Amid controversies, state nears decision to award billions for Medicaid Managed Care

by | Feb 18, 2024

With billions on the line and the healthcare of millions in question, Florida’s Agency for Health Care Administration must find ways to hold Medicaid providers accountable.

As Florida’s Agency for Health Care Administration (AHCA) prepares for next week’s unveiling of the chosen providers for its Medicaid managed care contracts, the spotlight intensifies on a procurement process enveloped in scrutiny and anticipation. With billions at stake and the healthcare of millions of Floridians hanging in the balance, this year’s selection process is under more observation than ever, particularly due to controversies surrounding key contenders.

The re-procurement, a relatively routine procedure occurring every six years, is pivotal for continuing Medicaid services across the state. However, the cycle is fraught with challenges, notably highlighted by Julio Fuentes, President of the Florida Hispanic Chamber of Commerce, who recently emphasized the critical need for “accountability and oversight” amid ongoing Medicaid complexities.

In the legislature, proposed reforms aim to fortify this accountability. House Bill 783, currently under consideration, seeks to enforce regular performance reporting by Medicaid managed care plans, ensuring greater transparency and operational integrity. This legislative push aligns with AHCA’s efforts to scrutinize providers thoroughly, some of which carry significant baggage.

One such contender, Sentara Healthcare, faces a federal investigation over allegations of false statements concerning reimbursement rates in Virginia, casting a shadow over its bid for a Florida Medicaid contract. The case against Sentara, focusing on potential misrepresentations leading to improper federal payments related to the Affordable Care Act, underscores the heightened need for diligence in Florida’s provider selection.

But the controversy extends beyond Sentara, and in at least one case, on a far larger scale. Centene, another provider under consideration for Florida’s managed care business, recently settled with South Carolina over Medicaid overcharging claims, part of nearly $1 billion in settlements across 18 states. These issues spotlight the imperative for stringent evaluation in the procurement process to safeguard Florida’s Medicaid integrity and ensure equitable healthcare access.

Amid these procurement complexities, the state recently announced its intent to award a six-year contract to Florida Community Care under a pilot managed care program for individuals with developmental disabilities. This decision, pending final approval, marks a significant step in integrating traditional healthcare with home- and community-based services, aiming to enhance care for one of Florida’s most vulnerable populations.

“Holding our entire Medicaid system accountable to those it serves is what has helped bring many Medicaid issues in Florida to the forefront,” wrote Stephanie Nordin, president and executive director of Autism Collier, in a recent op-ed published in the Naples Daily News.  Nordin’s organization advocates for developmentally disabled individuals, and is paying close attention to the state’s accountability measures within the Medicaid procurement process. “By raising alarms, advocates have been able to shine a spotlight on the current Medicaid unwinding and the impacts on vulnerable populations in the state − a process that continues as advocates worry that technical issues with a new Medicaid benefit site could impact access to care.”

As AHCA prepares to announce the statewide Medicaid managed care winners on February 23, the broader implications for Florida’s healthcare landscape remain at the forefront. With controversies and challenges in the mix, the decisions made in the coming days will not only shape the operational dynamics of Medicaid providers but also influence the quality and accessibility of healthcare for millions of Floridians.


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