- The first re-procurement of Florida's Statewide Medicaid Managed Care (SMMC) program saw nine health plans awarded five-year Medicaid contracts, including major players UnitedHealth, Aetna and Humana.
- The contracts are reportedly worth tens of billions of dollars. Forty plans placed bids, including Molina Healthcare, which served about 360,000 Medicaid members in Florida and failed to win a contract this time around.
- Contract winners will provide Managed Medical Assistance and long-term care services to more than 3 million Floridians who are enrolled in SMMC.
Florida's large managed care population garnered intense interest from payers looking to land the contracts in the first procurement process for the state since 2013. The Florida Agency for Health Care Administration, which awards the contracts, said in a press release they include two new provider-based health plans.
The agency also touted agreements with the awarded payers to focus on reducing preventable hospitalizations and increasing the percentage of enrollees who receive long-term care services in the community instead of a nursing facility. The AHCA said it negotiated commitments from awarded plans to enhance coverage parity via telemedicine for all covered services and to ramp up efforts to fight the opioid epidemic. That includes alternative pain management and improved access to medication-assisted treatment.
Payers look to Florida for managed care contracts in Medicare as well, as the more stable Medicare Advantage market continues to draw interest. Anthem is the most recent example. The payer's Q1 earnings from this week show it's starting to see profit gains from reducing its footprint in the individual market to focus on MA. CEO Gail Boudreaux said on the company's earnings call that it will begin to focus on building presence in Florida.