Major overhaul of state’s Medicaid managed care program surfaces hours before 2022 session

by | Jan 11, 2022

It’s been no secret in Tallahassee that the state’s Medicaid managed care program was about to see a major shakeup. Last night, State Senator Jason Brodeur filed a 36-page bill proposing just that. Most Medicaid beneficiaries in Florida must be enrolled in a managed care plan to in order to receive healthcare services courtesy of the program. And only a handful of companies in Florida – those that win competitively bid Medicaid contracts – can provide that care.

The state’s current Medicaid managed care contracts, doled out on a regional basis, are set to expire at the end of 2023, but Florida’s Agency for Health Care Administration (AHCA) is already gearing up for the competitive bid process that is expected to determine which companies will help manage the flow of an estimated $70 billion or more in Medicaid services.

Brodeur’s bill proposes to radically overhaul the existing infrastructure in a number of ways, including a reduction in the number of managed care regions in Florida from the current 11 down to just eight. In addition, the bill overhauls the regional naming system from numbers to letters, combining, for instance, Medicaid Regions 1 and 2 into a new Medicaid Region A, with similar combinations in other regions.

The bill, if passed as written, also contains language requiring that all managed care providers enter into a contract with a state cancer hospitals that meet very specific criteria. Based on the language of the bill and on previous findings by AHCA, only two hospitals appear to meet the bill’s requirements: H. Lee Moffitt Cancer Center in Tampa, and the University of Miami Hospital’s Sylvester Comprehensive Cancer Center.

As we’ve previously reported, lobbyists for managed care companies who haven’t already seen the bill are undoubtedly pouring over it Tuesday morning as session gets underway, keeping an eye out for changes to the existing framework that could give a competitive advantage to one provider over another. Meanwhile, AHCA Secretary Simone Marstiller has already asked lawmakers to budget an additional $2 million just for litigation costs as the agency readies for legal challenges to the competitive bidding process.

As of Tuesday morning, there was still no House companion bill filed.

1 Comment

  1. Dwayne Mann

    Only two hospitals, the H. Lee Moffitt Cancer Center in Tampa and the University of Miami Hospital’s Sylvester Comprehensive Cancer Center, appear to meet the requirements of the bill based on its language and earlier assessments by AHCA.

%d bloggers like this: