Florida is finally moving ahead with a mammoth series of contracts that will control the future of the state’s $38 billion Medicaid program and how care is delivered to the millions of poor or disabled residents who rely on the program.
The long-awaited invitation to negotiate released Tuesday by the state Agency for Health Care Administration puts an increased emphasis on the delivery of behavioral health services and, according to the ITN, the agency intends to award contracts to “nationally accredited plans that offer an enhanced delivery systems and integration of integration of behavioral and physical health services.”
Moreover, the ITN also includes the introduction of “plus plans,” designed to allow family members to receive their services from a Medicaid-managed single-care plan that provides Managed Medical Assistance, Long Term Care and specialty plans.
According to the bid documents, the goal of the plus plan is to improve the continuity of coverage for families and individuals.
“Enrollees will no longer need to change plans to access specialty population services, split families up among multiple plans or choose between accessing Specialty plans,” the ITN reads.
Florida Politics contacted several managed care plans for comment, but they were still reading the finer details of the ITN and declined comment.
Florida’s existing managed care contracts expire Dec. 31, and the ITN sets an ambitious timeline to ensure new contracts are negotiated, signed and executed by then.
Managed care plans must submit their bids by noon on Aug. 15. The state anticipates holding a public opening of the bids at 3 p.m. the same day.
The agency will spend more than a month negotiating the multi-year contracts with managed care plans, anticipating that negotiations will begin on Oct. 2 and run through Nov. 17. Ultimately, AHCA hopes to post the notice of intent to award the six-year contracts, worth tens of billions for dollars, on Dec. 11.
There are steps between now and then, though. For instance, plans have until May 3 to review the ITN and electronically submit any questions to the state. The anticipated date for AHCA to respond to the questions and post the answers is June 27.
The new ITN could be a game changer for Medicaid managed care plans and the enrollees they serve. That’s because plans that aren’t chosen are essentially locked out of the health care safety net program for six years unless they acquire or merge with another health plan.
This is the third time the state has put its Medicaid Managed Care program up for competitive bid. According to the ITN, AHCA has used its past experiences to help inform the managed care networks it’s looking to contract with.
The ITN requires plans that want to provide LTC services to submit proposals that have them acting either as a comprehensive long-term care plan, a comprehensive long-term care-plus plan or a select comprehensive plan. Respondents wanting to provide MMA services will be required to submit proposals that have them acting either as a comprehensive LTC plan; a comprehensive LTC-plus plan; an MMA plan; or an MMA-plus plan.
Bidders wishing to provide specialty services will be required to submit responses that have them serving as a comprehensive LTC-plus plan or an MMA-plus plan.
Aside from the modifications included in the ITN, there are other changes ahead for the state’s Medicaid managed care program.
A 2022 law passed by the Legislature at the behest of AHCA cut the number of Medicaid regions from 11 to nine and replaced the numerical names for the regions with letter names. The new law also allows AHCA to award Medicaid-managed care contracts on either a statewide or regional basis.
However, it did not eliminate a requirement that AHCA ink contracts with at least one provider service network in each region. PSNs are networks formed by a group of providers that perform associated insurance functions, such as enrollee services, provider credentialing, claims processing and quality assurance.
The ITN notes that “the agency’s overall objectives are for Medicaid enrollees to receive all medically necessary services in a timely manner and in the most appropriate setting, thereby achieving high-quality outcomes while containing costs.”
The revamped program would “give families the freedom to choose a managed care plan, services, and programs that best suit the needs of all their family members; provide individuals and families the freedom to choose to participate in programs that will improve their health through the support of healthy behaviors and provision of robust chronic disease management; to provide enrollees with supports and opportunities to enter a Pathway to Prosperity toward the achievement of self-sufficiency where appropriate and for seniors to be able to live vibrant, fulfilling lives and age in their place of choice.”
Christine Jordan Sexton is a Tallahassee-based healthcare reporter who focuses on healthcare policy and the politics behind it. Medicaid, health insurance, workers’ compensation, and business and professional regulation are just a few of the things that keep her busy.