UPDATE: 3 Companies Win Big in Florida Medicaid

The Florida Current reported on Friday that the Agency for Health Care Administration reached agreements with two companies that filed protests for not being selected to participate in a long-term managed care program. AHCA said Molina Healthcare of Florida Inc. and Humana Medical Plan Inc. have accepted offers to serve Medicaid recipients. The two were not among companies selected when contracts were first announced in January. 

Humana and Molina join five other companies selected to participate in the program. Molina accepted AHCA’s offer to be a provider in regions 5, 6 and 11. Humana accepted the offer to serve regions 4, 10 and 11. The original article with the complete list of selected plans can be found below.

By , Health News Florida

Three companies stand out as major winners in Florida’s competition for contracts in the Statewide Medicaid Managed Care Program for Long-Term Care, a market worth an estimated $3 billion.

They are American Eldercare, Sunshine State Health Plan and UnitedHealthcare of Florida.

American Eldercare — a little-known Delray Beach firm that specializes in caring for seniors in independent living, assisted living and rehab centers, as well as in their homes — is the only company that won contracts to enroll customers in every region of the state.

The contracts, announced Tuesday morning by the Agency for Health Care Administration, are listed on the agency’s web site separately by region.

The companies will compete to sign up about 90,000 frail elderly and disabled Medicaid patients so sick that they qualify for nursing-home care. The state’s hope is that the companies, which assume financial risk, will provide enough nursing and support services to keep these patients out of nursing homes.

Because the long-term-care patients are so costly to Medicaid, the state elected to have them go first in the statewide managed-care enrollment experiment, if the federal waiver is granted. The rollout will begin Aug. 1 and continue through March of 2014.

Wall Street analysts have been watching closely to see which companies came out on top in the contracting competition. Soon after AHCA announced the winners Tuesday morning, Michael Wiederhorn and two colleagues at Oppenheim & Co. put out a note estimating the three top companies will enroll between 22,000 and 26,000 patients, triggering a revenue stream of between $900 million and $1 billion a year.

Wiederhorn noted that American Eldergroup is privately-held, so he encouraged investors to look at Centene, which owns Sunshine State Health Plan.

“Not only was this a large important market,” he wrote, “the winners of this bid could also have a leg up when the state outsources the rest of the Medicaid population.” Competition for those contracts is just heating up.

Sunshine State won contracts in 10 regions, losing only Region 2, around Tallahassee. United won contracts in nine regions, all but Regions 1 and 10. Region 1 is around Pensacola; 10 is Broward County. The largest concentrations of patients are in South and Central Florida.

Coventry took four regions, including the most populous, Miami-Dade. Amerigroup got just two regions, but they were big ones: Miami-Dade and Broward.

Companies that were rejected include three based in the Tampa/St. Pete area: WellCare, Freedom and Universal.

Humana also was rejected, even though it has the largest Medicare membership in the state. It has not been a big Medicaid player in Florida.

On Tuesday, AHCA announced the long-term-care Medicaid managed-care program will be launched on Aug. 1, assuming Florida gets its waiver. The rollout will begin with Region 7, which includes Orlando and Melbourne, and will add regions month by month.

The plans per region are as follows:

  • Region 1: American Eldercare, Sunshine State Health Plan
  • Region 2: American Eldercare, United Healthcare of Florida
  • Region 3: American Eldercare, Sunshine State Health Plan, United Healthcare of Florida
  • Region 4: American Eldercare, Sunshine State Health Plan, United Healthcare of Florida, Humana Medical Plan
  • Region 5: American Eldercare, Sunshine State Health Plan, United Healthcare of Florida, Molina Healthcare of Florida
  • Region 6: American Eldercare, Sunshine State Health Plan, United Healthcare of Florida, Coventry Healthcare of Florida, Molina Healthcare of Florida
  • Region 7: American Eldercare, Sunshine State Health Plan, United Healthcare of Florida, Coventry Healthcare of Florida
  • Region 8: American Eldercare, Sunshine State Health Plan, United Healthcare of Florida
  • Region 9: American Eldercare, Sunshine State Health Plan, United Healthcare of Florida, Coventry Healthcare of Florida
  • Region 10: American Eldercare, Sunshine State Health Plan, AmeriGroup Florida, Humana Medical Plan
  • Region 11: American Eldercare, Sunshine State Health Plan, United Healthcare of Florida, Coventry Healthcare of Florida, AmeriGroup Florida, Molina Healthcare of Florida, Humana Medical Plan

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