Health Plan To Challenge Medicaid Contracts With Pensacola Company

June 7, 2018

A decision last week to award Medicaid contracts to two additional managed-care plans, one to a Pensacola firm, could mean more legal challenges for the state Agency for Health Care Administration.

The state announced last that Lighthouse Health Plan would be given a contract in Medicaid Region 1, which includes the western counties of the Panhandle. Lighthouse is affiliated with Pensacola-based Baptist Health Care.

The  AHCA also announced that it was awarding additional contracts in Medicaid regions 9 and 11 to Miami Children’s Health Plan, which is affiliated with Nicklaus Children’s Hospital. Region 9 goes from Indian River County south to Palm Beach County and Okeechobee County, while Region 11 is made up of Miami-Dade and Monroe counties.

Attorneys for Molina Healthcare filed a notice with the state Tuesday announcing the HMO’s intention to challenge the agency’s decision last Thursday to award contracts to Miami Children’s Health Plan and Lighthouse Health Plan.

The HMO has 10 days to file a legal petition with the state.

The Agency for Health Care Administration has gone through a lengthy process to award new contracts in the Medicaid system, which requires most beneficiaries to enroll in managed-care plans. In April, the agency announced a decision to award five-year Medicaid contracts, which one official has estimated to be worth upwards of $90 billion in all, with nine HMOs.

That decision drew challenges from a dozen health plans that were not chosen for contracts, including Molina Healthcare.

Under a 2011 law that called for the statewide use of Medicaid managed care, AHCA is awarding contracts in 11 different regions. The number of contracts varies by region.

Molina’s notice filed Tuesday dealt with the additional contract awards.

Miami Children’s Health Plan and Lighthouse Health Plan are what are known as provider-sponsored networks because they are owned and operated by health-care providers. If the contract awards stand, they will provide “managed medical assistance” services, which involve the bulk of Medicaid beneficiaries and range from childhood checkups to surgeries.

Other health plans awarded contracts are expected to provide what AHCA describes as “comprehensive” services. In addition to managed medical assistance services, comprehensive plans would offer long-term care such as skilled nursing services.

by Christine Sexton The News Service of Florida

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Written by William Reynolds · Filed Under News