With procurement deadline approaching, need for Medicaid accountability front and center

by | Dec 5, 2023




In a matter of just weeks, Florida will hit a crucial deadline for Medicaid reprocurement, a process that awards massive government contracts to provide healthcare services to about 5 million people every month. With that many people and billions of dollars in taxpayer funding at stake, the need for heightened accountability in the process couldn’t be more apparent. Yet recent years have seen major scandals rock the foundations of Medicaid management, with major national providers like Centene, which does business in Florida under the name Sunshine Health, getting slapped with massive fines amid accusations of widespread Medicaid fraud.

Companies like Centene, which are entrusted with billions of dollars to help manage our state’s Medicaid program, continue to be plagued by mismanagement and legal non-compliance. As Florida’s largest Medicaid Managed Care company, Centene, for instance, has settled cases with 13 states totalling about $750 million dollars (examples here, here, and here, to name only a few) in the last two years, raising serious questions about the integrity of the company’s Medicaid stewardship. In Florida, by contrast, Centene was hit with a fine of just $9 million. It’s not clear why other states, regardless of size, generally fined Centene significantly more than Florida, but it underscores the need to make sure our state’s accountabilty processes are not missing anything.

In Florida, the reprocurement process cannot be viewed as just another bureaucratic routine in which proposals are rubber stamped and moved to the next inbox; it’ must be viewed as a critical reassessment of who controls a significant portion of the state’s healthcare resources. With the deadline for contract awards fast approaching, the stakes are high. Billions in Medicaid reimbursements hang in the balance, impacting healthcare providers and recipients alike. The Agency for Health Care Administration (AHCA) has initiated an Invitation to Negotiate (ITN) for the Statewide Medicaid Managed Care (SMMC) program, setting the stage for what could be transformative changes in Florida’s Medicaid landscape​​.

Critcally, this year, the Florida Legislature made significant amendments to Medicaid laws, including reducing the number of Medicaid regions from 11 to 9, which could have profound implications on the procurement process​​, divvying up larger slices of the Medicaid pie to fewer players, and making accountability even more important as a result.

That’s why the controversy surrounding players like Centene is so relevant. The stakes are higher, and the margin for error is smaller. Our economy is humming along, but inflation is squeezing low and middle income families like never before. As we saw with the series of so-called stimulus checks issued during the pandemic, there is no faster way to drive up inflation than to inject wasted dollars into the state economy.

To their credit, AHCA has recognized the public’s vested interest, and taken steps to solicit critical input from a range of stakeholders. A public meeting is scheduled for January 5 in Tallahassee, aimed at addressing questions about the agency’s managed care data book, which forms the baseline for a wide range of decisions that will need to be made​​. But the outcome of the procurement process is not just a matter of corporate profits; it’s about real people’s lives. Decisions made now will directly affect the quality and accessibility of healthcare for millions of Medicaid recipients in Florida. This includes addressing ongoing challenges like the state’s stringent eligibility reviews – and protecting our state’s ability to remove those who do not qualify, along with how our state addresses reported issues with Medicaid transportation services, claims of discrimination and access to resources.

The choices made in the coming weeks will shape the Medicaid landscape in Florida for years to come. It is imperative that lawmakers and agency decisions not only consider financial metrics and fiscal integrity and accountability, but also prioritize the quality of care and equitable access for all Medicaid recipients.

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