Miami-Dade County, the juiciest plum in Florida Medicaid’s switch to mandatory managed care, could still be in play following a ruling against the Agency for Health Care Administration in its contracting decisions. Hundreds of millions of dollars could ride on the outcome, reports Health News Florida.
Administrative Law Judge John Van Laningham "recommended" AHCA rescind its award to Prestige Health Choice for the Medicaid contract covering Dade and Monroe counties. Although AHCA has the option to reject the judge's recommendation, it must be prepared to back up its reasons, possibly in court.
The judge found that Presige, founded by non-profit health centers including Jessie Trice, didn’t meet the definition of a “provider service network," Health News Florida writes. Such a network is required in each of Florida's districts by the managed care law.
Care Access PSN, LLC, one of the bidders for the contract covering the South Florida region, contested the award. Read more.