July 25, 2024  – In a significant legal challenge that could impact the healthcare of Floridians, ImagineCare LLC has filed a lawsuit in Leon County circuit court against Florida health officials. The lawsuit intends to halt the progression of new multi-billion dollar Medicaid managed-care contracts from rolling out while the legal protection continues. It comes as the state grapples with protests over the bidding process.

ImagineCare, a provider service network that is a joint venture between Spark Pediatrics and CareSource, initiated the lawsuit after being informed it was no longer being considered for a contract. The Florida Agency for Health Care Administration (AHCA) had earlier announced its intention in April to award contracts to five managed-care organizations as part of a system overhaul affecting approximately 3.14 million Medicaid recipients in Florida.

The dispute arises amidst ongoing legal protests from various health plans, including ImagineCare. The health plans claim the continuation of the contract process during active protests could cause irreparable damage. This lawsuit specifically seeks an injunction to delay the execution and implementation of these contracts until the resolution of the pending protests.

“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 contentious bidding process, part of a reform initiated in 2011 requiring most Medicaid beneficiaries to enroll in managed-care plans, has seen its share of challenges. The agency had announced that the upcoming contracts would be awarded to Florida Community Care, Humana Medical Plan, Simply Healthcare Plans, Community Care Plan, and Sunshine State Health Plan. 

Following the announcement, many plans that failed to win contracts protested. Negotiations were conducted, and the State announced that Aetna Better Health of Florida, Molina Healthcare of Florida and UnitedHealthcare of Florida were to be awarded Medicaid managed care contracts as well. Molina Healthcare of Florida received a contract for the state’s southern region, while Aetna was awarded three state regions, and UnitedHealthcare was awarded two regions. 

The legal turmoil underscores the complex nature of managing state-funded health care services and the significant implications these contracts have on providers and recipients alike. As the case progresses, stakeholders within the Florida Medicaid system remain on high alert, awaiting outcomes that will determine the operational landscape of healthcare services in the state.