Florida's plan to bid out its $6.7 billion Medicaid program to managed-care plans this year has run into a snag: PCA Family Health Plan, a Miami-based HMO, has filed an administrative complaint contesting the state's bidding procedure.
A state administrative court judge in Tallahassee was scheduled to hear PCA's complaint this week. In the meantime, the selection of the plans is frozen pending a ruling. Some 33 HMOs, including PCA, have submitted bids for the program.
Among several issues, PCA contends the state is premature in seeking bids because HFCA hasn't yet approved Florida's request for a waiver, which would allow mandatory enrollment of state Medicaid recipients into HMOs. PCA also is miffed that a "bidders conference" wasn't held before the issuance of the request for proposals. Plan executives said that meeting could have addressed questions about bid requirements.
"We feel that we cannot prepare a responsible proposal until we are absolutely sure of the RFP's meaning," PCA said in a written statement. "Therefore, the only legal way for PCA to respond appropriately was to file a protest so that these questions can be answered."
In its complaint, PCA also contends the RFP's provisions are "illegal, arbitrary, capricious, vague, ambiguous, one-sided . . ." It seeks a judicial ruling on whether the state Agency for Health Care Administration, which administers Medicaid, has exceeded its "delegated legislative authority" in preparing the RFP.
Based on legislation approved in 1995, the AHCA was mandated to begin a managed-care program for the state's 1.6 million Medicaid recipients, said Sandy Berger, an AHCA spokeswoman.
"We are following the Legislature's wishes," Berger said. "We will contest PCA's complaint vigorously."
Unlike previous Medicaid RFPs that were limited to inpatient, outpatient and emergency care, Florida wants its Medicaid recipients also to be covered for a full-range of preventive services that include mental health, substance-abuse treatment, vision, hearing and dental care, as well as transportation.
Since 1991, Florida has offered Medicaid patients the choice of enrolling in Medicaid HMOs. About 380,000 recipients are enrolled in more than 30 Medicaid HMOs.
Over the past five years, the state's managed-care program has saved an estimated $1 billion, Berger said. Competitive bidding is expected to save an additional $17 million a year, or 3% of Medicaid's annual budget, she said.
If HCFA approves Florida's Medicaid waiver, the state would join eight other states with a competitive bidding process. Those states are Arizona, California, Connecticut, Hawaii, Missouri, New Jersey, New York and Rhode Island.
"We have received oral approval from HCFA," Berger said. "We are just waiting for formal approval . . . . We expect that very soon."