Florida Awards Next Slate of Medicaid Managed Care Contracts

Capping off a one-year procurement process, the Florida Agency for Health Care Administration (AHCA) has published its intent to award notice for its Statewide Medicaid Managed Care (SMMC) procurement. The SMMC program, an outgrowth of the 2005 Medicaid Managed Care Pilot program, serves approximately 71% of Medicaid enrollees. This procurement is the second re-procurement of the original SMMC program that began in 2013.

In developing the procurement, AHCA noted that it was focusing on a plan structure that provides continuity of care for individuals and families, allowing family members to receive the full spectrum of acute, long-term, and specialty care services from a single plan. Additionally, AHCA sought plans that provided “innovative and evidence-based” approaches providing care, such as improving adolescent mental health and maximizing home and community-based services.

AHCA contemplated five categories of plans in the procurement, no longer seeking standalone specialty plans:

• Comprehensive Long-term Care Plan - a plan that may provide managed medical assistance (MMA) and long-term care (LTC) services to recipients eligible to receive MMA or LTC services.
• Comprehensive Long-Term Care Plus Plan - a Comprehensive Long-Term Care Plan that may also provide one or more MMA specialty products to eligible recipients.
• Select Comprehensive Plan - a plan that may provide MMA and LTC services to individuals eligible to receive LTC services.
• Managed Medical Assistance Plan - a plan that may provide MMA services for recipients eligible to receive MMA services.
• Managed Medical Assistance Plus Plan - a Managed Medical Assistance Plan that may also provide one or more MMA specialty products to eligible recipients.

In accordance with recently amended Florida law that consolidated a number of Medicaid regions, AHCA sought a minimum of three plans for each of the nine regions, with the exception of Region D (Hardee, Highlands, Hillsborough, Manatee and Polk, 4 plans) and Region I (Miami-Dade and Monroe, 5 plans).

Continuing the evolution of the program towards greater value-based purchasing, the evaluation criteria created by AHCA allocated nearly 50% of the total evaluation points to the “incentivizing value and quality” and “delivery system enhancements and integration” aspect of the procurement, which includes birth outcomes, chronic disease management, value-based purchasing, behavioral health/primary care integration, telemedicine, and evidence-based programs for children with intense behaviors.

AHCA’s notice of intent to award includes only Comprehensive Long-Term Care Plus plans, with three of the five plans operating statewide:

• Florida Community Care, LLC - regions A, B, C, D, and I. Specialty care includes HIV/AIDS and SMI.
• Humana Medical Plan, Inc. - all regions. Specialty care includes HIV/AIDS and SMI.
• Simply Healthcare Plans, Inc. - all regions. Specialty care includes HIV/AIDS and SMI.
• South Florida Community Care Network, LLC - regions E, F, G, H, and I. Specialty care includes SMI.
• Sunshine State Health Plan, Inc. - all regions. Specialty care includes child welfare, HIV/AIDS, and SMI.

The intended award represents a significant consolidation of the 18 plans awarded a contract in 2014 and the 16 plans awarded a contract in 2018, due in part to mergers and consolidations in the industry.

A protest of the intended plan awards must be filed within 72 hours of the publication of the notice—i.e., approximately 4 p.m. today. Contracts will be awarded on a non-renewable, six-year basis, with an end date of December 31, 2030.