in St. Petersburg with his wife, Michelle, and their daughter, Ella.