Medicaid

Tucked in proviso: Medicaid managed-care rollout

There were no efforts this legislative session to change how the state’s Medicaid managed-care program would be rolled out under five-year contracts totaling billions of dollars.

Until, that is, it came to health-care budget negotiations.

In a late-night weekend meeting, the Florida House floated proviso language that would require the state to develop a new equitable formula for assigning Medicaid recipients to managed-care plans when they don’t voluntarily make a choice.

The proviso requires the Agency for Health Care Administration to submit to the Legislature no later than August 31 details on how it will change the current assignment process. The proviso also requires the new process to be implemented no later than November 1. The late-night proviso also would eliminate $3 million from the state agency for Health Care Administration’s administrative budget until it delivers the new formula.

The Senate did not agree to the move and the issue remains in flux as lawmakers continue to negotiate the details of the $90 billion budget.

The proposed change in the formula is a move to help two new “provider sponsored networks,” or PSNs, that were awarded five-year contracts. Lighthouse Health Plan is a PSN in Northwest Florida in Medicaid Regions 1 and 2. The latest enrollment figures at AHCA show that 27,060 people enrolled in the plan in March.

The other PSN is Miami Children’s Health Plan which has 12,880 members. That PSN serves children in Medicaid Region 9, which includes Indian River County south to Palm Beach County, and Medicaid Region  11, which includes Miami-Dade and Monroe counties.

Though the Legislature meets annually and considers hundreds of bills, it only is required by law to pass one: the budget. The state spending plan also is the only bill that must be distributed and available to read for 72 hours before final passage.   The regular legislative session is slated to end May 3, meaning the budget agreement must come Tuesday for lawmakers to wrap on time.

Florida has a mandatory Medicaid managed-care program. The state recently completed a new procurement and signed five-year contracts worth at least $90 billion with different HMOs and PSNs across the state. For contracting purposes, the state is divided into 11 different Medicaid regions.

The proviso language requires AHCA to submit a report to the Senate president and House speaker no later than August 31 detailing how the agency will change the assignment process. The  new process must be implemented no later than November 1.

To help ensure compliance with the mandate,  $3 million in administrative funds is being held in reserve. The agency can ask the Legislature to release the funds when it completes the new plan.

By Christine Sexton.