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Health News Florida

WellCare Wins New Medicaid Contract

WellCare Health Plans is forecast to remain No. 1 in Florida Medicaid managed care enrollment next year after winning a challenge to  a state contracting decision affecting patients in northeast Florida.

According to a new report from the Wall Street firm Stifel, Nicolaus & Co., WellCare's enrollment at the completion of  the statewide Medicaid managed-care rollout will likely edge out that of Centene Corp., which does business in Florida as Sunshine State Health Plan.

WellCare, based in Tampa, has held the largest market share of Florida Medicaid HMO enrollees for more than a decade. Centene, which is also publicly traded, had gained projected enrollment last month after challenging a contract decision in September by the Agency for Health Care Administration, as Health News Floridareported.

But according to the latest report from  Tom Carroll, a Stifel analyst, WellCare moved back into "pole position" on Oct. 31 after it was awarded contracts in Region 4, which includes Baker, Clay, Duval, Flagler, Nassau, St. Johns and Volusia counties.

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Based on all of the contract awards, including those announced in September and more recent additions in October,WellCareis likely to end up with  669,000 Florida Medicaid members, Carroll said. Centene is projected to have total membership of 606,000.

Most of those members are young children and their mothers. Those who haven't enrolled in an HMO by next year -- and many already have -- will be required to do so, region by region.

AHCA is currently busy enrolling a different population in managed care: low-income elderly and disabled patients who are in nursing homes or in the community but need assistance to remain there.

The statewide Medicaid managed care initiative is aimed at improving coordination of care, keeping patients healthy and holding costs down, AHCA says.

--Health News Florida is part of WUSF Public Media. Contact Lottie Watts at 813-974-8705 (desk) or e-mail at lottiewatts@wusf.org. For more health news, visit  

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