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AIDS Group Seeks To Prevent Patient Shift

Feb 6, 2019
Originally published on February 6, 2019 8:36 am

The AIDS Healthcare Foundation has filed a lawsuit in Leon County circuit court arguing that it’s illegal for the state to require patients with HIV and AIDS in Southeast Florida to switch Medicaid managed-care plans by the end of the month. 

The lawsuit, filed Monday, is the latest move in a long-running fight between the AIDS Healthcare Foundation and the agency about serving Medicaid beneficiaries in Broward, Miami-Dade and Monroe counties.

Jeffrey Blend, assistant general counsel of the AIDS Healthcare Foundation, told The News Service of Florida that the foundation also will seek an injunction to prevent the state from requiring patients to disenroll from the foundation’s managed-care plan, Positive Healthcare, and enroll in a health plan run by competitor Simply Healthcare.

Mallory McManus, a spokeswoman for the Agency for Health Care Administration, declined comment, saying the state doesn’t comment on pending litigation.

As of Jan. 1, 1,545 people were enrolled in Positive Healthcare, according to AIDS Healthcare Foundation officials.

Florida lawmakers in 2011 required that almost all Medicaid beneficiaries enroll in managed-care plans, with contracts divvied up in 11 regions of the state. The state went through a lengthy process during the past two years to evaluate proposals from managed-care plans and issue new contracts. That resulted in the Agency for Health Care Administration entering a multi-year contract with Simply Healthcare to provide care to people with HIV and AIDS.

The decision meant that the AIDS Healthcare Foundation’s managed-care plan would be locked out of the Southeast Florida Medicaid market for five years.

The AIDS Healthcare Foundation challenged the decision in state administrative court last year. After a lengthy hearing, an administrative law judge issued a recommended order in December that the state enter into negotiations with the AIDS Healthcare Foundation for new Medicaid contracts. But the agency in late December issued a final order rebuking the judge’s recommendations. The AIDS Healthcare Foundation filed an appeal at the 1st District Court of Appeal in Tallahassee, where the case remains pending.

Meanwhile, the state forged ahead with the transition from old Medicaid contracts to the new contracts, beginning the rollout in Southeast Florida.

In the lawsuit filed Monday in Leon County circuit court, attorneys argue that if a managed-care plan, such as Simply Healthcare, bid on more than one region of the state, won a contract in at least one area of the state and is a named party in pending administrative challenge, it is banned by law “from serving Medicaid recipients” in any region.

“Simply meets all three criteria,” the AIDS Healthcare Foundation attorneys wrote, noting that the health plan was awarded contracts for HIV and AIDS in every Medicaid region of the state, received other types of Medicaid contracts in five regions and is a named party in the pending administrative challenge.

It is the latest legal skirmish involving the AIDS Healthcare Foundation and stems from decisions made by the administration of former Gov. Rick Scott.

But Scott moved to the U.S. Senate last month, and Gov. Ron DeSantis now is calling the shots. Blend said he hopes the change in leadership will bolster his cause and lead to reversing “the decision from the previous administration.”