Business

Heath Plans Lining Up for State's New Medicaid System

By: Jim Saunders News Service of Florida | Posted: April 24, 2012 3:55 AM
Preparing for Florida's shift to a statewide Medicaid managed-care system, 20 health companies and organizations are interested in competing for contracts to serve seniors who need long-term care.

Potential bidders faced a deadline last week to submit nonbinding letters of intent that signaled their interest in the long-term care program, as the state Agency for Health Care Administration gets ready to move forward with a lengthy contracting process.

Those expressing interest ranged from major managed-care industry players, such as Humana and WellCare, to smaller regional organizations, such as Brevard Alzheimer's Foundation Inc., and Miami Jewish Health Systems.

The list of potential bidders only reflects health plans interested in the long-term care portion of a statewide managed-care system. AHCA has not sought similar letters of intent for plans hoping to serve the broader Medicaid population, such as children and women.

Nevertheless, the list of potential long-term care bidders is the first of its kind since Florida lawmakers last year approved a plan to transform Medicaid. That plans remains subject to federal approval, but AHCA is preparing to start the contracting process.

Under the system, the state would be divided into 11 regions, with managed-care plans competing for contracts in each region. Plans could win contracts in multiple regions.

The list of potential long-term care bidders provides a glimpse of how different parts of the state could be served --- and how companies and organizations view the markets.

Seven health plans submitted letters indicating they are interested in competing in all regions. They are American Eldercare, Amerigroup, Humana, Simply Healthcare, Sunshine State Health Plan, UnitedHealthcare and WellCare.

Those seven also are the only plans that indicated interest in competing in a massive region of 14 counties that spans from Holmes and Washington counties in the Panhandle to Madison and Taylor counties in the Big Bend.

During the legislative deliberations last year, questions were raised about the number of health plans that would want to do business in such relatively rural areas. In the end, lawmakers decided that contracts would only be awarded to two plans in the 14-county region. Similarly, two plans would win contracts in another region of the western Panhandle.

By comparison, 17 companies and organizations submitted letters indicating they are interested in long-term care contracts in a heavily populated region made up of Orange, Osceola, Brevard and Seminole counties. Those potential bidders range from large HMOs to companies involved in the nursing-home industry to the Brevard Alzheimer's Foundation.

Similarly, 15 plans indicated interest in a region that includes Miami-Dade and Monroe counties. Lawmakers last year said AHCA could award as many as 10 contracts in that region --- the most of any region in the state.

AHCA plans this summer to issue what is known as an "invitation to negotiate" that is a key first step in the contracting process for long-term care plans. It hopes to start enrolling Medicaid beneficiaries in the new system in 2013, with statewide enrollment finished by April 2014, according to an AHCA timeline.

The process for shifting the broader Medicaid population into managed care would take longer, with an invitation to negotiate issued in January 2013 and full statewide enrollment by April 2015.

Exact dates for the changes are difficult to pinpoint, at least in part because it is unclear how long the federal-approval process could take.

Republican leaders argue a statewide managed-care system would help hold down costs and better coordinate health coverage for Medicaid beneficiaries. But Democratic lawmakers and some patient advocates have fought the move, arguing that for-profit HMOs could make it harder for beneficiaries to get needed care.

Comments (0)

Leave a Comment on This Story

The content of this field is kept private and will not be shown publicly.
To prevent automated spam submissions leave this field empty.