By Dr. Ryan Cantville, Pediatrician, Jacksonville Pediatrics, Duval County, Florida
More than 40% of Florida’s children rely on Medicaid, which means more than two million of the most vulnerable children in our state have no option but to put their health and care options in the state’s hands.
The state’s Medicaid program is administered through the Agency for Health Care Administration’s (AHCA) Medicaid Managed Care Program. The program was designed to provide better, coordinated care for these vulnerable patients with hopes of avoiding more costly care down the line, like an emergency room visit, or for care which may have been addressed with preventable measures.
The state contracts with private insurers to administer Medicaid benefits. Many of these insurers have a record of consistently underpaying or delaying payments to physicians, like those within my practice, for the care we provide to Florida’s most vulnerable patients, including very sick and disabled children.
Unfortunately, AHCA has just awarded new six-year contracts to the private payers administering the program like Centene and other big corporations with longstanding records of mismanagement and profiteering—at the expense of Florida taxpayers and Medicaid patients.
Small, independent physician practices rely on reimbursement for this care to keep their doors open and remain in operation. There are fewer and fewer physicians providing care in our state, and even fewer providing care for patients with Medicaid coverage.
Our state’s ability to provide high-quality care to all children in Florida, regardless of socioeconomic status, is in grave danger. We employ dedicated community members throughout our practices and rely on timely and complete payments to keep our practices running, our employees receiving their hard-earned paychecks, and to provide great care to patients. However, the ability to keep practices in operation is in jeopardy, and our pleas to companies like Centene have largely fallen on deaf ears.
Moreover, Florida’s Medicaid Managed Care plans notoriously lack transparency in their operations and administration of Medicaid care across the country, many with hundreds of millions of dollars in legal settlements for questionable business practices. In Florida alone, two such cases have made headlines in the past few years.
Despite current law requiring AHCA to monitor and oversee plan performance for those managing lucrative contracts under the Medicaid program, the corporate plan managers operate — with an alarmingly low level of accountability and an unchecked level of authority — in Florida and beyond. The state’s existing oversight and accreditation program requires immediate improvement and attention.
With the recent announcement of new six-year Medicaid contracts valued at $18.6 billion, awarded to the same bad actors, are we to expect another six years of the same? Something’s got to give.
As a pediatrician who cares deeply about all of my patients, I implore AHCA to enforce greater accountability and transparency among the plans they have chosen to administer lifesaving coverage for those who need it most.
As a state, we simply cannot afford to let Medicaid Managed Care plans skimp on their contractual obligations. Florida Community Care, Humana, Elevance Health’s Simply Healthcare, Community Care Plan, and Centene’s Sunshine Health must pay for the care that their beneficiaries need – and that they agreed to cover – to support the health and well-being of Florida’s most vulnerable populations.
Ryan Cantville, DO, is a Board-Certified pediatrician at Jacksonville Pediatrics in Duval County, Florida. ]