In another step toward transforming Medicaid into a statewide managed-care system, the Florida Agency for Health Care Administration said Tuesday it has chosen five health plans to provide coverage to seniors who need long-term care.
The announcement came after a months-long bidding process that included HMOs and other types of managed-care plans competing in 11 regions of the state. While losing plans can still launch bid protests, AHCA expects to start using the new long term-care system in August in the Orlando area --- and would gradually expand to other parts of Florida.
The state also still needs federal approval of what is known as a "waiver" for the long-term care changes, but Medicaid director Justin Senior said he is optimistic that will occur by a Feb. 7 deadline.
“The Agency has selected plans that will be able to meet the needs of the recipients we serve and be good stewards of taxpayer dollars," AHCA Secretary Liz Dudek said in a prepared statement. "We look forward to beginning to work with the selected plans and to finalizing negotiations with CMS (the federal Centers for Medicare & Medicaid Services) for waiver approval within the next several weeks.”
Lawmakers in 2011 approved a far-reaching proposal to eventually shift almost all Medicaid beneficiaries into managed-care plans. The first phase would involve seniors who need long-term care, while a later phase would address the broader Medicaid population.
In both phases of the program, AHCA is required to contract with a limited number of plans in each of the 11 geographic regions. Along with HMOs, lawmakers called for contracting with another type of managed care known as provider-service networks.
The announcement Tuesday included selection of provider-service network American Eldercare to receive contracts in all 11 regions. The firm participates in already-existing state "diversion" programs, which are designed to help keep seniors out of nursing homes by providing services in their homes and communities.
Among the other selected plans, Sunshine State Health Plan, a subsidiary of the St. Louis-based health company Centene Corp., was selected to serve 10 regions. United HealthCare of Florida was selected for nine, while Coventry Health Care of Florida was chosen for four, and Amerigroup Florida was picked for two.
HMOs that were not chosen for contracts included prominent companies such as Humana and WellCare. If such companies want to challenge the agency's decisions, Senior said they have 72 hours to file notices of bid protests.
"We are definitely preparing for it," Senior said.
But Senior said he expects that the agency could continue moving forward with the selected plans even if bid protests are filed. In most regions of the state, AHCA did not choose the maximum number of plans allowed by the 2011 law. As a result, plans could be added to the system if they are successful in bid protests.
Supporters of the statewide managed-care system argue it will hold down costs while also improving the coordination of care for beneficiaries. In the long-term care portion, that includes health plans providing care that ultimately would help keep seniors from moving into nursing homes.
But Democratic lawmakers and some patient-advocacy groups have long said they fear statewide managed care will involve squeezing the services provided to beneficiaries.
"Their (supporters of the changes) motivation is money,'' said Rep. Mark Pafford, a West Palm Beach Democrat who works on health-care issues. "It's not access and quality."
AHCA wants to gradually roll out the long-term care program, starting in August in a region that includes Orange, Brevard, Osceola and Seminole counties. It would follow in September in southwest Florida and in Palm Beach County and the Treasure Coast, before gradually expanding later to other parts of the state.
During a presentation Tuesday to the House Health Care Appropriations Subcommittee, Senior said a key challenge is helping beneficiaries in choosing the most-appropriate health plans. He said it will involve elder-advocacy groups and others playing a role in helping with the decisions.
"This is not going to be an easy undertaking over the next seven or eight months,'' Senior said. "But it is one we are committed to."
Jim Saunders reports for the News Service of Florida.