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State Faces 27 Medicaid Contract Challenges

After a lengthy process that involved awarding tens of billions of dollars in Medicaid contracts, the Florida Agency for Health Care Administration now will have to try to fend off legal challenges from health plans that were denied contracts. 

The agency this week forwarded 27 challenges to the state Division of Administrative Hearings and requested that the cases be consolidated.

The challenges were filed by five health plans: Our Children PSN of Florida, LLC; Florida MHS, Inc., which does business as Magellan Complete Care; South Florida Community Care Network, which does business as Community Care Plan; Coral Care, LLC; and AHF MCO of Florida, Inc., which does business as PHC Florida HIV/AIDS Specialty Plan. Each plan filed more than one challenge.

The challenges stem from the Agency for Health Care Administration awarding contracts to health plans in 11 regions of the state to provide services in the state’s Medicaid managed-care system.

One agency official has said the overall value of the five-year contracts could total about $90 billion. The agency also awarded contracts for different types of services.

For example, Magellan is challenging the denial of contracts to provide mental-health services, and PHC Florida HIV/AIDS Specialty Plan --- which is an arm of the AIDS Healthcare Foundation --- is challenging the denial of contracts to provide services to HIV and AIDS patients.

In seeking to consolidate the cases, the Agency for Health Care Administration pointed to “similar issues” and said consolidation could help speed up resolution of the issues.

But attorneys for Magellan and PHC Florida HIV/AIDS Specialty Plan filed documents Thursday objecting to the agency’s request.

Magellan, for example, said in a document posted on the Division of Administrative Hearings website that “because of the significant differences in the specialty populations at issue, consolidation of Magellan’s 11 bid protests with 16 dissimilar protests will create confusion, lengthen the time of the final hearing and increase Magellan’s costs.”

Copyright 2018 Health News Florida

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