Medicaid contracts spark lawsuit

TALLAHASSEE, Fla. — A losing bidder has filed a lawsuit seeking to prevent Florida health officials from moving forward with new Medicaid managed-care contracts while legal protests continue.

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ImagineCare LLC filed the lawsuit last week in Leon County Circuit Court after it was told it was “out of the running” for a contract, the lawsuit said. The multi-year contracts involve tens of billions of dollars, as about 3.14 million people received care through the Medicaid managed-care system as of May.

After a year-long process, the state Agency for Health Care Administration in April announced plans to award contracts to five managed-care organizations. That prompted bid protests from ImagineCare and other health plans and led to settlement discussions.

The lawsuit said ImagineCare, after being shut out, intends to continue pursuing a protest through the administrative law system. In the lawsuit, the health plan seeks an injunction to prevent the agency from moving forward with contracts while such protests play out.

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“Allowing AHCA and Secretary Weida (agency Secretary Jason Weida) to proceed with executing and implementing contracts while these protests remain pending will greatly prejudice ImagineCare and other protesting parties, cause irreparable harm to the Medicaid enrollees of the state of Florida and will violate both Florida law and the express provisions” of part of the bidding process known as invitation to negotiate, the lawsuit said.

The lawsuit, filed by attorneys with the Panza, Maurer & Maynard law firm, said AHCA has sought to dismiss the ImagineCare protest based on an issue related to a bond requirement. ImagineCare disputes the agency’s position on the issue.

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Lawmakers in 2011 created a system in which most Medicaid beneficiaries are required to enroll in managed-care plans. The agency has gone through lengthy contracting processes three times, including the process that started in 2023. In the past, it awarded contracts in 11 regions of the state; that was scaled back to nine regions in the latest process.

The agency announced in April that it planned to award contracts to Florida Community Care, LLC; Humana Medical Plan, Inc.; Simply Healthcare Plans, Inc.; South Florida Community Care Network, LLC, which does business as Community Care Plan; and Sunshine State Health Plan, Inc. The contracts are scheduled to take effect in January.

In all, 11 plans sought contracts. The ImagineCare lawsuit said that after the April announcement, the agency held negotiations with Aetna Better Health of Florida, Molina Healthcare of Florida and UnitedHealthcare of Florida, which had filed protests.

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Molina announced Friday that it had received a contract to provide Medicaid services in Miami-Dade and Monroe counties. The agency also issued a notice that said Aetna and UnitedHealthcare would receive contracts, which was first reported by the Florida Politics website.

ImagineCare is a type of health plan known as a provider service network. A joint venture of Spark Pediatrics and CareSource, it does not currently have a Medicaid managed-care contract in Florida.

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