Health plans ready to vie for Medicaid contracts

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With Florida gradually moving toward a statewide Medicaid managed-care system, 14 health plans are ready to compete for contracts to provide long-term care to seniors, reports Jim Saunders of the News Service of Florida.

The health plans met a deadline last week for submitting documents that will be used by the state Agency for Health Care Administration as it works to award contracts in 11 different regions of the state.

Six companies, including some major names in the managed-care industry, submitted documents to seek contracts in each region, according to AHCA. Those companies are American Eldercare, Coventry Health Care of Florida, Humana, Sunshine State Health Plan, United Healthcare of Florida and WellCare.

Three firms — Freedom Health, Molina Healthcare and Universal Health Care — are bidding in eight regions, while five others are seeking contracts in three or fewer regions.

Michael Garner, president and chief executive officer of the Florida Association of Health Plans, said AHCA will use information from the documents in a scoring system that ultimately will lead to the agency negotiating contracts with a limited number of plans in each region. For example, contracts will be awarded to a maximum of two health plans in a region that includes the western Panhandle, while as many as 10 plans could get contracts in a region that includes Miami-Dade and Monroe counties.

Michelle Dahnke, an AHCA spokeswoman, said in an email that the agency is expected to review the documents — known as responses to an “invitation to negotiate” — until November. She said negotiations are expected to last from Nov. 13 to Jan. 4.

Garner said AHCA will look at numerous issues in evaluating the health plans’ responses, such as whether they have adequate networks of medical providers in the regions and whether their rates are actuarially sound.

A lingering question, however, remains about when, or even if, the federal government will approve Florida’s plan to move to a statewide system of managed care. AHCA submitted proposals to the federal Centers for Medicare & Medicaid Services in August 2011 but is still awaiting approvals.

Republican lawmakers in May 2011 approved a controversial overhaul that would eventually enroll almost all Medicaid beneficiaries in HMOs or other types of managed care plans. Supporters say the idea will help hold down costs and improve a fragmented system of care, while critics warn that HMOs could scrimp on care for needy Floridians.

The overhaul is supposed to move forward in two stages. First, it will apply to seniors who need long-term care, and then it will apply to the broader Medicaid population, such children and mothers.

Both stages will involve contracting in 11 regions. All 14 of the health plans seeking long-term care contracts submitted documents to compete in Miami-Dade and Monroe counties. By contrast, two huge, relatively rural regions that include the Big Bend area and north central Florida each drew six health 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.