With billions of dollars on the line, three fights about Medicaid managed care contracts have been sent to a state administrative law judge.
The health plans AmeriHealth Caritas Florida Inc., Sentara Care Alliance LLC and ImagineCare LLC argue that they were improperly shut out of receiving contracts from the state Agency for Health Care Administration to manage care for Medicaid beneficiaries.
The plans filed protests in April after the agency announced its intention to award contracts to other managed care organizations. The agency on Friday sent the disputes to the state Division of Administrative Hearings, where they were assigned to Judge Robert Cohen.
With about 3.1 million Medicaid beneficiaries enrolled in managed care plans, the multiyear contracts involve big money. The agency in April announced it intended to award contracts to five plans and added three plans this month.
AmeriHealth Caritas, Sentara and ImagineCare are challenging various aspects of a yearlong procurement process that led to the contract announcements. As an example, Sentara and ImagineCare — which have not had such Medicaid contracts in the past in Florida — contend in their protests that the process was tilted toward managed care organizations that have previously been part of the system.
“AHCA's negotiation team never intended to conduct a fair procurement where all vendors were on equal footing and subject to the same standards,” attorneys for Sentara wrote. “Instead, the negotiation team conducted negotiations in a manner that was arbitrary and capricious and created an unfair competition between incumbent vendors, who were treated more favorably by the negotiation team, and new vendors, who were disfavored due to the bias and favoritism of the negotiation team.”
Similarly, ImagineCare attorneys alleged that contract awards under what is known as an invitation to negotiate process were “based on unfair favoritism for incumbent plans.”
“As a review of the complete ITN (invitation to negotiate) record will show, ImagineCare’s reply to the ITN provided the best value to the citizens of Florida,” the ImagineCare protest said. “Yet, at every turn, the AHCA negotiators assumed — without factual basis — that ImagineCare would not be able to deliver the services as it outlined in its legally binding reply and negotiation submissions. In turn, AHCA erroneously used those baseless and manufactured assumptions to sideline ImagineCare’s reply, ignoring that it provided the best value to Florida — it was just a ‘newbie.’ ”
Lawmakers in 2011 created a system in which most Medicaid beneficiaries are required to enroll in managed care plans. The agency has gone through lengthy contracting processes three times, including the process that started in 2023 and ended this spring. In the past, it awarded contracts in 11 regions of the state; that was scaled back to nine regions in the latest process.
The agency announced in April that it planned to award contracts to Florida Community Care LLC; Humana Medical Plan Inc.; Simply Healthcare Plans Inc.; South Florida Community Care Network LLC, which does business as Community Care Plan; and Sunshine State Health Plan Inc.
On July 18, AHCA said it also intended to award contracts to Aetna Better Health of Florida Inc., Molina Healthcare of Florida Inc. and UnitedHealthcare of Florida Inc. and to revise the awards to Florida Community Care and South Florida Community Care.
Contracts are expected to take effect in 2025.
Meanwhile, ImagineCare also has filed a lawsuit in Leon County circuit court seeking to prevent AHCA from moving forward with the new contracts while legal protests continue.
As a sign of the stakes involved, health plans that were awarded contracts have intervened in the cases at the Division of Administrative Hearings and are seeking to intervene in the Leon County case.
