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— A LOT OF JACK —
That’s a lot of jack … As lawmakers consider making changes to Florida’s Medicaid-managed care program ahead of the next round of significant contracts, here’s some interesting information. Medicaid managed care and managed dental plans returned $274.8 million in excessive profits to the state in 2020, according to the state Agency for Health Care Administration.
Information obtained by Florida Politics shows that 11 contracted managed care plans were required to return premiums to the state in 2020 for making excessive profits off the mandatory managed-care program, including all three dental plans that have contracts with the state.
No plan, though, returned more premium to the state than the “Children’s Medical Services” plan administered by Sunshine Health Plan. According to AHCA, the plan returned nearly $155 million in premiums in 2020.
Sunshine Health also has a Medicaid-managed medical assistance plan which returned about $12.2 million in excessive profits to the state in 2020. It also bought WellCare of Florida (operated as Staywell), which produced $14.7 million in excessive profits.
The Florida Legislature passed a sweeping rewrite of its Medicaid laws in 2011, which included a requirement for most Medicaid beneficiaries to enroll in a managed care plan. Included in the Medicaid rewrite was the “achieved savings rebate” program meant to ensure that the plans weren’t making too much profit.
The law allows managed care plans to keep all profits from the program up to 5% of their revenue. Generally, half of the profit above that threshold and up to 10% of revenue is split between the plan and the state. Plans must return to the state all profits beyond the 10% threshold.
All three Medicaid-managed dental plans returned premium in 2020 under the achieved savings rebate provision in the law. DentaQuest returned $27.4 million, LIBERTY Dental Plan of Florida returned $18.6 million, and Managed Care of North America Inc., better known as MCNA Dental, returned $9.7 million in premiums in 2020.
The profits were made in 2020 and included when all non-emergency procedures were halted and during lockdowns that kept people inside their homes.
It was the second consecutive year that the CMS plan returned more than $100 million in excessive profits to the state; it returned nearly $128 million in premium in 2019. LIBERTY Dental Plan of Florida was the only other contracted Medicaid plan that had to return excessive profits to the state in 2019, returning $1.4 million.
This Session, lawmakers are now considering bills that would revise how the Medicaid managed care program works. Lawmakers are wrestling with whether to keep dental care as a separately managed care offering or require the contracted Medicaid managed care plans to provide the services and other health care services.
— CRITICAL CARE ON LIFE SUPPORT —
$50.4 billion. That’s the amount of General Revenue legislators are estimated to have to spend — and save — in the state fiscal year 2022-2023. Yet, hospitals providing the most care to the poor, elderly, and disabled could face around $300 million in Medicaid cuts in the coming year.
That is what would happen if the Legislature doesn’t heed the call of Gov. Ron DeSantis to keep setting aside money for what safety-net hospitals have dubbed the “critical care fund.”
The money is intended for 28 hospitals that provide the greatest Medicaid care in the state — to enhance Medicaid payments for those facilities.
But they have been a source of contention for hospitals that don’t receive the enhanced rates, and HCA Healthcare has been successful over the years in convincing lawmakers to pare back the annual appropriation.
Last year, the Legislature agreed to earmark $309 million for enhanced payments in the current fiscal year and agreed not to use any recurring revenue for the fund beyond June 30, 2022. In the proposed FY 2022-2023 spending plan released in January, DeSantis advocated reversing the Legislature’s decision. The Governor’s recommended budget continues funding the critical care fund at $309 million and uses recurring general funds to do so.
It did not go unnoticed and could have been a reason why House Health Care Appropriations Subcommittee Chair Rep. Bryan Ávila pressed Agency for Health Care Administration Secretary Simone Marstiller on what was more critical: annual rate enhancements for some hospitals or addressing the state’s workforce training needs.
Sen. Aaron Bean, responsible for crafting the chamber’s health care budget, will unveil the Senate’s proposed spending plan Wednesday. He told Florida Politics that no final decisions had been made on retaining the fund. Avila will most likely reveal the House’s proposed health care budget the following day.
Republished with permission [/vc_message]
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